Modeling patient refused colonoscopy?

[nradov]

Is there a recommended way to model that a patient refused a recommended procedure? This issue came up at the recent NCQA Digital Quality Summit. Many quality measures are calculated based on whether a patient has undergone certain procedures. For example, most patients between 45 - 75 should receive periodic colonoscopies. But some patients refuse due to cost, discomfort, etc. How can we model that in FHIR resources? We need to be able to report on why individual patients are out of compliance.

Would it make sense to add a “refused” code to the EventStatus value set for the Procedure.status element? Or would it be more appropriate create an Observation to record the patient’s refusal? I don’t know if there’s an appropriate LOINC code for that.

(Tagging @Linda_Michaelsen as part of that discussion.)

[blessed_tabvirwa1]

Hi Nick,

I would think you would handle this use case as follows:

• Set Procedure.status to a value of not-done (http://www.hl7.org/fhir/codesystem-event-status.html#event-status-not-done)
• Set Procedure.statusReason (http://www.hl7.org/fhir/procedure-definitions.html#Procedure.statusReason) to SNOMED Code 105480006, Refusal of treatment by patient, (http://www.hl7.org/fhir/valueset-procedure-not-performed-reason.html)
• Optionally, use Procedure.note for any additional text regarding the refusal/not-done reason e.g. “Patient sighted cost as an issue” etc

Regards

PS: There are other SNOMED codes you could use depending on the patient’s reason for refusal e.g. “Procedure refused for religious reason”, “Procedure refused - uncooperative”, “Care/help refused by patient” etc

[nradov]

Thanks that makes sense. I see there is actually a specific SNOMED CT child code 116101000119100 for “colonoscopy refused”.