====== Self-assessment (Intermed) ====== The Self-Assessment Questionnaire of [[http://www.intermedconsortium.com/|INTERMED]] (IM-SA) ((Stiefel F.C. et al. (2006). Operationalizing integrated care on a clinical level: the INTERMED Project. Medical Clinics of North America 90 (4): 713-­‐758)) is an instrument to identify individual (complex) health care needs. This instrument assesses biopsychosocial complexity, health care needs and barriers to receive standard care.\\ [[start|Lifelines]] participants of 65 years and older received (parts of the) Intermed in assessment [[1A]] and [[2A]] ([[Sections|section]]: [[elderly]]).\\ ===== Background ===== The IM-SA score indicates an individual level of complexity of health care needs. Complexity is subdivided in four domains: Biological, Psychological, Social and Health System. Every domain is divided into three time segments: History, Current State and Vulnerability/Prognosis.\\ To determine the complexity of patients per time segment and per domain the scores of the single questions are added up according to this table (corresponding with the individual variables listed below): ^ Domain ^ History ^ Current state ^ Prognosis ^ | Biological | 1, 2, 3 | 4, 5 | 6 | | Psychological | 7, 8 | 9,10 | 11 | | Social | 12, 13 | 14, 15, 16 | 17 | | Health System | 18, 19 | 20, 21, 22 | 23 | ===== Scoring ===== All IM-SA items are scored on a four-level rating scale. The rating scores range from 0 to 3: 0 Zero evidence for a symptom, disturbance or health care need 1 Mild vulnerability/need for monitoring or prevention 2 Moderate vulnerability/need for treatment or inclusion in treatment plan 3 Severe vulnerability/need for immediate or intensive treatment For an overview of possible answers and associated scores, see here: {{ :engelse_versie_intermed_-_im-e-sa.pdf |IM-SA scores}}\\ The total maximum score of the IM-SA is 60. The complexity cutoff point of the IM-SA is 19, i.e. a score of 19 or higher indicates complexity. ===== Variables ===== | **Questions English** | **Questions Dutch** | **Code** | **Variable** | **Assessment** | **Age** | | i do not experience any restrictions / for how long do you experience any restrictions due to physical complaints? | ik ervaar geen beperkingen / hoe lang ervaart u beperkingen door lichamelijke klachten? | intermed_biological_adu_q_01_a | intermed1a | [[1B]] [[3B]] | 65+ | | i have experienced restrictions for a period shorter than 3 months / for how long do you experience any restrictions due to physical complaints? | ik ervaar minder dan drie maanden beperkingen / hoe lang ervaart u beperkingen door lichamelijke klachten? | intermed_biological_adu_q_01_b | intermed1b | [[1B]] [[3B]] | 65+ | | i have experienced restrictions for a period longer than 3 months / for how long do you experience any restrictions due to physical complaints? | ik ervaar langer dan drie maanden beperkingen / hoe lang ervaart u beperkingen door lichamelijke klachten? | intermed_biological_adu_q_01_c | intermed1c | [[1B]] [[3B]] | 65+ | | in the past 5 years i have experienced several short periods with restrictions / for how long do you experience any restrictions due to physical complaints? | ik heb de afgelopen vijf jaar meerdere, kortere perioden met beperkingen ervaren / hoe lang ervaart u beperkingen door lichamelijke klachten? | intermed_biological_adu_q_01_d | intermed1d | [[1B]] [[3B]] | 65+ | | do you suffer from one or more longlasting or chronic diseases (such as diabetes, high blood pressure, rheumatoid arthritis, lung disease or cancer)? | heeft u één of meerdere langdurige of chronische ziektes (bijvoorbeeld suikerziekte, hoge bloeddruk, reuma, longziekte, kanker)? | intermed_biological_adu_q_02 | intermed2 | [[1B]] [[3B]] | 65+ | | how difficult has it been in the past 5 years to diagnose the physical problems you experience? | hoe