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Patient-Reported Drugs and Conditions

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(Erica Voss) #7

@ColinOrr or @ColinOrr2006 , I’m hoping to take part of the conversation over here.

“Erica, yes, for some of this data I agree, it is the same class of problem. However, some of the data as you have already pointed out belongs in their already defined domains such as drug exposure. The method of collection may be somewhat irrelevant or least secondary.”

Can you give me an example of where you think my examples above wouldn’t leverage the survey infrastructure?

I’m asking because what our team is struggling with is what constitutes a drug exposure or a condition. For example when you answer questions on an HRA questionnaire the answers most likely won’t be associated with a date that makes any sense for true exposure (e.g. I took drug X in April, and took the HRA survey in October). I’m nervous about mixing it in with all the drug dispensed/condition information - don’t know if people will remember to exclude by DRUG_TYPE_CONCEPT_ID.


(Vojtech Huser) #8

ad 1: target table

I can see a good reason why all raw data should go to the OBSERVATION table. The “cleaned” data can than go the appropriate table.

Consider CRFs from clinical trial and answer: jan 31 2016 to question: End date of second pregnancy. We don’t know how the pregnancy ended (e.g., delivery or miscarriage). We don’t know dates of first pregnancy… etc… lots of problem with “cleaning/inference”.

ad 2. Do we treat all patient reported data in the same way in regards to the movement or should we treat them differently depending on source.

I think differently depending on the source. Different type of “inference” may require different ETL treatment.


(Erica Voss) #9

Reviving this thread . . .

At the THEMIS F2F this was discussed and here was the recommendation:

RECOMMENDATION
Patient reported data recommendation should land in the appropriate domain table (e.g. if a patient reports they had lymphoma it should land in the CONDITION_OCCURRENCE table. These data should be strongly typed so that it easily known which records are patient reported.

ACTION
Ask the CDM WG to add this to the FAQ https://github.com/OHDSI/CommonDataModel/wiki/Frequently-Asked-Questions


(Christian Reich) #10

@ericaVoss:

Where are we getting the Type Concepts from? Is anybody creating them?


(Erica Voss) #11

Good point, I guess part of the recommendation requires us to recommend the types. I don’t know if anyone is doing that


(Seng Chan You) #12

@Christian_Reich @ericaVoss
We’re making the rules for converting Patient Generated Health Data into CDM with the IT/ PHR / Life style Coaching companies.
The target records include the diet, exercise, blood sugar and insulin. So we need the Type Concept for this (The target tables in CDM will be ‘observation’, ‘drug_exposure’ and ‘measurement’).


(Christian Reich) #13

@SCYou, @ericaVoss :

Right now, we have the following Patient reported types:

Do we need anything else?


(Seng Chan You) #14

@Christian_Reich That’s all we need. Thank you!! :grinning:


(Erica Voss) #15

I’ve updated the ticket under review to include these:


(Seng Chan You) #16

Thank you, @ericaVoss

I released the sample of Patient Generated Health Data, which was generated by a gentleman for a year.

Together with Noom (@yipaulkim) , LifeSemantics and Samsung medical center, we’ll convert PGHD into CDM and combine these data with hospital’s CDM under the patients’ approval.


(Ajit Londhe) #17

Should these patient reported drugs or conditions be a part of eras?

I vaguely remember discussing this at the F2F, and we decided that if, as an ETL person, you feel confident that the patient reported events should be part of standard analytic queries, then do bring them into drug_exposure / condition_occurrence, and expect them to be part of drug or condition eras. But, if you have question marks around the validity of patient reported events, then bring them in as observations. Is this correct?


(Erica Voss) #18

But @SCYou isn’t this data coming from a device? Something is counting steps?


Ugggggggggggggggggggggggggg . . . . my vote would be no, patient reported drugs should not be part of eras cause they probably don’t contain information about how much drug was consumed or when exactly it was . . . but originally I wanted to shove all patient reported items in OBSERVATION. :smile:

@bailey - I remember once you told me that you see the value in patient reported drugs, would you argue that they should be in ERAs?


All,

Could we also consider Health Risk Assessment data as patient reported?

  • 44786633 – numeric HRA values
  • 44786634 – categorical HRA values

(Seng Chan You) #19

@ericaVoss Patient Generated Health Data (PGHD) not only includes step counts (activity), calories intake (nutrition), but also include patient reported condition, measurement or drug.
Since first target population is diabetic patients, we’ll start with glucose level and insulin dosages. I think these data can be captured in measurement and drug_exposure table only when the time and the dosage or the result are specified.
Otherwise, I agree with @Ajit_Londhe 's opinion, which somewhat ambiguous data would be stored in observation table.

I’m developing ETL document for accessible PGHD now. I’ll release it soon. Then, we can discuss further!

Sorry, since we don’t have these data in our data network, I don’t know… I hope these data also to be integrated within OMOP-CDM.


(Erica Voss) #20

@bailey or @karthik or @Christian_Reich

You have been randomly selected to help decided . . . should patient reported data affect DRUG_ERAs? I’m assuming yes as some datasets this is the bulk of the data.

However data that falls outside of the OBSERVATION_PERIOD should not impact the DRUG_ERA regardless of where it is from. (see this thread)

Here is the current text, but would like to add something about ERAS.

RECOMMENDATION
Patient reported data recommendation should land in the appropriate domain table (e.g. if a patient reports they had lymphoma it should land in the CONDITION_OCCURRENCE table. These data should be strongly typed so that it easily known which records are patient reported. Type concepts include 44814721-Patient reported 44818706-Patient reported device 44818704-Patient reported value 45905770-Patient Self-Reported Condition 44787730-Patient Self-Reported Medication 44786633 – numeric HRA values 44786634 – categorical HRA values

NEXT STEPS
Ask the CDM WG to add this to the FAQ https://github.com/OHDSI/CommonDataModel/wiki/Frequently-Asked-Questions


(Karthik) #21

I think for condition_era, you’d include it into the observation_period, but it is tricky for drug_era. For drugs, unless the information from PGHD can give us an accurate duration, I don’t think it should be included. Obviously, there are exceptions and if we believe a dataset his reliable and granular enough, then it should be included in the observation table, but I don’t see that happening.


(Erica Voss) #22

Thank you @cukarthik. @Christian_Reich help us finish up this ticket. What should we do in terms of eras for patient reported drugs/conditions.


(Steve Lyman) #23

There was an earlier question from @Christian_Reich on whether we need any additional patient reported types. We just found that we have a need for a patient reported procedure. Can we get a concept added to the Procedure Type vocabulary?


(Anna Ostropolets) #24

@sblyman Can’t you use 581412 Procedure Recorded from a Survey for now? The underlying meaning is the same: it’s used when a patient reports a history of procedure.


(Steve Lyman) #25

Thanks for the suggestion @aostropolets. We’ll go ahead and use that concept for now. Longer term, it would be nice to have something more in line with what other domains provide for general patient reported events.


(Christian Reich) #26

Will add, @sblyman. Actually, we are supposed to overhaul all of them and potentially make them domain-independent. That’s a THEMIS job that’s still open. So, you will just have “Patent reported”, irrespective of what table it is in. Let’s see if this will work.


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