Admitting_source_concept_id when admitted from home

[solmazeradat]

Admitting_source_concept_id when admitted from home

CDM or THEMIS convention?

CDM

Table or Field level?

Field

Is this a general convention?

No

Summary of issues

• According to visit_occurrence table definition, the field admitted_source_concept_id is used to determine where the patient was admitted from.
• It is a required field and should be filed by a standard concept in the Visit domain.
• Although there is a concept for admission from Ambulance, from Outpatient clinics, and more, I can’t find a concept for visits which were admitted by self-referral (or no referral). This is the common case for ER visits.
• Which concept is the most appropriate for admitting_source_concept_id?

Summary of answer

Author 1:
concept_id=0, because a visit concept by definition describes the interaction between a patient and the healthcare system. If there was no such interaction there is no visit concept.

• Based on the following Github issues the final answer is:

Documentation for the field ADMITTING_SOURCE_CONCEPT_ID in the VISIT_OCCURRENCE and VISIT_DETAIL tables need to be updated to include setting the field to zero when the person is admitted from home.

Related links

• https://forums.ohdsi.org/t/admitting-source-concept-id-when-admitted-from-home/13205

• https://forums.ohdsi.org/t/discharge-to-concept-id-description-vs-accepted-concepts/13931

• Admitting_source_concept_id when admitted from home #382 (comment)

Other comments/notes

• This updated in the CDM has already been done

[cgreich]

Are we sure this is the right recommendation? Usually, concept_id=0 means there was something, we just don't know. But as @solmazeradat pointed out there might have been no healthcare setting from which the patient was admitted, and we know that for a fact. Sounds to me we should go to @clairblacketer and make this field nullable.

[MelaniePhilofsky]

It is a nullable field, @cgreich. However, there is CDM guidance to set to concept_id = 0 when patient was admitted from home. Will assign to @clairblacketer