moeilijk was het in de afgelopen vijf jaar om vast te stellen welke ziekte of aandoening u had? | intermed_biological_adu_q_03 | intermed3 | [[1A Questionnaire 1|1A]] [[1B]] [[3B]] | 65+ | | how much are your daily activities restricted by physical problems? | in hoeverre worden uw dagelijkse activiteiten beïnvloed door lichamelijke klachtenen beperkingen? | intermed_biological_adu_q_04 | intermed4 | [[1B]] [[3B]] | 65+ | | do you understand the origin of your physical complaints and restrictions? | begrijpt u waar uw lichamelijke klachten en beperkingen vandaan komen? | intermed_biological_adu_q_05 | intermed5 | [[1A Questionnaire 1|1A]] [[1B]] [[3B]] | 65+ | | in the next 6 months, do you expect your physical complaints and limitations to change? | verwacht u dat uw lichamelijke klachten en beperkingen in de komende 6 maanden veranderen? | intermed_biological_adu_q_06 | intermed6 | [[1A Questionnaire 1|1A]] [[1B]] [[3B]] | 65+ | | in the past 5 years, how did you cope with stressful, difficult situations? | hoe bent u in de afgelopen vijf jaar omgegaan met spannende, moeilijke situaties? | intermed_psychiological_adu_q_07_v1 | stress | [[1A Questionnaire 1|1A]] [[1B]] | 18+ | | in the past 5 years, how did you cope with stressful, difficult situations? | hoe bent u in de afgelopen vijf jaar omgegaan met spannende, moeilijke situaties? | intermed_psychological_adu_q_07_v2 | intermed7 | [[1A Questionnaire 1|1A]] [[1B]] [[3B]] | 65+ | | did you ever have psychological problems, such as being tense, anxious, down/blue or confused? | heeft u wel eens last gehad van psychische problemen, zoals zich gespannen voelen, angst, somberheid of in de war zijn? | intermed_psychological_adu_q_08 | intermed8 | [[1B]] [[3B]] | 65+ | | do you think it is difficult to follow health recommendations regarding for example diet, physical activity, lifestyle or medication intake? | vindt u het moeilijk om gezondheidsadviezen op te volgen rondom bijvoorbeeld dieet, beweging, leefwijze of het innemen van medicijnen? | intermed_psychological_adu_q_09 | intermed9 | [[1A Questionnaire 1|1A]] [[1B]] [[3B]] | 65+ | | at present, are you experiencing psychological problems, such as being tense, anxious, down/blue or confused? | heeft u op dit moment psychische problemen, zoals zich gespannen voelen, angst, somberheid of in de war zijn? | intermed_psychological_adu_q_10 | intermed10 | [[1B]] [[3B]] | 65+ | | in the next 6 months, do you expect your psychological complaints to change? | verwacht u dat uw psychische klachten in de komende 6 maanden veranderen? | intermed_psychological_adu_q_11 | intermed11 | [[1A Questionnaire 1|1A]] [[1B]] [[3B]] | 65+ | | what do you generally do in a week? | wat doet u zoal in een week? | intermed_social_adu_q_12 | intermed12 | [[1B]] [[3B]] | 65+ | | i am engaged in several activities per week, during which i meet many people | ik doe meerdere activiteiten per week, waarmee ik in contact kom met veel mensen | intermed_social_adu_q_12_a | clubsb1 | [[1A Questionnaire 1|1A]] [[1B]] [[3A Questionnaire 2|3A]] | 65+ | | i am engaged in a different activity every week, during which i meet quite a few people | ik doe elke week een andere activiteit, waarmee ik in contact kom met redelijk veel mensen | intermed_social_adu_q_12_b | clubsb2 | [[1A Questionnaire 1|1A]] [[1B]] [[3A Questionnaire 2|3A]] | 65+ | | i am usually engaged in the same activity, during which i always meet the same people | ik doe bijna altijd dezelfde activiteit, waarmee ik in contact kom met steeds dezelfde mensen | intermed_social_adu_q_12_c | clubsb3 | [[1A Questionnaire 1|1A]] [[1B]] [[3A Questionnaire 2|3A]] | 65+ | | i am engaged in (almost) no activities during which i meet other people | ik doe (bijna) geen activiteiten, waarmee ik in contact kom met andere mensen | intermed_social_adu_q_12_d | clubsb4 | [[1A Questionnaire 