eNCPT vs ICHI - Nutrition Intervention Terms

       

          In late 2018, the World Health Organization has released the Beta version of the classification system for health interventions called the International Classification of Health Interventions. (1)  As "Beta" indicates this is not a final version, but is being released for testing and comment.  

          While many countries and professions have developed their own list of  procedures to describe interventions, this classification is hoped to be a unifying structure.  It will be interesting to see how the eNCPT can be mapped to the ICHI in the future.  

         This classification system is intended to reflect the interventions delivered across all sectors of the health system: medical, surgical, primary care, community health, rehabilitation, allied health, mental health, nursing, assistance with functioning, traditional medicine and public health interventions.  The terms are now available in an on-line searchable database and have ~8000 intervention terms.  

          The health interventions are grouped into four sections depending on the target of the intervention:

• Interventions on Body Systems and Functions
• Interventions on Activities and Participation Domains
• Interventions on the Environment
• Interventions on Health-related Behaviours

          Each intervention in ICHI is described in terms of the target (the entity on which the action is carried out), the action (the deed done by an actor to the target), and means (the processes and methods by which the action is carried out).   

Below are a few of the comparisons from the ICHI and the eNCPT

eNCPT Definition of Nutrition Intervention	ICHI Definition of Health Intervention
an act performed for, with or on behalf of a person or a population whose purpose is to assess, improve, maintain, promote or modify health, functioning or health conditions.	a purposely planned action(s) designed with the intent of changing a nutrition-related behavior, risk factor, environmental condition, or aspect of health status to resolve or improve the identified nutrition diagnosis(es) or nutrition problem(s).

This Classification is comparable to the Nutrition Intervention terms included in the eNCPT. See below for a few examples.

eNCPT	Similar ICHI Term
Nutrition Education (E) Nutrition Education Content (1)  (3 more specific terms)	Education to influence eating behaviours
Nutrition Education Application (2) (3 more specific terms)	Training to influence eating behaviours
NUTRITION COUNSELING (C) (5 more specific theoretical basis/approach and 11 more specific strategies)	Advising about eating behaviours Or Counselling about eating behaviours
NUTRITION BASED POPULATION ACTION (P) Population strategies (2)       Environmental change       (3 more specific terms)	Environment modification to influence eating behaviours

(1)  International Classification of Health Interventions (ICHI), World Health Organization, Beta version.  Available at:  https://www.who.int/classifications/ichi/en/.  Accessed December 23, 2018

To Use or Not to Use The Medical Diagnosis in a PES statement??  
That is the question!!

When developing the dietetics standardized language, now called the eNCPT, there was considerable debate about the connections between the medical diagnosis and nutrition diagnoses. 


We concluded that a medical diagnoses alone was insufficient to describe the problems that dietitians address..

But ...

Can a medical diagnosis be used in the PES as an etiology (or underlying cause) of the nutrition diagnosis?
   (Actively discouraged)

Can a medical diagnoses be used in the PES a sign and symptom for a nutrition diagnoses?
   (Can be used WITH other data)

Medical Diagnoses as Etiology
Relying on a medical diagnosis as the etiology is not particularly useful.  Using the medical diagnoses as the etiology is problematic since dietitians are not expected to directly "intervene" to resolve a medical diagnoses.  Using a medical diagnoses also can limit the dietitian's thinking about what etiologies exist for a nutrition diagnoses that dietitians can impact.

Examples have been created to demonstrate this difficulty and show alternative ways to construct the PES statement..

For Example the two following PES statements for a person with COPD are accurate, but one is not helpful in directing the nutrition intervention

• Inadequate energy intake related to COPD as evidenced by energy intake ~800 kal less than estimated energy needs.

While this may be accurate, the dietitian is not usually able to intervene directly on the shortness of breath caused by COPD. 

So the dietitian is encouraged to identify a more nutrition related etiology which may focus on the specific activities that are caused by the COPD.  For example:

• Inadequate energy intake related to inability to eat large quantities of food OR inability to cook and serve food as evidenced by reports of SOB and fatigue prior to finishing meal and limitations on ADL of cooking and serving food.

Both of these etiologies are certainly a results of shortness of breath caused by COPD, but they are etiologies that a dietitian can reasonably create nutrition interventions to address.

So the recommendation given has been given.....whenever possible find an etiology that is not a medical diagnosis that the dietitian can independently address.

Medical Diagnoses as Signs and Symptoms

So if we are not recommending using a medical diagnoses as an etiology, why is it included in the Nutrition Diagnoses Reference Sheet?

Data from the medical history, including medical diagnoses, are shown as signs and symptoms in the Nutrition Diagnosis reference sheets.  Signs and Symptoms are nutrition assessment data that are clustered together to identify whether a specific nutrition diagnoses exists.  You can use a medical diagnosis as "proof" or "evidence" that a specific nutrition diagnosis is present, along with other specific data. 

For example including the medical diagnosis of diabete mellitus along with Hemoglobin A1C value and carbohydrate intake will fully describe how the dietitian identified and verified that excessive carbohydrate intake was a nutrition diagnosis.   The medical diagnosis usually would not be sufficient by itself to support a nutrition diagnosis.

Bottom line:  Use of medical diagnoses as an etiology is discouraged since it is not usually helpful in guiding the selection of a nutrition intervention.  However a medical diagnosis may be PART of the cluster of data used to determine whether a nutrition diagnosis exists and may be used as a sign to support selection of a Nutrition Diagnoses.