Missing visit end date

[solmazeradat]

Missing visit end date

CDM or THEMIS convention?

THEMIS

Table or Field level?

Field

Is this a general convention?

No

Summary of issues

• How to handle missing visit_end_date in the VISIT_OCCURRENCE table?
• How to address the missing visit_end_date with the non-standard concept_id = 32220 for “Still patient”?

Summary of answer

• Suggested solution:

Visit_end_date is mandatory. Use the best information to infer a visit end date. If end dates are not provided, possible ways to derive them include:

1. Outpatient Visit: end_date=start_date
2. Emergency Room Visit: end_date=start_date
3. Inpatient Visit: usually there is information about discharge. If not you should be able to derive from the sudden decline of activity, or from the absence of inpatient procedures/drugs. But the latter would be not obvious.
4. Long Term Care Visits: particularly for claims data, if end dates are not provided assume the visit is for the duration of month that it occurs.
5. For inpatient visits ongoing at the date of ETL, put date of processing the data as mandatory visit_end_date and VISIT_TYPE_CONCEPT_ID with 32220-"Still patient" to identify the visit as incomplete.

On the subject of address the missing visit_end_date with the non-standard concept_id = 32220 for “Still patient”"

... need to update concept_id = 32220 to standard status since only standard concept_ids are allowed in the visit_type_concept_id field.

Related links

• forum post - http://forums.ohdsi.org/t/themis-2-how-do-you-handle-missing-visit-end-dates/4308
• Github post - Missing Visit End Dates #13

Other comments/notes

• Please use this section to add any other relevant notes or comments. (i.e. if links are not working, something is out of date or deprecated)

[MelaniePhilofsky]

This issue needs to be addressed by Themis. Current guidance (use type_concept_id field to flag an ongoing visit) conflicts with current guidance (end_date is required) and breaks general CDM guidance (*_type_concept_Id fields must contain standard concept_ids). I will move it to the "needs work" column.

[MelaniePhilofsky]

This issue is for a missing visit_end_date. The "still a patient" issue, is issue OHDSI/CommonDataModel#698 in Themis.

There is already guidance on how to populate the mandatory visit_occurrence.visit_end_date when the source doesn't supply an end date. The following is the heuristic found on the CDM v5.4 website. This needs to be documented as a Themis issue, posted to the Themis convention library and then the wording should be removed from the CDM website.

"If end dates are not provided in the source there are three ways in which to derive them: - Outpatient Visit: visit_end_datetime = visit_start_datetime - Emergency Room Visit: visit_end_datetime = visit_start_datetime - Inpatient Visit: Usually there is information about discharge. If not, you should be able to derive the end date from the sudden decline of activity or from the absence of inpatient procedures/drugs. - Non-hospital institution Visits: Particularly for claims data, if end dates are not provided assume the visit is for the duration of month that it occurs."

[cgreich]

Non-hospital institution Visits: Particularly for claims data, if end dates are not provided assume the visit is for the duration of month that it occurs.

Apart from the clumsy English: Is that true? Skilled Nursing Facilities are claimed per month? And if so, shouldn't they then be cobbled together into a lengthy overall stay?

[MelaniePhilofsky]

Agree the wording needs improvement, @cgreich. Also, if the guidance is inaccurate, we need to correct it. Themis will add it to the agenda for discussion