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chase-jonesMike Krahulec
chase-jones
authored and
Mike Krahulec
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932 if encounters between claims and clinical datasets overlap ie adt both encounter get thrown out in readmissions (#933)
* Make updates to readmissions log to pick one out of the bunch of overlapping instances. Choose the medical claim over the encounter. Prefer longer duration * Rename columns to match * Pulling through encounter source type * adding column name * Encounter type is not needed * Adding distinct to fix logic on mapping * database compatibility
1 parent 6e25122 commit 7744bbb

6 files changed

Lines changed: 111 additions & 58 deletions

‎models/readmissions/intermediate/readmissions__encounter.sql‎

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@@ -18,5 +18,6 @@ select
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, cast(drg_code as {{ dbt.type_string() }}) as drg_code
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, cast(paid_amount as {{ dbt.type_numeric() }}) as paid_amount
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, cast(primary_diagnosis_code as {{ dbt.type_string() }}) as primary_diagnosis_code
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, cast(encounter_source_type as {{ dbt.type_string() }}) as encounter_source_type
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, '{{ var('tuva_last_run') }}' as tuva_last_run
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from {{ ref('readmissions__stg_core__encounter') }}

‎models/readmissions/intermediate/readmissions__encounter_data_quality.sql‎

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@@ -54,12 +54,9 @@ select
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else 0
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end as no_diagnosis_ccs_flag
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, aa.ccs_diagnosis_category as diagnosis_ccs
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, case
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when aa.encounter_id in (select distinct encounter_id_a
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from {{ ref('readmissions__encounter_overlap') }})
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or
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aa.encounter_id in (select distinct encounter_id_b
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from {{ ref('readmissions__encounter_overlap') }})
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, case /* WHEN ENCOUNTER IS NOT THE BEST, THEN FLAG THIS ERROR. */
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when exists (select 1 from {{ ref('readmissions__encounter_overlap') }} as overlap
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where aa.encounter_id = overlap.encounter_id and overlap.is_best_encounter = 0)
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then 1
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else 0
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end as overlaps_with_another_encounter_flag

‎models/readmissions/intermediate/readmissions__encounter_overlap.sql‎

Lines changed: 99 additions & 41 deletions
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@@ -3,55 +3,113 @@
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)
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}}
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-- Here we give a list of all pairs of encounters
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-- that have some date overlap.
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with encounter_enhanced as (
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select
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*
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, COALESCE(
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case
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when {{ dbt.datediff("discharge_date", "admit_date","day") }} >= 1
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then {{ dbt.datediff("discharge_date", "admit_date","day") }}
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end
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, 1
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) as actual_length_of_stay
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10-
with encounters_with_row_num as (
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select
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encounter_id
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, person_id
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, admit_date
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, discharge_date
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, row_number() over (
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partition by person_id
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order by encounter_id
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) as row_num
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from {{ ref('readmissions__encounter') }}
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)
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-- Source type priority (lower number = higher priority)
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, case
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when UPPER(TRIM(COALESCE(encounter_source_type, ''))) = 'CLAIM' then 1
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else 2
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end as source_type_priority
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24+
-- Data completeness score (count of complete fields, higher = better)
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, (case when discharge_disposition_code is not null
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and TRIM(discharge_disposition_code) != ''
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and TRIM(discharge_disposition_code) != '00' then 1 else 0 end) +
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(case when drg_code_type is not null
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and TRIM(drg_code_type) != '' then 1 else 0 end) +
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(case when drg_code is not null
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and TRIM(drg_code) != ''
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and TRIM(drg_code) not in ('998', '999') then 1 else 0 end) +
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(case when paid_amount is not null then 1 else 0 end) +
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(case when primary_diagnosis_code is not null
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and TRIM(primary_diagnosis_code) != '' then 1 else 0 end) as completeness_score
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from {{ ref('readmissions__encounter') }}
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)
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, cartesian as (
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select
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aa.encounter_id as encounter_id_a
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, bb.encounter_id as encounter_id_b
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, aa.person_id
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, aa.admit_date as ai
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, aa.discharge_date as af
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, bb.admit_date as bi
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, bb.discharge_date as bf
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, case
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when (aa.admit_date between bb.admit_date and bb.discharge_date) or (aa.discharge_date between bb.admit_date and bb.discharge_date) or
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(bb.admit_date between aa.admit_date and aa.discharge_date) or (bb.discharge_date between aa.admit_date and aa.discharge_date)
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then 1
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else 0
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end as overlap
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from encounters_with_row_num as aa
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left outer join encounters_with_row_num as bb
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on aa.person_id = bb.person_id and aa.row_num < bb.row_num
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-- Identify all encounters that have overlapping dates with other encounters for the same person
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, overlapping_encounters as (
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select distinct
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e1.encounter_id
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, e1.person_id
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, e1.admit_date
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, e1.discharge_date
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from encounter_enhanced as e1
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where exists (
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select 1
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from encounter_enhanced as e2
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where e1.person_id = e2.person_id
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and e1.encounter_id != e2.encounter_id
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and e1.admit_date <= e2.discharge_date
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and e1.discharge_date >= e2.admit_date
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)
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)
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57+
-- Create overlap groups by assigning a group identifier
58+
, overlap_groups as (
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select distinct /* distinct here to prevent fan out for >2 overlapping encounters. */
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e1.encounter_id
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, e1.person_id
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, MIN(e2.encounter_id) over (
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partition by e1.person_id, e1.encounter_id
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) as overlap_group_id
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from overlapping_encounters as e1
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inner join overlapping_encounters as e2
67+
on e1.person_id = e2.person_id
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and e1.admit_date <= e2.discharge_date
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and e1.discharge_date >= e2.admit_date
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)
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45-
, overlapping_pairs as (
46-
select
47-
person_id
48-
, encounter_id_a
49-
, encounter_id_b
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from cartesian
51-
where overlap = 1
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-- Rank encounters within each overlap group
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, encounter_rankings as (
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select
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e.*
76+
, COALESCE(og.overlap_group_id, e.encounter_id) as overlap_group_id
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, case when og.encounter_id is not null then 1 else 0 end as has_overlaps
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, ROW_NUMBER() over (
79+
partition by e.person_id, COALESCE(og.overlap_group_id, e.encounter_id)
80+
order by
81+
e.source_type_priority asc -- prefer 'claim' source type
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, e.actual_length_of_stay desc -- prefer longer date spans
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, e.completeness_score desc -- prefer more complete data
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, e.encounter_id asc -- Consistent tie-breaker
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) as encounter_rank_in_group
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from encounter_enhanced as e
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left outer join overlap_groups as og
88+
on e.encounter_id = og.encounter_id
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and e.person_id = og.person_id
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)
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93+
select
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encounter_id
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, person_id
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, admit_date
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, discharge_date
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, actual_length_of_stay
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, source_type_priority
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, completeness_score
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, overlap_group_id
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, has_overlaps
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, encounter_rank_in_group
104+
, case
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when encounter_rank_in_group = 1 then 1
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else 0
107+
end as is_best_encounter
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109+
, case
110+
when encounter_rank_in_group = 1 and has_overlaps = 1 then 'Selected as best among overlapping encounters'
111+
when encounter_rank_in_group = 1 and has_overlaps = 0 then 'No overlapping encounters'
112+
else 'Not selected - better encounter exists'
113+
end as selection_reason
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56-
select *, '{{ var('tuva_last_run') }}' as tuva_last_run
57-
from overlapping_pairs
115+
from encounter_rankings

