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Condition type for French discharge diagnosis codes

Vocabulary Users
#1

We are currently working on the ETL of the French National Healthcare System database (SNDS), which merges, among others, claims data and hospital discharge summaries.

Four different types of condition can be found:

  • Primary diagnosis [hospital settings]: the health problem that motivated the admission in the hospital.

  • Related diagnosis [hospital settings]: exists only if the primary diagnosis is a care procedure with a code Z of the ICD-10 classification (e.g. chemotherapy session). It indicates the pathology at the origin of the care procedure

  • Associated diagnoses [hospital settings]: specified if they justify the use of specific healthcare resources. They are mainly underlying chronic diseases, making patient management more complex (and more expensive).

  • Long term disease registration: mainly concerned costly chronic diseases, obtained at the request of a patient’s practitioner and validated by the health insurance system physician. Once registered, patients receive full reimbursement for expenditure related to the disease.

We will use 44786627 “Primary Condition” for Primary diagnosis. Associated diagnoses could fit 44786629 “Secondary Condition”, but what about the others?

Thank you !

#2

your type 4 (Long term disease registration) is truly a new and unique type of condition entry not covered well. You can create a local code for it (2B+ range; not preferred by me) or request a new condition type (I would prefer this).
From analytical point of view I can see it as quite useful for cohort definition. (we will have to support country specific phenytope variants one day anyway) (translate this French phenotype concept to USA claims data or Japan data)

your type 2 is also interesting. As informatician I always wish for reason for drugX or reason for procedureY and it seems like French data gives me that so I would want to not loose it. (so local concept_id or new network wide type)

#3

I agree!

Who should I bother to request this new condition type concept_id?

#4

@nthurin:

This is a good time to bring this up. We are currently revising all the Type Concepts and making them more international.

44786627 “Primary Condition” sounds about right. But we also have two more:

  • 38000183 “Inpatient detail - primary”
  • 38000199 “Inpatient header - primary”

The distinction between detail and header is a US claims artifact, and we will clean that up.

You probably don’t need that. Any diagnosis can be related. What you do need is the explicit “Related to” relationship to a procedure. Right now, there is no explicit cross-link between the CONDITION_OCCURRENCE and PROCEDURE tables. Funny thing is in an older CDM we used to have a field relevant_condition_concept_id to point to the related diagnosis (but not the to a record in the table), but we abandoned it for lack of utility and lack of data.

So, now your only choice is to write records into the FACT_RELATIONSHIP table linking those together. There is no need for a Type Concept.

Is there an analytical use cases for you to know this? If so, what should the type be called?

Same question. Is there a need for knowings in some analytic you are planning?

#5

Thank you for your feedback @Christian_Reich
I agree on Primary diagnosis, 38000183 “Inpatient detail - primary” could also be a good option.

Regarding this point, the issue is not only to conserve the relationship but also to consider the condition. So far these codes are very useful in our studies. Usually, we almost always consider them as principal diagnoses.
I think, alongside using FACT_RELATIONSHIP table, we could also put them into CONDITION_OCCURENCE table with the same Type Concept than the Primary diagnosis (“Inpatient detail - primary” or “Primary Condition”)

As explained above they are mainly underlying chronic diseases coded by hospitals to justify an increased cost of stay. They are not the motive for the hospital admission, but they are still very useful to characterize patient chronic conditions, since in the SNDS we do not have outpatients diagnoses.

What about “Significant associated condition” ?

Yes! They are eminently important! They are very specific with a very high positive predictive value. It is the major way to identify chronic conditions for out/inpatients in the database (e.g. diabetes, parkinson disease, cancer…).

We could call them “Long term condition”.

#6

Once you agree on the list of new concepts, please post the issue here

#7

Hi there,
We are also working on the transformation from the french SNDS to OMOP and I was wondering if you agree on a decision for these diagnoses (especially long term and associated diagnoses)

We have also the case of other Primary and Related Diagnoses that have been made during different units of the hospital stay (Medical Unit (RUM) diagnoses).
We are considering the following choices for these RUM diagnoses:

  • Primary diagnoses in RUM : 38000184 // Inpatient detail - 1st position
  • Secondary diagnoses in RUM : “38000185” // Inpatient detail - 2nd position

I would add that this RUM propriety is considered for some analytics.

#8

Hi Matthieu, just to ensure we agree on the concepts to use, before posting on the vocabulary working group.

We would have :

Diagnostic principal: 44786627 “Primary Condition”

Diagnostic relié: 44786627 “Primary Condition” (since there is a diagnostic relié only when the diagnostic principal is a z code = a procedure)

Diagnostique associé: Significant associated condition ” to create

ALD: “ Long term condition ” to create

Do you see so far other “new” concept to add ?

#9

Friends:

We are going to publish a new list of Condition Status Concepts. Will ping you to get your input.

#10

Friends:

Trying to make progress on this the Condition Status concepts here: Primary dx vs Secondary dx.

These would be also Primary diagnosis. The Z code would be a record in the PROCEDURE_OCCURRENCE table.

These would be Secondary diagnoses.

They would also be Secondary diagnoses. The cost would be attached to the procedure. The fact that the procedure has a cost speaks for itself. Would that work?

You don’t? Doctors don’t have to justify what they are doing with a diagnosis?

I would not overload them. Think of the analytical use cases. In all honesty, I don’t expect folks to use these Condition Status concepts at all much. Whether something is primary or secondary might seem very relevant, but at the end of the day folks will always revert to finding the first diagnosis of something to make the assumption of the disease to have begun.

Yes, but if something is a chronic condition or not is defined by the condition. There is no acute diabetes mellitus and you can have only one of them in your life. And there is no chronic trauma, but you can have many. This needn’t a Condition Status. SNOMED btw tells you as well.

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