Background
-
Recognize and evaluate the condition of disability, using common methodologies and instruments based on the person-environment interaction framework, across the network of health and social services and institutions;
-
Allow interoperability and information sharing, on a common semantic base, between health and social information systems;
-
Arrange the fragmented interventions and disability policies, at least from the point of view of the organization, management and information continuity, as components of a single personalized project of intervention embracing health and social systems as well as private resources (personal resources, family resources and local community resources).
Disability as result of a person-environment relationship
Methods
Definition of person with disability
a) The role of UN Convention
b) The role of ICF
Contents of the evaluation and definition of a protocol for data collection
The focus of A&P evaluation
The study population
Data analysis
The person-environment interaction classification tree (PEIC tree)
The left side of the classification tree: positive person-environment interactions
The right side of the classification tree: negative person-environment interactions
Summarizing the person-environment interaction
Grouping people with similar person-environment patterns
Results
Descriptive data
Age class | Male | Female |
---|---|---|
0-5 | 125 (94) | 125 (65) |
6-17 | 125 (162) | 125 (110) |
18-64 | 125 (142) | 125 (162) |
65-W | 125 (141) | 125 (175) |
ICD10 chapters | No. of ICD10 codes | % on total codes | % on total cases |
---|---|---|---|
Mental and behavioral disorders | 583 | 19.0 | 56.4 |
Diseases of the circulatory system | 521 | 17.0 | 50.4 |
Diseases of the nervous system | 380 | 12.4 | 36.8 |
Diseases of the musculoskeletal system and connective tissue | 305 | 9.9 | 29.5 |
Endocrine, nutritional and metabolic diseases | 219 | 7.1 | 21.2 |
Neoplasms | 187 | 6.1 | 18.1 |
Congenital malformations, deformations and chromosomal abnormalities | 145 | 4.7 | 14.0 |
Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified | 124 | 4.0 | 12.0 |
Diseases of the ear and mastoid process | 123 | 4.0 | 11.9 |
Diseases of the eye and adnexa | 86 | 2.8 | 8.3 |
Diseases of the digestive system | 79 | 2.6 | 7.6 |
Injury, poisoning and certain other consequences of external causes | 75 | 2.4 | 7.3 |
Diseases of the genitourinary system | 67 | 2.2 | 6.5 |
All remaining chapters | 176 | 5.7 | 14.9 |
Total
|
30.170
|
100.0
|
ICF A&P domains | No moderate to complete difficulty in performance No. of cases (%) | At least one moderate to complete difficulty in performance (No. of cases) | No moderate to complete difficulty in capacity No. of cases (%) | At least one moderate to complete difficulty in capacity (No. of cases) | Total (No. of cases) |
---|---|---|---|---|---|
d1 Learning and applying knowledge | 579 (55.1) | 472 | 394 (37.5) | 657 |
1051
|
d3 Communication | 554 (52.7) | 497 | 394 (37.5) | 657 |
1051
|
d4 Mobility | 354 (33.7) | 697 | 276 (26.3) | 775 |
1051
|
d5 Self care | 969 (92.2) | 82 | 314 (29.9) | 737 |
1051
|
d6 Domestic life | 437 (41.6) | 614 | 228 (21.7) | 823 |
1051
|
d7 Interpersonal interactions and relationships | 637 (60.6) | 414 | 523 (49.8) | 528 |
1051
|
d8d9 Major life areas - Community, social and civic life | 684 (65.1) | 367 | 233 (22.2) | 818 |
1051
|
In all A&P domains | 139 (13.2) | 912 | 50 (4.8) | 1001 |
1051
|
ICF A&P domains | ||||||||
---|---|---|---|---|---|---|---|---|
ICF environmental factors domains | d1 Learning and applying knowledge | d3 Communication | d4 Mobility | d5 Self care | d6 Domestic life | d7 Interpersonal interaction and relationship | d8d9 Major life areas - Community, social and civil life | |
No. of EF codes (%) | No. of EF codes (%) | No. of EF codes (%) | No. of EF codes (%) | No. of EF codes (%) | No. of EF codes (%) | No. of EF codes (%) | ||
