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
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.
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.
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.
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:
For Further Information