Analytics Follow-up and Related Terminology – PainChek Support

The terminology in this section aids the definition of follow-up based metrics. Several concepts are first built up to allow for more succinct descriptions.

Follow-ups refer to a subsequent assessment being conducted after an initial assessment. We are interested in follow-ups for two main reasons:

identify residents who need to be reassessed after being in pain (i.e. there is no follow-up yet), or
establish if a resident who was in pain was reassessed within an acceptable timeframe

Next Assessments

Consider assessments ordered chronologically and grouped by unique (patient, site) pairs under a license. When using Follow-up Terminology the ‘Next Assessment’ of an assessment, refers to the next chronological assessment in its unique (patient, site) group - when an assessment has no next chronological assessment, i.e. it is the last in its group, the ‘Next Assessment’ is considered null.

An assessment could be identified with its next assessment like so:

for each unique (patient, site) pair in all_assessments:
  patient_site_assessments = get_all_assessments_with_patient_and_site(patient, site)
  ordered_patient_site_assessments = order_assessments_by_assessment_date(patient_site_assessments)
  ordered_patient_site_assessment_indicies = get_indicies(ordered_patient_site_assessments)
  for assessment_index in ordered_patient_site_assessment_indicies:
    initial_assessment = ordered_patient_site_assessments[assessment_index]
    
    next_assessment_index = assessment_index + 1
    if next_assessment_index in ordered_patient_site_assessment_indicies:
      next_assessment = ordered_patient_site_assessments[next_assessment_index]
    else:
      next_assessment = null

Generally, the ‘Next Assessment’ cares about all assessments for a given patient and site. If the next assessments were calculated for a filtered subset of assessments, it would lead to an incorrect chronology. There is a notable exception of excluding future assessments for historical purposes (like metrics).
For instance, in a case where PainChek and NRS assessments exist on the same patient/site, it is important to not filter out either assessment mode before applying an algorithm to find the next assessment.
We do not know the nature of time gaps between an initial assessment and its next assessment. Unrecorded assessments or edge cases of a patient changing admission/sites/licenses could lead to larger gaps.
We can also define Next Assessments by grouping on just unique patients under a license (as opposed to patient, site) - which is equivalent to treating the license as a single site

Follow-up Details

Now assessments can be thought of as an initial assessment with knowledge of its next assessment. The following details can be calculated for every (initial) assessment, and are used throughout the Follow-up Terminology. If a next assessment is null (does not exist), the details dependent on it are also null.

	Detail Name	Source	Type
1	initial_date	assessment_date on the initial assessment	date with a timezone e.g. '2022-10-01 11:24:46.037+10'
2	initial_pain_level	assessment_pain_level on the initial assessment	‘none', ‘mild’, ‘moderate’ or 'severe’
3	initial_mode	assessment_mode on the initial assessment	‘painchek’ or ‘nrs’
4	initial_timing	assessment_timing on the initial assessment	‘rest’ or ‘movement’
5	next_pain_level	assessment_pain_level on the next assessment	‘none', ‘mild’, ‘moderate’ or 'severe’; or null
6	next_date	assessment_date on the next_assessment	date with a timezone; or null
7	time_till_next_assess	the amount of time from initial_date to next_date	date interval; or null e.g. initial_date = ‘2022-11-01 11:00:00.000 +10’ next_date = ‘2022-11-01 12:10:00.000 +10’ time_till_next_assess = ‘1 hour 10 minutes’
8	data_cutoff_date	A fixed value - which should match the time of the last assessment data update. This is pretending the current time is some other time in the past, so time_till_data_cutoff isn’t larger than it should be, which could flag more Outstanding Follow-ups	date with a timezone
9	time_till_data_cutoff	the amount of time from initial_date to data_cutoff_date (this allows us to keep track of how long it has been since the initial assessment - when there is no next assessment)	date interval
10	patient_archived_at	time at which the patient was archived, null if the patient was not archived (patient identified by the assessment patient_id)	date with a timezone; or null

