IFI PROJECT

NOTE:  An approved final draft of the IFI report is now available. To view the report CLICK HERE.

Background to the IFI
Since its conception, NAHCC has a number of important achievements including the development of a commonly agreed framework of a minimum data set, a set of standard intervention categories for each profession involved, and, most importantly the development of an allied health service weight.

One important item missing in the minimum data set developed for allied health is an “Indicator for Intervention" (IFI). An IFI is what the clinician believes is the most relevant issue of the client/patient that has led the client/patient to seek or be referred to an allied health professional for service. Unlike the diagnosis, it is not one of the medical disorders or complex illnesses that are described by the "diagnosis" (e.g., ICD-10, DSM-IV), but is more likely to be one of the symptoms, behavioural characteristics or circumstances associated with a person for which allied health services are being sought. For example, a stroke patient may have an IFI of mobility problems, swallowing difficulties or mood problems or possibly all three. IFIs focus on a client/patient’s needs and difficulties, rather than an esoteric disease process.

Although the Allied Health Minimum data set adequately provides for the diagnosis of the client and of the identification of the care provider, it does not provide information on why the allied health professional is intervening. Within the healthcare sector, and particularly in the acute hospital setting, Diagnosis Related Groups (DRGs) are widely used as a way of classifying inpatients and their admission s. They do so by grouping together inpatient stays of similar levels of complexity and which utilise similar levels of resources. However, DRGs and diagnoses are not a sensitive or accurate basis for predicting allied health costs. For example, the diagnostic group of dementia does not actually predict how much allied health intervention may be needed. It is more likely to be the current living circumstance s of the patient or particular patient characteristics, rather than the specific type of dementia or even its severity that predicts the type of allied health intervention needed.

The IFI Project
NAHCC has undertaken a large scale pilot project to develop and test the use of an IFI dataset for allied health professionals to use in their clinical work that will add to the current minimum data set. This project was being managed by the Australian Psychological Society, and conducted in two phases. The pilot project is now complete.

Stage One:

Stage 1 involved developing a set of codes to be used as IFIs. A codeset already developed by the World Health Organisation – the International Classification of Functioning, Disability and Health (ICF), was used for this purpose. While the ICF codeset was used,  the codes were used differently than for the purpose they were originally developed, and only the basic three digit codes were utilised. The full ICF codeset can be accessed at http://www3.who.int/icf/onlinebrowser/icf.cfm.

In addition, Stage 1 also involved the development of an IFI coding manual to assist allied health professionals when using the IFI codes throughout the pilot project. This manual, which also includes a number of IFI-coded allied health profession-specific case studies was developed in conjunction with an allied health advisory group made up of a representative from eleven allied health professions who had an ongoing advisory role in the pilot project.

Phase Two:

Pilot testing the IFI codes
Stage 2 data collection ended on the 30th November 2007. Stage 2 involved pilot testing the IFI data set and an on-line data collection system developed for the pilot study. This pilot testing occurred across ten metropolitan and regional hospitals across Australia for a duration of six months. The hospitals involved with data collection for the IFI project were:

  • The Royal Hobart Hospital (Tasmania)
  • Lyell McEwin Hospital (South Australia)
  • Hunter New England Health (Tamworth and Armidale, New South Wales)
  • Mater Allied Health Services (Queensland)
  • The Canberra Hospital (Australian Capital Territory)
  • Southern Health (Victoria)
  • Barwon Health (Victoria)
  • The Royal Victorian Eye and Ear Hospital - Audiology and Orthoptics (Victoria)
  • The Royal Children's Hospital - Prosthetics and Orthotics (Victoria)
  • Austin Health - Exercise Physiology (Victoria).

Allied Heath Professions Representation

In addition to gaining representation from hospitals across Australia, the IFI project also included representation from the eleven allied health professions trialling the IFI codes in the pilot study. The following list shows the number or participants from each of the eleven professions.

  • Audiology (14)
  • Dietetics (30)
  • Exercise Physiology (9)
  • Occupational Therapy (72)
  • Orthoptics (12)
  • Physiotherapy (82)
  • Podiatry (11)
  • Prosthetics and Orthotics (16)
  • Psychology (68)
  • Social Work (43)
  • Speech Pathology (43)

      TOTAL = 400 allied health professionals

Training in the use of the IFI

To prepare allied health professionals in each of the participating hospitals, the IFI-project team conducted a training workshop. This three-hour workshop provided background information about why the IFI is being developed, training in its use, large and small group work in using the IFI to code case studies provided, and entering the chosen IFI on the on-line data collection system.

IFI Data collection

Following their training session, allied health professionals within the participating hospitals were required to code the primary characteristic(s) of the patient that has led them to seek, or be referred for, allied health treatment, on their first visit using the IFI codes. This coding was carried out for a six-month period. The codes were entered into an on-line collection system, and the data gathered in a database that was then analysed by the research team at the Australian Psychological Society. More than 19 000 IFI data entries were collected.


Reliability Study

In October of 2007, participating allied health professionals from across the participating hospitals were invited to participate in a reliability study. Having gained some experience in using the IFI codes in-situ, these allied health professionals were presented with 20 profession-specific case studies created by representatives from their profession.  These on-line case studies were coded using the IFI, and responses from participants in each profession compared to determine if there was consistent use of the IFI codes amongst these professionals. Results of the reliability study can be found in the approved final draft IFI report.

Pilot Study Outcomes

The results of the overall IFI pilot study and the reliability study can be found in the approved final draft IFI report. The IFI pilot study demonstrated that the IFI was a useful indicator of the reasons that patients had sought allied health intervention in the public health system. The reliability study demonstrated that most professions were able to use the IFI codes in a consistent way.

View the IFI interim reports to the Department of Health and Ageing below:

View the approved final draft of the IFI Report below:

For Further Information
Further information on the progress of the IFI project will be provided on this page as it occurs. Alternatively, contact the IFI Project – Project Officer, Dr Angela Nicholas at a.nicholas@psychology.org.au