Clarification on creating visits from Truven data

donohara · May 19, 2016, 6:44pm

On pg. 15 of the spec, the logic for building visit_occurrence records is described:

https://github.com/OHDSI/ETL-CDMBuilder/blob/master/man/TRUVEN_CCAE_MDCR/Truven_CCAE_and_MDCR_ETL_CDM_V5.doc

If an outpatient services record contains proc1=99285, and dx1=5990,
are 2 visit_records created, one for the ER and one for the OP, for the same svcdate and provid,
Or does the ER attribute of proc1 propagate to all other populated diag/proc fields on the service record,
and thus 1 ER visit only is created?

Thanks,
Don

ericaVoss · May 19, 2016, 6:57pm

@donohara,

No, the claims are associated to an ER visit, not an OP visit. You can have an ER and IP visit both on the same day. The claims associated with the ER part of the visit will get associated to an ER visit, all else will attach to the IP portion of the visit.

Our paper goes into a bit more detail. Figure 1 highlights the ER/IP case.

ncbi.nlm.nih.gov

The impact of standardizing the definition of visits on the consistency of multi-database observational health research.

EA Voss, Q Ma and PB Ryan, BMC medical research methodology, Mar 2015 08

Use of administrative claims from multiple sources for research purposes is challenged by the lack of consistency in the structure of the underlying data and definition of data across claims data providers. This paper evaluates the impact of applying a standardized revenue code-based logic for defining inpatient encounters across two different claims databases.We selected members who had complete enrollment in 2012 from the Truven MarketScan Commercial Claims and Encounters (CCAE) and the Optum Clinformatics (Optum) databases. The overall prevalence of inpatient conditions in the raw data was compared to that in the common data model (CDM) with the standardized visit definition applied.In CCAE, 87.18% of claims from 2012 that were classified as part of inpatient visits in the raw data were also classified as part of inpatient visits after the data were standardized to CDM, and this overlap was consistent from 2006 to 2011. In contrast, Optum had 83.18% concordance in classification of 2012 claims from inpatient encounters before and after standardization, but the consistency varied over time. The re-classification of inpatient encounters substantially impacted the observed prevalence of medical conditions occurring in the inpatient setting and the consistency in prevalence estimates between the databases. On average, before standardization, each condition in Optum was 12% more prevalent than that same condition in CCAE; after standardization, the prevalence of conditions had a mean difference of only 1% between databases. Amongst 7,039 conditions reviewed, the difference in the prevalence of 67% of conditions in these two databases was reduced after standardization.In an effort to improve consistency in research results across database one should review sources of database heterogeneity, such as the way data holders process raw claims data. Our study showed that applying the Observational Medical Outcomes Partnership (OMOP) CDM with a standardized approach for defining inpatient visits during the extract, transfer, and load process can decrease the heterogeneity observed in disease prevalence estimates across two different claims data sources.

donohara · May 21, 2016, 1:36pm

Thanks @ericaVoss ! That paper clarifies things for me very well.

Another question, (you can tell I’m moving down the spec!)
The logic for building procedure_occurrence records is straightforward (and pretty involved!). However bullet #1 under the Key Conventions section has me a little confused: Does it boil down to a sub-sort of records with priority=1 and position=1? Is this logic only performed when building procedure_cost records? Associated_provider_id is a relic of CDM v4, right?

If I ask nicely, maybe someday you can update the specs with diagrams like you published as Figure 1 in your paper?

Thanks!
Don

ericaVoss · May 23, 2016, 6:10pm

@donohara - basically all this sorting was to ensure the records fell out consistently. Especially was helpful for picking out an ASSOCIATED_PROVIDER_ID, but as you have pointed out that is no longer in CDM v5 PROCEDURE_OCCURRENCE. I’ll make a note to update the document.

donohara · May 24, 2016, 2:28pm

Thanks @ericaVoss

On a side note, do you have a set of standard temporal relationship terms that are used in the literature ? I’ve heard and seen various terms used to explain the fixed set of ways 2 dates can relate.

EG. Is “occurs” equivalent to “starts within”, or “starts-and-ends within”?

In the past our internal teams worked out the combinations and agreed upon terms (“entirely before”; “overlaps-left”; “identical”; “contained-within”; “spans”, etc), but there are probably better terms I should use.

Thanks,
Don

ericaVoss · May 24, 2016, 3:11pm

@donohara - This is a nice idea, hadn’t thought about this before. If you have any references on this topic please share. However this was not integrated into this document.

Mark_Danese · May 24, 2016, 3:18pm

Allen’s interval algebra is what we are using. You might want to roll up a few of the categories, but it is the best place to start.

Mark_Danese · May 24, 2016, 3:21pm

Sorry – forgot link. We have it in our spec document: https://github.com/outcomesinsights/conceptql_spec

donohara · May 24, 2016, 3:30pm

Thanks @Mark_Danese ! ConceptQL looks very interesting.

so…
post_to_forum {<,m} lunch {<,m} siesta {<,m} read_more_about_allens_i_i

FYI:
Allen’s interval algebra