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Which is the best choice? drug_type_concept_id in drug_exposure table (cdm v 4.0)

Implementers
#1

Hello, everyone.
My name is Eun Kyoung Ahn, research fellow, Prof. Rae Woong Park’s team of Ajou university School of medicine in Korea.

We try to update our database (AUSOM) which is an EMR database of a tertiary hospital, into CDM version. 4.0.

About the “drug_type_concept_id” column of Drug_Exposure table, there are 11 concepts on the CONCEPT table. And we want to choose two concepts among them.

This is my opinion,

  • ‘inpatient administration (38000180)’ for inpatient, including emergency room visited person
  • ‘prescription dispensed in pharmacy (38000175)’ for out-patient

If anyone has better choice at this case, your advice would be appreciated.

Total list of concepts for drug exposure type is below;

38000175 Prescription dispensed in pharmacy
38000176 Prescription dispensed through mail order
38000177 Prescription written
38000178 Medication list entry
38000179 Physician administered drug (identified as procedure)
38000180 Inpatient administration
38000181 Drug era - 0 days persistence window
38000182 Drug era - 30 days persistence window
43542356 Physician administered drug (identified from EHR problem list)
43542357 Physician administered drug (identified from referral record)
43542358 Physician administered drug (identified from EHR observation)

Thank you.

#2

@EunkyoungAhn:

Here is how it works. You pick the one that describes best the origin of the data. If it doesn’t exist, we add it.

From what you are writing it looks like you want to describe drug exposure events that are recorded as part of the inpatient hospital visit, and as part of the outpatient visit. For the inpatient it sounds like your choice is right. For the outpatient - we don’t have that in the US. Patients don’t receive drug in the doctor’s office, unless it is a drug that the doctor or nurse administer, like vaccination or chemotherapy. For those, you can use 38000179 “Physician administered drug (identified as procedure)”. Is that what you are trying to say?

#3

For inpatient and ER-administered drugs, I think the choice you made to use
‘inpatient administration’ seems to make good sense.

For outpatient drugs, in your EHR system are you capturing dispensing
information or are you capturing prescription ordering information? If the
former, then I agree with your choice to use ‘prescription dispensed in
pharmacy’. If you have only orders, and not dispensings, then I think you
way want to instead use ‘prescription written’.

Cheers,

Patrick

#4

@Christian_Reich, @Patrick_Ryan,
Thank you much for the replies!
By your suggestions, does my understanding as follows seems good?

  1. for inpatient medication --> ‘inpatient administration’
  2. For outpatient prescriptions, we have two kind of them.
  1. prescription only: in this case, the patients have to visit pharmacy to get the medicine, as like USA. --> ‘prescription written’
  2. Some medicines are dispensed in the hospital. That includes vaccine, chemotherapy, narcotics, medicines for psychiatric patients, etc. --> ‘prescription dispensed in pharmacy’
#5

Yes, that sounds like a good strategy to me.

#6

Rae: Are they really dispensed? They are administred. Usually, you don’t put the syringe with the vaccine into the patient’s hand and say “Give yourself a shot”. :slight_smile: I’d proboably pick one of the following:

  • 38000179 Physician administered drug (identified as procedure)
  • 43542356 Physician administered drug (identified from EHR problem list)
  • 43542357 Physician administered drug (identified from referral record)
  • 43542358 Physician administered drug (identified from EHR observation)
#7

@Christian_Reich, @Patrick_Ryan
Thank you very much.

I think that three concepts are good to our data.

  1. ‘inpatient administration’ for inpatient medication
  2. ‘physician administered drug (identified as procedure)’ for some medicines are dispensed in the hospital from outpatient prescriptions
  3. ‘prescription written’ for prescription-only outpatient
#8

HI all!
Although this is an old topic, I have one more question on this topic.
Next year, the whole 10 years of claim data of Korean (51M, 2005-2014) will be converted into CDM v5.0.
The data includes complete claim data from all the hospitals and pharmacies in the nation.
Therefore, many of drug exposures must have both “38000177 Prescription written” and “38000175 Prescription dispensed in pharmacy”.Do we have any mechanism recognizing and discriminating the duplication in the data while displaying and analyzing?

#9

Hi @rwpark. Yes, you can use the DRUG_TYPE_CONCEPT_ID as the field to
designate whether a record from your source is a ‘prescription written’
from your hospital or a ‘prescription dispensed’ from your pharmacy. It’ll
be ok (and encouraged) to have both of these different perspectives for the
same drug exposure. When we build DRUG_ERA records, these records will be
combined together if they are for the same patient having the same
ingredient during the same duration.

#10

Replying to the top question: Your site may be the first to import this type of data and there may be no precedent.

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