Condition/Procedure types for clinicians

Implementers
21

Yeah. We had the relevant_condition_concept_id. But that wasn’t a link to a record, but only to a Concept. The reason for that was that the exact record isn’t really the indication. For example, if a patient gets prescribed insulin for diabetes, the diabetes code on the prescription that gives rise to a CONDITION_OCCURRENCE record, is as much the reason as any other previous record. The FACT_RELATIONSHIP table connects records, not records with concepts. So, if we were to bring it back we would have to create a nice use case, optimally with a concrete dataset. Do you have that?

22

Would it be possible to use the fact relationship table to connect a procedure/drug record with the associated condition record using a concept that means “associated with” or “is used for”? Or we could connect the condition to the procedure/drug, depending on how the concepts are worded (e.g., a concept labeled "“is an indication for”). I think that would solve the problem within the current system.

The only challenge with the fact relationship table is that it is less transparent as to what is in there and which things are connected. It is like a hidden network of relationships that may, or may not, exist, depending on how the ETL was done. This will probably get easier to anticipate the more we use it.

23

What is the scientific question that the distinction between “Admitting
diagnosis” and “Discharge diagnosis” would answer?

I found two papers in PubMed that looked at this very question:

  1. “Discrepancy between admission and discharge diagnoses as a predictor of
    hospital length of stay”
  2. “Cost and quality implications of discrepancies between admitting and
    discharge diagnoses”

In practical terms, the Admitting diagnosis is what the patient was
admitted for, but the discharge diagnosis, with the benefit of hindsight,
is a assumed to be the more accurate of the two when there is a discrepancy.

24

@Chirs,

I used “inpattient detail - 10th position” to illustrate my point only. “Secondary” may work, but some may need greater granularity. For this, again, the hierarchy of “Secondary” -> 2nd, 3rd, …, 10th position would do the job.

Thanks,
Rimma

25

There may also be a true difference between Admitting and Discharge diagnoses, such as Infection acquired in the hospital, worsening of diagnosis, new co-morbidities, all interesting research aspects.