‎models/readmissions/intermediate/readmissions__readmission_crude.sql‎

Lines changed: 2 additions & 6 deletions
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@@ -16,20 +16,16 @@ select
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, enc.admit_date
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, enc.discharge_date
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from {{ ref('readmissions__encounter') }} as enc
19-
left outer join {{ ref('readmissions__encounter_overlap') }} as over_a
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on enc.encounter_id = over_a.encounter_id_a
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left outer join {{ ref('readmissions__encounter_overlap') }} as over_b
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on enc.encounter_id = over_b.encounter_id_b
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where
2420
admit_date is not null
2521
and
2622
discharge_date is not null
2723
and
2824
admit_date <= discharge_date
29-
and over_a.encounter_id_a is null and over_b.encounter_id_b is null
25+
and not exists (select 1 from {{ ref('readmissions__encounter_overlap') }} as overlap
26+
where overlap.encounter_id = enc.encounter_id and overlap.is_best_encounter = 0)
3027
)
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32-
3329
, encounter_sequence as (
3430
select
3531
encounter_id

‎models/readmissions/readmissions_models.yml‎

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@@ -265,14 +265,14 @@ models:
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alias: _int_encounter_overlap
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tags: readmissions
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materialized: view
268-
description: "This model lists all pairs of encounters that have some date overlap."
268+
description: "This model lists and labels encounters that overlap to identify the best one out of the group."
269269
columns:
270270
- name: person_id
271271
description: "The unique identifier for the patient"
272-
- name: encounter_id_A
273-
description: "Unique identifier for one of the overlapping encounters"
274-
- name: encounter_id_B
275-
description: "Unique identifier for the other overlapping encounter"
272+
- name: is_best_encounter
273+
description: "Flag that identifies the best encounter that has overlapping dates between encounters for the same patient."
274+
- name: selection_reason
275+
description: "Reason why or why not a particular encounter is selected as best for overlapping dates"
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277277
- name: readmissions__encounter_specialty_cohort
278278
config:

‎models/readmissions/staging/readmissions__stg_core__encounter.sql‎

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@@ -14,6 +14,7 @@ select
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, drg_code
1515
, paid_amount
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, primary_diagnosis_code
17+
, encounter_source_type
1718
, '{{ var('tuva_last_run') }}' as tuva_last_run
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from {{ ref('core__encounter') }}
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where encounter_type = 'acute inpatient'

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