e1 | Products and technology | 1706 (18.5) | 1164 (17.4) | 2663 (24.7) | 920 (11.7) | 348 (9.6) | 416 (9.7) | 569 (12.3) |
e2 | Natural environment and human-made changes to environment | 8 (0.1) | 7 (0.1) | 19 (0.2) | 8 (0.1) | 4 (0.1) | 5 (0.1) | 14 (0.3) |
e3 | Support and relationships | 4730 (51.4) | 3585 (53.5) | 5232 (48.5) | 5127 (64.9) | 2673 (73.7) | 2276 (53.3) | 2724 (58.7) |
e4 | Attitudes | 331 (3.6) | 251 (3.7) | 177 (1.6) | 250 (3.2) | 80 (2.2) | 648 (15.2) | 230 (5.0) |
e5 | Services, systems and policies | 2423 (26.3) | 1692 (25.3) | 2689 (24.9) | 1589 (20.1) | 520 (14.3) | 926 (21.7) | 1106 (23.8) |
Total
|
9198
(100)
|
6699
(100)
|
10780
(100)
|
7894
(100)
|
3625
(100)
|
4271
(100)
|
4643
(100)
|
ICF A&P domains | ||||||||
---|---|---|---|---|---|---|---|---|
ICF environmental factors domains | d1 Learning and applying knowledge | d3 Communication | d4 Mobility | d5 Self care | d6 Domestic life | d7 Interpersonal interaction and relationship | d8d9 Major life areas - Community, social and civil life | |
No. of EF codes (%) | No. of EF codes (%) | No. of EF codes (%) | No. of EF codes (%) | No. of EF codes (%) | No. of EF codes (%) | No. of EF codes (%) | ||
e1 | Products and technology | 54 (13.6) | 42 (14.0) | 270 (38.8) | 79 (24.8) | 36 (17.1) | 40 (9.3) | 68 (16.9) |
e2 | Natural environment and human-made changes to environment | 41 (10.4) | 30 (10.0) | 106 (15.2) | 6 (1.9) | 7 (3.3) | 26 (6.1) | 28 (7.0) |
e3 | Support and relationships | 140 (35.4) | 113 (37.5) | 95 (13.6) | 76 (23.8) | 57 (27.0) | 169 (39.5) | 128 (31.8) |
e4 | Attitudes | 62 (15.7) | 59 (19.6) | 57 (8.2) | 56 (17.6) | 46 (21.8) | 155 (36.2) | 84 (20.9) |
e5 | Services, systems and policies | 99 (25.0) | 57 (18.9) | 168 (24.1) | 102 (32.0) | 65 (30.8) | 38 (8.9) | 94 (23.4) |
Total
|
396
(100)
|
301
(100)
|
696
(100)
|
319
(100)
|
211
(100)
|
428
(100)
|
402
(100)
|
Application of the person-environment classification tree to the A&P categories
ICF A&P domains | ||||||||
---|---|---|---|---|---|---|---|---|
Classification tree classes | d1 Learning and applying knowledge | d3 Communication | d4 Mobility | d5 Self care | d6 Domestic life | d7 Interpersonal interaction and relationship | d8d9 Major life areas - Community, social and civil life | |
A
|
Designing facilitators
| 14.0 | 16.0 | 11.2 | 0.8 | 0.1 | 0.2 | 0.2 |
B
|
Removing barriers
| 0.2 | 0.2 | 0.4 | 0.1 | 0.2 | 1.2 | 1.0 |
C
|
Redesigning facilitators and removing barriers
| 6.0 | 5.8 | 3.9 | 1.1 | 18.6 | 15.8 | 14.3 |
Total
|
20.2
|
22.0
|
15.5
|
2.0
|
19.0
|
17.2
|
15.5
| |
D
|
Monitoring
| 53.6 | 56.8 | 57.6 | 45.7 | 22.4 | 55.7 | 34.6 |
D1
|
No difficulty in capacity
| 47.0 | 49.4 | 49.3 | 44.6 | 19.9 | 50.7 | 32.3 |
D2
|
Mild difficulty in capacity
| 6.6 | 7.4 | 8.3 | 1.1 | 2.5 | 5.0 | 2.3 |
E
|
Monitoring and evaluating sustainability over time
| 13.0 | 9.4 | 8.2 | 19.1 | 12.8 | 13.4 | 16.1 |
E1
|
No difficulty in capacity
| 1.5 | 1.3 | 1.6 | 1.3 | 1.0 | 2.9 | 2.3 |
E2
|
Mild difficulty in capacity
| 11.5 | 8.1 | 6.6 | 17.8 | 11.8 | 10.5 | 13.8 |
F
|
Evaluating sustainability of facilitators over time
| 13.2 | 11.8 | 18.7 | 33.2 | 45.8 | 13.7 | 33.8 |
Total
|
79.8
|
78.0
|
84.5
|
98.0
|
81.0
|
82.8
|
84.5
|
From item classification to grouping of cases
Output of the person-environment interaction classification tree | Clusters | ||||||
---|---|---|---|---|---|---|---|
1 | 2 | 3 | 4 | 5 | 6 | ||
A
|
Designing facilitators
| 0.6 | 0.9 | 1.8 | 2.7 | 5.0 | 15.8 |
B
|
Removing barriers
| 0.1 | 0.1 | 0.2 | 0.1 | 0.2 | 0.0 |
C
|
Redesigning facilitators and removing barriers
| 0.4 | 0.3 | 1.3 | 1.6 | 5.9 | 4.6 |
Total A, B and C
|
1.1
|
1.3
|
3.3
|
4.4
|
11.1
|
20.5
| |
D
|
Monitoring
| 31.6 | 19.6 | 22.0 | 10.8 | 12.7 | 6.3 |
E
|
Monitoring and evaluating sustainability over time
| 3.2 | 10.5 | 4.3 | 5.2 | 2.8 | 1.1 |
F
|
Evaluating sustainability of facilitators over time
| 2.0 | 6.2 | 8.1 | 18.4 | 11.9 | 10.0 |
Total D, E and F
|
36.8
|
36.3
|
35.0
|
34.4
|
26.4
|
17.4
|