Visit vs place of service

[MPhilofsky (Melanie Philofsky)]

The proposed vocabulary additions need clear definitions and conventions to be useful.

@MPhilofsky

"Office Visit = ‘Patient goes to provider, but not inpatient, emergency room, ambulatory surgical center or other specialized units’?

What’s the definition for “other specialized units”? Office Visit needs to be distinguished from the Outpatient Visit. Why isn’t Urgent Care an “other specialized unit”?

@Gowtham_Rao

In both Inpatient and Long Term Care, patient sleep in a healthcare facilities bed that is not ‘home’. But the distinction between long-term vs short-term is not unambigious.

I agree the distinction is ambiguous. We need better definitions. I mapped Skilled Nursing Facility to Long Term Care based on the term for Concept Name = “Long Term Care Visit”. From Usagi:

Long Term Care Visit has a term name = Non-acute institutional stay. In my opinion, SNF, Rehab, LTC, etc. fall under the Non-acute institutional stay definition.

@Gowtham_Rao

definition for “intensive care” visit

These are services that are also called ‘critical care’, ‘ICU’ etc. Intensive care are for patients with severe and life-threatening illnesses and injuries, which require constant, close monitoring and support from specialist equipment and medications in order to ensure normal bodily functions (Ref)

I still don’t understand the definition for an “intensive care visit”. I know the definition for the care site “intensive care”. The link you provide gives the definition for an intensive care Care Site. It seems that care sites and visits are being combined.

[Gowtham_Rao]

Thanks! There is an opportunity to improve. In the US health Care claims system, HIPAA place of service is an attribute of the visit and not caresite. Why - because it is information that is provided at the claim level.

https://www.cms.gov/Medicare/Coding/place-of-service-codes/Place_of_Service_Code_Set.html

Mapping that into higher order visits are done using omop generated vocabulary. That mapping was done by the OHDSI community in past one month and information was shared on this forum. Active roles were played by

We (@Christian_Reich @Dymshyts @Dave_Kern @Gowtham_Rao) worked on cleaning up these concepts, and would like the communities input. See document. We propose to change the domain for the vocabulary ‘Place of Service’ (standard concept) to ‘Visit’, because we found that ‘Place of Service’ is an attribute of the Visit and not attribute of ‘Care Site’ as discussed here

@jenniferduryea also helped

We can improve the omop generated vocabulary in a future release if the community agrees and thinks it’s of value.

Plus - we don’t have code level best practice instructions documented in omop vocabulary. E.g. each code does not have an instruction manual - a limitation

[Christian_Reich]

Are we rolling this out at the THEMIS meeting? Are we ready?

[Gowtham_Rao]

Are we ready?

Themis could tackle what omop generated vocabulary means what. E.g. what is intensive care.

However, external vocabulary adapted by OHDSI like place of service, type of bill may not need much discussion.

[Gowtham_Rao]

These are some OMOP generated concept_id’s that are present in OMOP vocabulary. Do we know when was it introduced. It is incorrectly labelled as belonging to ‘CMS place of service’ vocabulary. CMS place of service vocabulary are here https://www.cms.gov/Medicare/Coding/place-of-service-codes/Place_of_Service_Code_Set.html . Should we assign a new vocabulary to these codes?

[Sooyeon_Cho]

Hi, @Christian_Reich, @Gowtham_Rao

I’m curious if there have been any changes or progresses of place of service concepts since MAR because we need more detailed concepts for visit detail table.

For CDM v5, I need these concepts for three tables, visit, visit_detail, care_site.

According to the CDM document, I have to find “Place of Service Vocabulary” for admitting/discharge source concept id in visit_occurrence & visit_detail tables. (may mean ‘vocabulary_id’=‘place of service’, and there are 60 standard concepts)

And also I need to find “Place of Service Concept ID” for place of service concept id in care_site table, referred to visit tables via care_site_id. Does it mean ‘domain’=‘place of service’ like the explanation usually does? There are 491 non-standard concepts only. Maybe I can use 60 standard concepts mentioned above.

I remember (sorry I couldn’t find where the link is…) it was discussed that how to follow-up the exact care sites where the patient was during hospitalization. It can be followed-up by care_site_id from Visit_detail table.
Then we need more detailed concepts of medical department, but 60 standard concepts (domain=visit, vocabulary=place of service) are not sufficient.

[Christian_Reich]

@Sooyeon_Cho:

We are cleaning this up as we speak. Unfortunately, the ball is in my court, which means it can’t come out quickly, because I am swamped. Hope to finish it over the weekend and present the proposal here.

[Sooyeon_Cho]

Very happy to hear that, I am waiting for the completion with pleasure.
Thank you for all of your hard work.

[Christian_Reich]

I am waiting for the completion with pleasure.

Your waiting has come to an end: New Comprehensive Hierarchy for Providers, Visits (and Place of Service, Specialty, Care Site). Let us know how it will work in the Korean setting.

[ericaVoss]

@Christian_Reich, we are reviewing to see if THEMIS should address this. However, tell me if I’m wrong here, but it looks like this is a current Vocabulary task not a THEMIS task. If you disagree, we will continue to dig into this topic.

[Christian_Reich]

No, it’s a THEMIS task (and therefore a vocabulary task). I just took it out from here, because I think the community will have strong opinions. But if not, and I got it right first time - even better.