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Place of Disposition (non-standard concepts)

Hello all,

Have an issue I’m trying to solve – I’ve reviewed past forum questions, but I haven’t found my answer. We are remapping a few of our “place of disposition” concepts as they’ve become non-standard. When looking in Athena for our replacement concepts we reached a sticking point with 2 of them.

Place of Disposition:
Return to Independent (Home). (8536 non-standard). Reading the spec doc, it instructs to use a 0 for a disposition to home as it is assumed most patients will be discharged to home. Discussing this with my team there was a lot of pushback as per Athena 0 represents an unknown value and is non-standard. A significant portion of the VA population is sent to an alternative care environment vs. home. There are instances where you would want to know if a patient was discharged to home vs. inpatient cardiac rehab, to a physical rehab center or to a nursing home, etc.
Could we have a standard concept for home or return to independent?

Other Placement/Unknown (Not Specified) (8844 non-standard). For this one, 0 might be suggested however it is non-standard. A custom concept could be created but this could then exclude many patients from any network studies. I initially thought this would have to be a small percentage of patients. It turns out this is one of the top disposition codes used. There are many reasons for this, including elopement, leaving AMA and homelessness. Any thoughts on this?

Thank you for your help,

Hi @fren39i:

I think we actually have what you need, except different from that you expect:

Home is not an engagement with healthcare. That’s what 0 means. You could make tons of differentiations, like home, vacation home, cruise ship, all that. The NHS actually has prison and police custody for their admission from and discharge to concepts. In OMOP, we only capture visits data that have some kind of exposure of the patient to the healthcare system. If not, it’s a 0. Doesn’t matter the number.

Other: This is what we call a “flavor of null”. We don’t know what the placement is. That’s what 0 also means: no information. You could claim that there was some exposure to healthcare, but there is no use case imaginable asking the question about patients having some visit, don’t know which one.

Or do you have a use case?

Thank you for the explanation, I will take back to my group and see what specific feedback they have to this and if they have other particular use cases. Use cases I was considering technically can be handled with the descriptions/concepts already available as you’ve pointed out.