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Long Term Care Start and End Dates

CDM Builders
#1

How are people handling long term care visits start and end dates? By current guidelines in the OMOP CDMv5 Specification the start and end dates for a Long Term Care visit would be the when the person enters long term care and the end date would either be NULL if you don’t know when the care ended or maybe some imputed date. Regardless, this will result in a single visit with many possible medical events over a long span of time.

We have decided to treat the time period for long term care visits similarly to an outpatient visits, that is to set the duration of the visit to one day and will create a new visit the next time we see a medical event taken place for the patient at a long term care facility. How have others handled the Long Term Care visits and the ambiguity of determining the End Date?

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Utilizing the CDM for Clinical Applications with Second-Level Response Times
#2

For the Medicaid dataset we are doing the following, I guess technically we are imputing the end date.

For claim type = ‘LTCP’:
 - Sort data in ascending order by ENROLID, START_DATE, END_DATE, PROV_ID, and STDPROV.
 - Then by ENROLID, collapse lines of claim as long as the time between the END_DATE of one line and the START_DATE of the next is <=1. Each consolidated long term care claim is considered as one long term care visit, set 
  * MIN(START_DATE) as VISIT_START_DATE
  * MAX(END_DATE) as VISIT_END_DATE
  * ‘LTCP’ as PLACE_OF_SERVICE_SOURCE_VALUE
 - Following the step above, when VISIT_START_DATE is equal to VISIT_END_DATE, set the first date of month (VISIT_START_DATE) as VISIT_START_DATE and last date of month (VISIT_START_DATE) as VISIT_END_DATE. Sort data in ascending order by ENROLID, VISIT_START_DATE, VISIT_END_DATE, PROV_ID, and STDPROV.  For each ENROLID, collapse lines of claim as long as the time between the VISIT_START_DATE of one line and the VISIT_END_DATE of the next is <=1. Then each consolidated long term care claim is considered as one long term care visit:
  * MIN(VISIT_START_DATE) as VISIT_START_DATE
  * MAX(VISIT_END_DATE) as VISIT_END_DATE
  * ‘LTCP’ as PLACE_OF_SERVICE_SOURCE_VALUE
 - As you are collapsing records take the PROVID and STDPROV from the first claim line of each visit as VISIT_PROVID and VISIT_PROVSTD, this will be used later to assign providers associated to a visit.
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