Updated VISIT_OCCURRENCE (markdown)
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@ -26,12 +26,23 @@ No.|Convention Description
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| 1 | A Visit Occurrence is recorded for each engagement of a patient with the healthcare system. It reflects the constellation of such engagement, not an actual concrete healthcare institution.|
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| 1 | A Visit Occurrence is recorded for each engagement of a patient with the healthcare system. It reflects the constellation of such engagement, not an actual concrete healthcare institution.|
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| 2 | Valid Visit Concepts belong to the 'Visit' domain.|
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| 2 | Valid Visit Concepts belong to the 'Visit' domain.|
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| 3 | Standard Visit Concepts are defined hierarchically, rolling up into 12 top concepts: Note that there is a combined ER and Inpatient Visit because it is close to impossible to separate the two in many EHR system.|
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| 3 | Standard Visit Concepts are defined hierarchically, rolling up into 12 top concepts:
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* 581478 "Ambulance Visit"
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* 38004193 "Case Management Visit"
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* 262 "Emergency Room and Inpatient Visit"
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* 9203 "Emergency Room Visit"
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* 581476 "Home Visit"
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* 38004311 "Inpatient Hospice"
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* 9201 "Inpatient Visit"
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* 32036 "Laboratory Visit"
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* 42898160 "Non-hospital institution Visit
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* 9202 "Outpatient Visit"
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Note that there is a combined "ER and Inpatient Visit" because it is close to impossible to separate the two in many EHR system. |
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| 4 | Handling of death: Visits are not used to indicate a patient's death. If the source data contains death information in a visit context the date should be derived (admission or discharge) and placed into the death_datetime field of the PERSON table. For details, see [there](https://github.com/OHDSI/CommonDataModel/wiki/VISIT_OCCURRENCE/_edit).|
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| 4 | Handling of death: Visits are not used to indicate a patient's death. If the source data contains death information in a visit context the date should be derived (admission or discharge) and placed into the death_datetime field of the PERSON table. For details, see [there](https://github.com/OHDSI/CommonDataModel/wiki/VISIT_OCCURRENCE/_edit).|
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| 5 | Source Concepts from a number of vocabularies are mapped into Standard Visit Concepts. Visit Concepts form a hierarchy. Therefore, the most detailed Visit Concept should be picked or mapped to during ETL. It is no longer necessary to infer a top Concept from the hierarchy. |
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| 5 | Source Concepts from a number of vocabularies are mapped into Standard Visit Concepts. Visit Concepts form a hierarchy. Therefore, the most detailed Visit Concept should be picked or mapped to during ETL. It is no longer necessary to infer a top Concept from the hierarchy. |
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| 6 | At any one day, there could be more than one visit. |
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| 6 | At any one day, there could be more than one visit. |
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| 7 | One visit may involve multiple providers, in which case the ETL must specify how a single PROVIDER_ID is selected or leave the PROVIDER_ID field null. |
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| 7 | One visit may involve multiple providers, in which case the ETL must specify how a single PROVIDER_ID is selected or leave the PROVIDER_ID field null. |
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| 8 | One visit may involve multiple Care Sites, in which case the ETL must specify how a single CARE_SITE_ID is selected or leave the CARE_SITE_ID field null. |
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| 8 | One visit may involve multiple Care Sites, in which case the ETL must specify how a single CARE_SITE_ID is selected or leave the CARE_SITE_ID field null. |
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| 9 | The discharge disposition (discharge_to_concept_id) should be filled with Visit concept. Death is no longer captured here. In addition to the Standard Visit Concepts the special concept 44814693 "Absent without leave" and 4021968 "Patient self-discharge against medical advice" can be used. |
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| 9 | The discharge disposition (discharge_to_concept_id) should be filled with Visit concept. Death is no longer captured here. In addition to the Standard Visit Concepts the special concept 44814693 "Absent without leave" and 4021968 "Patient self-discharge against medical advice" can be used. |
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| 11 | The preceding_visit_id can be used to link a visit immediately preceding the current visit. Note this is not symmetrical, and there is no such thing as a "following_visit_id". |
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| 10 | The preceding_visit_id can be used to link a visit immediately preceding the current visit. Note this is not symmetrical, and there is no such thing as a "following_visit_id". |
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| 12 | Visit end dates are mandatory. If end dates are not provided in the source there are three ways in which to derive them:<br><ul><li>Outpatient Visit: visit_end_datetime = visit_start_datetime</li><li>Emergency Room Visit: visit_end_datetime = visit_start_datetime</li><li>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.</li><li>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.</li><li>For inpatient visits ongoing at the date of ETL, put date of processing the data into visit_end_datetime and visit_type_concept_id with 32220 "Still patient" to identify the visit as incomplete.</li></ul>([THEMIS issue #13](https://github.com/OHDSI/Themis/issues/13)).|
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| 11 | Visit end dates are mandatory. If end dates are not provided in the source there are three ways in which to derive them:<br><ul><li>Outpatient Visit: visit_end_datetime = visit_start_datetime</li><li>Emergency Room Visit: visit_end_datetime = visit_start_datetime</li><li>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.</li><li>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.</li><li>For inpatient visits ongoing at the date of ETL, put date of processing the data into visit_end_datetime and visit_type_concept_id with 32220 "Still patient" to identify the visit as incomplete.</li></ul>([THEMIS issue #13](https://github.com/OHDSI/Themis/issues/13)).|
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