The classification of feeding and eating disorders in the ICD-11: results of a field study comparing proposed ICD-11 guidelines with existing ICD-10 guidelines
The classification of feeding and eating disorders in the ICD-11: results of a field study comparing proposed ICD-11 guidelines with existing ICD-10 guidelines
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DOI：
10.1186/s12916-019-1327-4
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发表时间：
2019-05-14
期刊：
影响因子：
9.3
通讯作者：
Reed, Geoffrey M.
中科院分区：
文献类型：
--
作者：
Claudino, Angelica M.;Pike, Kathleen M.;Reed, Geoffrey M.
背景世界卫生组织（WHO）的国际疾病和相关健康问题分类（ICD）在全球范围内被194个WHO成员国使用。它用于分配临床诊断，为报告公共卫生数据提供框架，并为卫生服务的组织和报销提供信息。在增加临床实用性和全球适用性的总体原则指导下，ICD第11次修订版提出了自1992年上一次修订以来的经验性进展的重大变化。为了测试精神、行为和神经发育障碍章节中建议的变化，进行了多项基于小插曲的病例对照现场研究，检查临床医生准确、一致地使用新指南并评估其总体临床效用的能力。这份手稿报告的结果，从拟议的ICD-11指南喂养和进食障碍（FEDs）的研究。MethodParticipants是2288精神卫生专业人员注册与世界卫生组织的全球临床实践网络。研究以中文、英文、法文、日文和西班牙文进行。临床医生被随机分配应用ICD-11或ICD-10的FED诊断指南，以测试特定的临床问题的一对案例插图。临床医生选择的诊断，他们认为是正确的每个小插曲，评估所选诊断的每个基本特征的存在下，和临床效用的诊断guidelines.ResultsThe拟议的ICD-11诊断指南显着提高了准确性，所有联邦储备银行测试相对于ICD-10，并达到更高的临床效用评级;在所有五种语言获得类似的结果。包括暴食症和避免-限制性食物摄入障碍减少了残留诊断的使用。需要进一步完善的领域identified.ConclusionsThe拟议的ICD-11诊断指南始终优于ICD-10在区分进食障碍的情况下，并显示出全球适用性和适当的临床效用。这些结果表明，拟议中的ICD-11指南将有助于提高公共卫生数据的准确性，改善临床诊断，并加强卫生服务的组织和提供。这是ICD修订过程中第一次及时完成大规模实证研究的数据，以检查拟议的指南，为最终的诊断指南提供信息。
BackgroundThe World Health Organization (WHO) International Classification of Diseases and Related Health Problems (ICD) is used globally by 194 WHO member nations. It is used for assigning clinical diagnoses, providing the framework for reporting public health data, and to inform the organization and reimbursement of health services. Guided by overarching principles of increasing clinical utility and global applicability, the 11th revision of the ICD proposes major changes that incorporate empirical advances since the previous revision in 1992. To test recommended changes in the Mental, Behavioral, and Neurodevelopmental Disorders chapter, multiple vignette-based case-controlled field studies have been conducted which examine clinicians' ability to accurately and consistently use the new guidelines and assess their overall clinical utility. This manuscript reports on the results from the study of the proposed ICD-11 guidelines for feeding and eating disorders (FEDs).MethodParticipants were 2288 mental health professionals registered with WHO's Global Clinical Practice Network. The study was conducted in Chinese, English, French, Japanese, and Spanish. Clinicians were randomly assigned to apply either the ICD-11 or ICD-10 diagnostic guidelines for FEDs to a pair of case vignettes designed to test specific clinical questions. Clinicians selected the diagnosis they thought was correct for each vignette, evaluated the presence of each essential feature of the selected diagnosis, and the clinical utility of the diagnostic guidelines.ResultsThe proposed ICD-11 diagnostic guidelines significantly improved accuracy for all FEDs tested relative to ICD-10 and attained higher clinical utility ratings; similar results were obtained across all five languages. The inclusion of binge eating disorder and avoidant-restrictive food intake disorder reduced the use of residual diagnoses. Areas needing further refinement were identified.ConclusionsThe proposed ICD-11 diagnostic guidelines consistently outperformed ICD-10 in distinguishing cases of eating disorders and showed global applicability and appropriate clinical utility. These results suggest that the proposed ICD-11 guidelines for FEDs will help increase accuracy of public health data, improve clinical diagnosis, and enhance health service organization and provision. This is the first time in the revision of the ICD that data from large-scale, empirical research examining proposed guidelines is completed in time to inform the final diagnostic guidelines.