1|1A]] [[1B]] [[3A Questionnaire 2|3A]] | 65+ | | how is your relationship with other people? | hoe is uw relatie met andere mensen? | intermed_social_adu_q_13_v1 | relaties | [[1A Questionnaire 1|1A]] [[1B]] | 65+ | | how do you generally relate to other people? | hoe is uw contact met andere mensen? | intermed_social_adu_q_13_v2 | intermed13 | [[1A Questionnaire 1|1A]] [[1B]] [[3B]] [[ACTQ]] | 65+ | | to what extent does your living situation fit your circumstances; are any adjustments required? | in hoeverre past uw woonsituatie bij uw omstandigheden; zijn er aanpassingen nodig? | intermed_social_adu_q_14_v1 | zelf2 | [[1A Questionnaire 1|1A]] [[1B]] | 65+ | | is your home living situation satisfactory? or are adjustments needed, such as home modifications, receiving home care, or going to live somewhere else? | is uw thuissituatie naar tevredenheid? of zijn veranderingen nodig, zoals woningaanpassingen, thuiszorg, of verhuizen naar een andere woonsituatie | intermed_social_adu_q_14_v2 | intermed14 | [[1A Questionnaire 1|1A]] [[1B]] [[3B]] | 65+ | | how do you feel about the support from your partner, family, work, friends? | wat vindt u van de steun van uw partner, gezin, werk, vrienden? | intermed_social_adu_q_15 | steun | [[1A Questionnaire 1|1A]] [[1B]] [[3B]] | 65+ | | when necessary, is support given by your spouse, family, co-workers or friends available at any time? | is ondersteuning van uw partner, gezin, werk of vrienden, indien nodig, op elk gewenst moment beschikbaar? | intermed_social_adu_q_16 | intermed16 | [[1B]] [[3B]] | 65+ | | do you expect that something will need to be changed in your (living) situation in the coming 6 months? | verwacht u dat er in de komende 6 maanden iets aan uw (woon)situatie veranderd moet worden? | intermed_social_adu_q_17 | zelf3 | [[1A Questionnaire 1|1A]] [[1B]] [[3B]] | 65+ | | i have had contact with a general practitioner less than four times a year / how often have you been in contact with health care in the past five years? | ik heb minder dan vier keer per jaar contact gehad met een huisarts / hoe vaak bent u de laatste vijf jaar in aanraking geweest met de gezondheidszorg? | intermed_healthsystem_adu_q_18_a | intermed18a | [[1A Questionnaire 1|1A]] [[1B]] [[3B]] | 65+ | | i have had contact with a general practitioner more than 4 times per year / how often have you been in contact with health care in the past five years? | ik heb vier keer per jaar of vaker contact gehad met een huisarts / hoe vaak bent u de laatste vijf jaar in aanraking geweest met de gezondheidszorg? | intermed_healthsystem_adu_q_18_b | intermed18b | [[1A Questionnaire 1|1A]] [[1B]] [[3B]] | 65+ | | i have had contact with the same specialist once or multiple times / how often have you been in contact with health care in the past five years? | ik heb één of meerdere keren contact gehad met dezelfde specialist / hoe vaak bent u de laatste vijf jaar in aanraking geweest met de gezondheidszorg? | intermed_healthsystem_adu_q_18_c | intermed18c | [[1A Questionnaire 1|1A]] [[1B]] [[3B]] | 65+ | | i have had contact with a specialist once / how often have you been in contact with health care in the past five years? | ik heb een keer contact gehad met een specialist / hoe vaak bent u in de laatste vijf jaar in aanraking geweest met de gezondheidszorg? | intermed_healthsystem_adu_q_18_c1 | health80c | [[1A Questionnaire 1|1A]] [[1B]] | 65+ | | i have had contact with a specialist more than once / how often have you been in contact with health care in the past five years? | ik heb meerdere keren contact gehad met een specialist / hoe vaak bent u in de laatste vijf jaar in aanraking geweest met de gezondheidszorg? | intermed_healthsystem_adu_q_18_c2 | health80d | [[1A Questionnaire 1|1A]] [[1B]] | 65+ | | i have had contact with several medical specialists / how often have you been in contact