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Intermediate Care - How map this type of care?

Vocabulary Users
#1

Hello everyone,

I hope this message finds you well. We are currently in the process of mapping the units and wards within our hospital as part of our ongoing efforts. However, we have come across a specific challenge that we would appreciate your insights on.

In our hospital, we have a unit dedicated to intermediate care, which we refer to as “Intermediate Care Unit.” While attempting to map this unit to the appropriate concept in the various vocabularies available in Athena, we were surprised to find that there is no corresponding concept available. This has led us to wonder why such a crucial care category like intermediate care does not seem to be attributed within the vocabularies.

We understand the importance of comprehensive and accurate mapping within the OHDSI OMOP framework, and this situation has prompted us to seek your expertise. Could anyone shed some light on why a concept for intermediate care might be missing in the vocabularies, or provide guidance on how we could approach this mapping issue effectively?

Thank you all for your time and assistance. We truly value the collaborative nature of this community and look forward to hearing your thoughts.

Best regards,

#2

Perhaps this is why?
From: What is intermediate care? - PMC

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To be fair, there is also not a mapping for med-surg either, but I am assuming that would be assumed if it is inpatient and not ICU.

#3

Possible “Intermediate Care Unit” is the same as “Stepdown unit” (Step down unit - wikidoc) and we have this concept in SNOMED (Athena). The most appropriate concept in domain Visit may be “Skilled Nursing Facility” (Athena)

#4

This is Open Source, @Mateus. It is not there because nobody has claimed a need for it, yet. If you need it please submit through the community contribution. Then it will exist. :slight_smile:

#5

@Christian_Reich and vocabulary friends,

We need to discuss the Visit domain. In its current state it’s ambiguous. There’s one domain and two tables with different definitions. One set of standard concept_ids covers both of these tables. Folks with EHR data need to map their individual units (which vary from hospital to hospital even within a healthcare system) to a anemic set of standard concepts. And the standard concepts are not defined. What is a step down unit? Does it belong with intensive care unit or with intermediate care unit? I will argue it depends on the hospital. The step down unit in a rural location will have quite a different level of care than the step down unit at the urban, trauma hospital. Some of the standard concepts in the Visit domain are a combination of care site and visit type. Examples include: ambulatory physical therapy clinic, dental laboratory, etc. It’s a mess and the topic of concept_ids with domain_id = Visit continues to come up.

Before we start adding more concepts to the mix, we need to:

  1. Fully define the use cases. What are the questions? Why are the questions posed that way? Are the questions proxies for something else? How do other observational health data models ask these questions?

  2. Model the data from a holistic point of view.

  3. Update the concepts and vocabularies based on the above.

  4. Write up clear conventions and definitions for the ETLer and the researcher.

  5. Present it to the community.

And in order to properly do the above, we need the community to participate and bring their use cases.

#6

Thanks @Mikita_Salavei, @Mark , @Christian_Reich anda @MPhilofsky

I apologize for not mentioning in the initial post that the intermediate care bed I am looking for is of the Step Down type, as mentioned by @Mikita_Salavei (which indeed supports what @Mark mentioned: the term does not represent a well-defined type of care, as it can be interpreted as either less specialized than an ICU or as intermediate care between a hospital and a non-hospital institution).

I appreciate the suggestion and I will bring it to the vocabulary group to understand the considerations from @MPhilofsky .

One point I also notice is what @MPhilofsky mentioned: there is ambiguity and overlap between the visit_concept_id (inpatient, outpatient, emergency room, etc) and the care_site.

For visit_occurrence, what could make sense is the type of visit (inpatient, outpatient, emergency room, etc), while in visit_detail it should show the patient’s navigation within the healthcare unit during their period of hospitalization.

#7

Is PCU the same as step down? My dear nurse friend uses the terms interchangeable, but according to defined terms, that I find on the web, whist synonyms, there seems to be a bit of difference, but is the difference different enough to make a difference?

In my area, we have rural level 5 trauma units whist the more urban hospitals do not. I am not trying to be pedantic (although I probably am), but reinforcing the claim that different hospitals will have drastic differences in how they operate, more than just on location.

#8

Exactly! That is why it is hard to standardize these data because they have different meanings in different healthcare systems and within one healthcare system. Therefore, I don’t think we should add this as a standard concept.

If you tell me the use case, I might be able to help you find a solution.

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