Terminology

	Term	Concept	Definition	Example
1	Follow-up Initial Assessment	An assessment that requires a follow-up	An assessment with “mild”, “moderate” or “severe” pain
2	Follow-up Assessment (a.k.a. Follow-up)	Referring to the actual follow-up assessment	The Next Assessment of a Follow-up Initial Assessment
3	Follow-up Success	An assessment with pain that was followed up within an appropriate amount of time	A Follow-up Initial Assessment with a time_till_next_assessment of under 24 hours.	A patient has an assessment with mild pain, and receives their next assessment after 3 hours. This is a follow-up success.
4	Follow-up Fail	An assessment with pain that was not followed up in an appropriate amount of time If an assessment with pain is not a follow-up success, this does not mean it is a follow-up fail - as the follow-up may be pending, with not much time having passed.	A Follow-up Initial Assessment which either: has a time_till_next_assessment that takes place after 24 hours or later OR if the Next Assessment is null, and both: time_till_data_cutoff takes place after 24 hours or later Patient is a Currently Active Patient¹	A severe assessment has its next assessment after 3 days, this is a follow-up fail. A patient's last assessment was of mild pain, and months have passed, despite updated data. If the resident was archived, this would not be counted as a follow-up fail. If the resident was not archived, this would be a follow-up fail.
5	Follow-up Rate Total	The total assessments with pain, which have a set follow-up result (success or fail). For use in the Follow-up Rate	Given a group of assessments, count the Follow-up Initial Assessments which are either a Follow-up Fail or Follow-up Success
6	Follow-up Rate (a.k.a Follow-up %)	What percentage of Follow-up Successes do we have?	Given a group of assessments, the Follow-up (Success) Rate, refers to the percentage of Follow-up Successes out of the Follow-up Rate Total	5 follow-up fails and 10 follow-up successes, would mean 15 rate total followups → a follow-up rate of 10/15 = 66.7%
7	Follow-up Outcome	The resulting pain level of the Follow-up	The pain level of a Follow-up Assessment, equivalently the next_pain_level of a Follow-up Initial Assessment	A patient is assessed with moderate pain and then an hour later with mild pain. The follow-up outcome was mild pain.
8	Nth-hour Follow-up	A Follow-up which took place a certain amount of hours after the initial assessment	Follow-up Initial Assessment with time_till_next_assessment having a value within the range [N hours, N+1 hours)	A patient receives a follow-up assessment for mild pain in 4.5 hrs. This was a 4th-hour follow-up.
9	Pending Follow-up	An assessment with pain which does not yet have a Follow-up Assessment Could also be a Follow-up Fail	The last assessment on a Currently Active Patient¹ where the assessment is not a Follow-up Success
10	Patient with Outstanding Follow-up	A patient who is overdue for a Follow-up Assessment	A Currently Active Patient¹ with a Follow-up Fail as their last assessment	It has been 4 days since a patient was last assessed with severe pain, they are active so this is a follow-up fail, as it was the last assessment they have an outstanding followup
11	Patient with Outstanding Assessment	A patient who is overdue for a regular assessment	A Currently Active Patient¹: with their last assessment having a time_till_data_cutoff of 90 days or greater OR that has never had an assessment and is also a Patient with First Assessment Outstanding	It has been a year since a patient was last assessed with none pain, they are active, so they have an outstanding assessment. Also note as the assessment was none pain, it is not a follow-up initial assessment.
12	Patient with First Assessment Outstanding	A patient never assessed who should be assessed	A Currently Active Patient¹ with no assessments which is under a license with NRS enabled (we may in the future extend this definition to patients who are custom chosen to require a first assessment)

“Active Patient” is defined in - Analytics Patient Type Terminology

Prefixes

The terms defined above are usually appended with a prefix which makes a specification about the initial assessments

	Common Prefixes	Effect on Term Definition	Example
1	Mild	The initial assessment must have mild pain	Mild Follow-up Success
2	Moderate	The initial assessment must have moderate pain	Moderate Follow-up %
3	Severe	The initial assessment must have severe pain	Severe Follow-up Fail
4	N-hour	Whenever a follow-up definition is dependent on 24 hours, replace 24 with N hours. If N=24, there is no definitional change.	4-hour Follow-up Rate “Follow-up Rate” (no prefix) is assumed to mean “24-hour Follow-up Rate”
5	PainChek	The initial assessment must be a painchek assessment	PainChek Follow-up Fail = a Follow-up Fail where the Follow-up Initial Assessment was PainChek
6	NRS	The initial assessment must be an nrs assessment	NRS Mild Follow-up Rate = % of NRS Follow-up Successes / NRS Follow-up Rate Total

Prefixes can be compounded. For example, a “PainChek 4-hour Follow-up Success” means a PainChek Follow-up Initial Assessment with time_till_next_assessment under 4 hours

Articles in this section

Next Assessments

Follow-up Details

Terminology

Prefixes

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