with health care in the past five years? | ik heb contact gehad met meerdere specialisten / hoe vaak bent u de laatste vijf jaar in aanraking geweest met de gezondheidszorg? | intermed_healthsystem_adu_q_18_d | intermed18d | [[1A Questionnaire 1|1A]] [[1B]] [[3B]] | 65+ | | i have been hospitalized / how often have you been in contact with health care in the past five years? | ik ben in het ziekenhuis opgenomen geweest / hoe vaak bent u de laatste vijf jaar in aanraking geweest met de gezondheidszorg? | intermed_healthsystem_adu_q_18_e2 | intermed18e | [[1A Questionnaire 1|1A]] [[1B]] [[3B]] | 65+ | | i have been hospitalized several times / how often have you been in contact with health care in the past five years? | ik ben meerdere keren opgenomen geweest in het ziekenhuis / hoe vaak bent u de laatste vijf jaar in aanraking geweest met de gezondheidszorg? | intermed_healthsystem_adu_q_18_f | intermed18f | [[1A Questionnaire 1|1A]] [[1B]] [[3B]] | 65+ | | i was admitted to an intensive care unit for more than 7 days / how often have you been in contact with health care in the past five years? | ik heb langer dan 7 dagen op een intensive care afdeling gelegen / hoe vaak bent u de laatste vijf jaar in aanraking geweest met de gezondheidszorg? | intermed_healthsystem_adu_q_18_g | intermed18g | [[1A Questionnaire 1|1A]] [[1B]] [[3B]] | 65+ | | i was admitted to a rehabilitation center or nursing home for more than 6 weeks / how often have you been in contact with health care in the past five years? | ik ben langer dan 6 weken opgenomen geweest in een revalidatiecentrum of verpleeghuis / hoe vaak bent u de laatste vijf jaar in aanraking geweest met de gezondheidszorg? | intermed_healthsystem_adu_q_18_h | intermed18h | [[1A Questionnaire 1|1A]] [[1B]] [[3B]] | 65+ | | how did you experience your contacts with doctors and healthcare providers in the past 5 years? | wat zijn uw ervaringen met zorgverleners of behandelaars in de afgelopen 5 jaar? | intermed_healthsystem_adu_q_19 | intermed19 | [[1A Questionnaire 1|1A]] [[1B]] [[3B]] | 65+ | | general practitioner / from whom do you receive treatment or care? | huisarts / bij wie bent u onder behandeling of van wie ontvangt u zorg? | intermed_healthsystem_adu_q_20_a | intermed20a | [[1B]] [[3B]] | 65+ | | nursing home physician / from whom do you receive treatment or care? | verpleeghuisarts / bij wie bent u onder behandeling of van wie ontvangt u zorg? | intermed_healthsystem_adu_q_20_b | intermed20b | [[1B]] [[3B]] | 65+ | | specialist for physical complaints (eg pulmonologist, cardiologist, surgeon, internist) / from whom do you receive treatment or care? | specialist voor lichamelijke klachten (bijv longarts, cardioloog, chirurg, internist) / bij wie bent u onder behandeling of van wie ontvangt u zorg? | intermed_healthsystem_adu_q_20_c | intermed20c | [[1B]] [[3B]] | 65+ | | several specialists for physical complaints / from whom do you receive treatment or care? | meerdere specialisten voor lichamelijke klachten / bij wie bent u onder behandeling of van wie ontvangt u zorg? | intermed_healthsystem_adu_q_20_d | intermed20d | [[1B]] [[3B]] | 65+ | | specialist for psychological complaints (e.g. psychiatrist) / from whom do you receive treatment or care? | specialist voor psychische klachten (bijv psychiater) / bij wie bent u onder behandeling of van wie ontvangt u zorg? | intermed_healthsystem_adu_q_20_e | intermed20e | [[1B]] [[3B]] | 65+ | | psychologist / from whom do you receive treatment or care? | psycholoog / bij wie bent u onder behandeling of van wie ontvangt u zorg? | intermed_healthsystem_adu_q_20_f | intermed20f | [[1B]] [[3B]] | 65+ | | dietitian / from whom do you receive treatment or care? | diëtist / bij wie bent u onder behandeling of van wie ontvangt u zorg? | intermed_healthsystem_adu_q_20_g | intermed20g | [[1B]] [[3B]] | 65+ | | social