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Self-assessment (Intermed)

The Self-Assessment Questionnaire of INTERMED (IM-SA) ¹⁾ is an instrument to identify individual (complex) health care needs. This instrument assesses biopsychosocial complexity, health care needs and barriers to receive standard care.
Lifelines participants of 65 years and older received (parts of the) Intermed in assessment 1A and 2A (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: 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
For how long do you experience any restrictions due to physical complaints?	Hoe lang ervaart u beperkingen door lichamelijke klachten?		INTERMED1A-D	1B	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)?		INTERMED2	1B	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?		INTERMED3	1A 1B	65+
How much are your daily activities restricted by physical problems?	In hoeverre worden uw dagelijkse activiteiten beïnvloed door lichamelijke klachten en beperkingen?		INTERMED4	1B	65+
Do you understand the origin of your physical complaints and restrictions?	Begrijpt u waar uw lichamelijke klachten en beperkingen vandaan komen?		INTERMED5	1A 1B	65+
In the next 6 months, do you expect your physical complaints and limitations to change? Try to make the best estimate.	Verwacht u dat uw lichamelijke klachten en beperkingen in de komende 6 maanden veranderen? Probeer een inschatting te maken.		INTERMED6	1A 1B	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?		INTERMED7/STRESS	1A 1B	18+
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?		INTERMED8	1B	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?		INTERMED9	1A 1B	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?		INTERMED10	1B	65+
In the next 6 months, do you expect your psychological complaints to change? Try to make the best estimate.	Verwacht u dat uw psychische klachten in de komende 6 maanden veranderen? Probeer een inschatting te maken.		INTERMED11	1A 1B	65+
The next question is about activities with which you come into contact with other people. You can think about (volunteer) work, study/training, shopping, sports, visiting people or receiving visitors. What do you generally do in a week?	Wat doet u zoal in een week?		INTERMED12/CLUBSB1-4	1B	65+
How do you generally relate to other people?	Hoe is uw contact met andere mensen?		INTERMED13/RELATIES	1A 1B ACTQ	18+
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.		INTERMED14	1A 1B	65+
What do you think of the support given by your spouse, family, co-workers or friends?	Wat vindt u van de steun van uw partner, gezin, werk, vrienden?		INTERMED15/SUPPORT	1A 1B	18+
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?		INTERMED16	1B	65+
In the next 6 months do you expect that a change will be needed in the way you are currently living? Try to make the best estimate.	Verwacht u dat er in de komende 6 maanden iets aan uw (woon)situatie veranderd moet worden? Probeer een inschatting te maken.		INTERMED17/ZELF3	1A 1B	65+
How often have you been in contact with health care in the past five years?	Hoe vaak bent u de laatste vijf jaar in aanraking geweest met de gezondheidszorg?		INTERMED18A-H/HEALTH80A-I	1A 1B	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?		INTERMED19	1A 1B	65+
From whom do you receive treatment or care?	Bij wie bent u onder behandeling of van wie ontvangt u zorg?		INTERMED20A-Q	1B	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?		INTERMED21	1A 1B	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?		INTERMED22	1A 1B	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? Try to make the best estimate.	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? Probeer een inschatting te maken.		INTERMED23	1A 1B	65+

Questions English	Questions Dutch	Code	Variable	Assessment	Age
For how long do you experience any restrictions due to physical complaints?	Hoe lang ervaart u beperkingen door lichamelijke klachten?		INTERMED1A-D	1B	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)?		INTERMED2	1B	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?		INTERMED3	1A 1B	65+
How much are your daily activities restricted by physical problems?	In hoeverre worden uw dagelijkse activiteiten beïnvloed door lichamelijke klachten en beperkingen?		INTERMED4	1B	65+
Do you understand the origin of your physical complaints and restrictions?	Begrijpt u waar uw lichamelijke klachten en beperkingen vandaan komen?		INTERMED5	1A 1B	65+
In the next 6 months, do you expect your physical complaints and limitations to change? Try to make the best estimate.	Verwacht u dat uw lichamelijke klachten en beperkingen in de komende 6 maanden veranderen? Probeer een inschatting te maken.		INTERMED6	1A 1B	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?		INTERMED7/STRESS	1A 1B	18+
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?		INTERMED8	1B	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?		INTERMED9	1A 1B	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?		INTERMED10	1B	65+
In the next 6 months, do you expect your psychological complaints to change? Try to make the best estimate.	Verwacht u dat uw psychische klachten in de komende 6 maanden veranderen? Probeer een inschatting te maken.		INTERMED11	1A 1B	65+
The next question is about activities with which you come into contact with other people. You can think about (volunteer) work, study/training, shopping, sports, visiting people or receiving visitors. What do you generally do in a week?	Wat doet u zoal in een week?		INTERMED12/CLUBSB1-4	1B	65+
How do you generally relate to other people?	Hoe is uw contact met andere mensen?		INTERMED13/RELATIES	1A 1B ACTQ	18+
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.		INTERMED14	1A 1B	65+
What do you think of the support given by your spouse, family, co-workers or friends?	Wat vindt u van de steun van uw partner, gezin, werk, vrienden?		INTERMED15/SUPPORT	1A 1B	18+
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?		INTERMED16	1B	65+
In the next 6 months do you expect that a change will be needed in the way you are currently living? Try to make the best estimate.	Verwacht u dat er in de komende 6 maanden iets aan uw (woon)situatie veranderd moet worden? Probeer een inschatting te maken.		INTERMED17/ZELF3	1A 1B	65+
How often have you been in contact with health care in the past five years?	Hoe vaak bent u de laatste vijf jaar in aanraking geweest met de gezondheidszorg?		INTERMED18A-H/HEALTH80A-I	1A 1B	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?		INTERMED19	1A 1B	65+
From whom do you receive treatment or care?	Bij wie bent u onder behandeling of van wie ontvangt u zorg?		INTERMED20A-Q	1B	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?		INTERMED21	1A 1B	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?		INTERMED22	1A 1B	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? Try to make the best estimate.	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? Probeer een inschatting te maken.		INTERMED23	1A 1B	65+

¹⁾

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

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Self-assessment (Intermed)

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Variables

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Self-assessment (Intermed)

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Variables

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