An episode defined by an interaction between a healthcare provider and the subject of care in which healthcare-related activities take place.

Data Element

Additional Information

Encounter Disposition
Description
Identifies the location or type of facility to where the patient left following a hospital or encounter episode.

Comment

Encounter Disposition

• We would need to consider capturing this variable in order to support the following domain related to Paul Coverdell National Acute Stroke Program/American Hospital Association’s (AHA) Get With The Guidelines (GTWG). The goal is to reduce gaps in stroke care across the continuum of care in states with high burden populations. • The information captured from stroke patients and those who encounter mobility related issues and are at risk of multiple hospitalizations due to post-discharge complications can help in reducing the gaps in care and to plan quality improvement efforts. # Domain # of Variables Variable Details Required or Optional 1 ED Visits 1 1. Was the patient admitted to hospital, discharged to home, discharged to SNF or other institutional long term care, or held for observation and then discharged? Optional • Currently the options displayed for “Encounter Disposition” data element are: discharged to home, discharged against medical advice, and or expired. We request the options to be expanded by including: admitted to hospital, discharged to SNF or other institutional long term care, held for observation, unknown/ND Use-Case Justification: The most challenging part is capturing the information post-hospital discharge for acute stroke patients. A lot of the pre-hospital care is captured through National Emergency Medical Services Information System (NEMSIS), a national database that stores EMS data from the U.S. States and Territories). The follow-up elements proposed above have been developed as a part of the Paul Coverdell National Acute Stroke Program (link provided below) and captured within EHR for submission into American Heart Association’s (AHA) Get With The Guidelines (GTWG) module. The ability to extract the follow-up encounter related dates would help with the identification of gaps in post-hospital discharge date for stroke patients and plan strategies for Quality Improvement efforts. https://www.cdc.gov/dhdsp/programs/stroke_registry.htm This field is for general comments on this specific data element. To submit new USCDI data classes and/or data elements, please use the USCDI ONDEC system: https://healthit.gov/ONDEC

USCDI_Version_2_Draft_Template for Comments_DHDSP_vFinal_04.14.2021_1.docx

Response to Comment on Encounter Disposition

We would need to consider capturing this variable in order to support the following domain related to Paul Coverdell National Acute Stroke Program/American Hospital Association’s (AHA) Get With The Guidelines (GTWG). The goal is to reduce gaps in stroke care across the continuum of care in states with high burden populations. • The information captured from stroke patients and those who encounter mobility related issues and are at risk of multiple hospitalizations due to post-discharge complications can help in reducing the gaps in care and to plan quality improvement efforts. # Domain # of Variables Variable Details Required or Optional 1 ED Visits 1 1. Was the patient admitted to hospital, discharged to home, discharged to SNF or other institutional long term care, or held for observation and then discharged? Optional • Currently the options displayed for “Encounter Disposition” data element are: discharged to home, discharged against medical advice, and or expired. We request the options to be expanded by including: admitted to hospital, discharged to SNF or other institutional long term care, held for observation, unknown/ND Use-Case Justification: The most challenging part is capturing the information post-hospital discharge for acute stroke patients. A lot of the pre-hospital care is captured through National Emergency Medical Services Information System (NEMSIS), a national database that stores EMS data from the U.S. States and Territories). The follow-up elements proposed above have been developed as a part of the Paul Coverdell National Acute Stroke Program (link provided below) and captured within EHR for submission into American Heart Association’s (AHA) Get With The Guidelines (GTWG) module. The ability to extract the follow-up encounter related dates would help with the identification of gaps in post-hospital discharge date for stroke patients and plan strategies for Quality Improvement efforts. https://www.cdc.gov/dhdsp/programs/stroke_registry.htm This field is for general comments on this specific data element. To submit new USCDI data classes and/or data elements, please use the USCDI ONDEC system: https://healthit.gov/ONDEC USCDI_Version_2_Draft_Template for Comments_DHDSP_vFinal_04.14.2021_1.docx Thank you for providing additional use cases for this data element. In the submission, CMS had noted a HL7 code system for discharge disposition (http://terminology.hl7.org/CodeSystem/discharge-disposition) which we believe encompasses many of the discharge dispositions noted in your comment. We agree that there are many important discharge dispositions that should be represented in the terminology standards to support care and coordination of care.

Encounter Disposition data element needs a definative value set

A single definitive value set needs to be defined to represent the range of concepts that are needed for expressing the Discharge Disposition data element. The existing lack of alignment across V2, C-CDA, FHIR US Core and Quality Measures makes in difficult, if not impossible, to support interoperability.       Several code sets are in use that identify External Transfer scenarios. Initiating Systems SHALL use one of the following:  
  1. The HL7 Value Set DischargeDisposition as stipulated in HL7 FHIR
  2. HL7 Table 112 codes referenced in the HL7 2.5.1 specification and referenced by C-CDA but under a different value set.
  3. SNOMED Codes used by quality measures for this same information
  These code sets deal with the following discharge scenarios, along with others that are different and in some cases are more specific or overlapping in difficult ways:
  • Discharge to Home
  • Discharge to Skilled Nursing Facility
  • Discharge to Rehabilitation Facility
  • Discharge to Other Healthcare Facility
  • Discharge to Psychiatric Hospital
  • Discharge to Hospice
  • Discharge to Long-Term Care
  • Discharge to Alternative Home
  • Left against advice
  • Expired
  • Other
  The problem is that the lists are not consistent and there is not reasonable way to map between them.  Image removed. See full ppt from January 2021 HL7 Work Group presentation summarizing the need to clarify a single definitive value set for this data element.

Value Set Alignment - Discharge Disposition 20210128.pdf

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