worker / from whom do you receive treatment or care? | maatschappelijk werker / bij wie bent u onder behandeling of van wie ontvangt u zorg? | intermed_healthsystem_adu_q_20_h | intermed20h | [[1B]] [[3B]] | 65+ | | physiotherapist / from whom do you receive treatment or care? | fysiotherapeut / bij wie bent u onder behandeling of van wie ontvangt u zorg? | intermed_healthsystem_adu_q_20_i | intermed20i | [[1B]] [[3B]] | 65+ | | speech therapist / from whom do you receive treatment or care? | logopedist / bij wie bent u onder behandeling of van wie ontvangt u zorg? | intermed_healthsystem_adu_q_20_j | intermed20j | [[1B]] [[3B]] | 65+ | | nurse/home care / from whom do you receive treatment or care? | verpleegkundige/verzorgende thuiszorg / bij wie bent u onder behandeling of van wie ontvangt u zorg? | intermed_healthsystem_adu_q_20_k | intermed20k | [[1B]] [[3B]] | 65+ | | nurse at general practitioner (nurse practitioner) / from whom do you receive treatment or care? | verpleegkundige bij de huisarts (praktijkverpleegkundige) / bij wie bent u onder behandeling of van wie ontvangt u zorg? | intermed_healthsystem_adu_q_20_l | intermed20l | [[1B]] [[3B]] | 65+ | | nurse in hospital (nurse practitioner, clinical nurse specialist) / from whom do you receive treatment or care? | verpleegkundige in ziekenhuis (nurse practitioner, verpleegkundig specialist) / bij wie bent u onder behandeling of van wie ontvangt u zorg? | intermed_healthsystem_adu_q_20_m | intermed20m | [[1B]] [[3B]] | 65+ | | caregivers in nursing home or residential care home / from whom do you receive treatment or care? | verzorgenden in verpleeghuis of verzorgingshuis / bij wie bent u onder behandeling of van wie ontvangt u zorg? | intermed_healthsystem_adu_q_20_n | intermed20n | [[1B]] [[3B]] | 65+ | | i have been admitted to or discharged from the hospital, nursing home or residential care home in the past month / from whom do you receive treatment or care? | ik ben de afgelopen maand opgenomen of ontslagen uit het ziekenhuis, verpleeg- of verzorgingshuis / bij wie bent u onder behandeling of van wie ontvangt u zorg? | intermed_healthsystem_adu_q_20_o | intermed20o | [[1B]] [[3B]] | 65+ | | i do not receive treatment or care / from whom do you receive treatment or care? | ik ontvang geen behandeling of zorg / bij wie bent u onder behandeling of van wie ontvangt u zorg? | intermed_healthsystem_adu_q_20_p | intermed20p | [[1B]] [[3B]] | 65+ | | other healthcare provider: / from whom do you receive treatment or care? | anders, nl. / bij wie bent u onder behandeling of van wie ontvangt u zorg? | intermed_healthsystem_adu_q_20_q | intermed20q | [[1B]] [[3B]] | 65+ | | specification of other healthcare provider / from whom do you receive treatment or care? | specificatie andere behandeling of zorg / bij wie bent u onder behandeling of van wie ontvangt u zorg? | intermed_healthsystem_adu_q_20_q1 | intermed20txt | [[1B]] [[3B]] | 65+ | | to what extent do your practitioners and healthcare providers work together? | in hoeverre werken de zorgverleners en behandelaars volgens u goed met elkaar samen? | intermed_healthsystem_adu_q_21 | intermed21 | [[1A Questionnaire 1|1A]] [[1B]] [[3B]] | 65+ | | do you think you are receiving enough and the appropriate care from your practitioners and health care providers? | krijgt u voldoende en de juiste zorg van uw zorgverleners en behandelaars? | intermed_healthsystem_adu_q_22 | intermed22 | [[1A Questionnaire 1|1A]] [[1B]] [[3B]] | 65+ | | in the next 6 months, do you expect that you will be in need of more or less help and support, or that the care you receive will need to be adjusted? | verwacht u dat u in de komende 6 maanden meer of minder hulp nodig heeft of dat de zorg voor u meer moet worden afgestemd? | intermed_healthsystem_adu_q_23 | intermed23 | [[1A Questionnaire 1|1A]] [[1B]] [[3B]] | 65+ |