当前位置：管理- 患病治疗期
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某段时期内，患者与医疗健康组织/机构之间发生的关联事件集，这些事件可能是Encounter医疗活动。在此期间，相关组织/机构对患者承担一定程度的责任。
EpisodeOfCare资源包含了患者与医疗服务提供者在一段时间内的关联信息，在此期间可能发生相关的医疗活动。
在许多情况下，这表示一段时间内，医疗服务提供者即使目前没有参与治疗，也对患者的某些情况或问题负有一定程度的照护责任。
下列资源在软件系统中的表现形式如下：
一个患病治疗期可能有多个机构同时参与，但是每个机构都有自己的EpisodeOfCare资源实例，用于跟踪其对患者的责任。
当一个机构完成与患者的诊疗活动并将其转移到另一个机构时。这通常以转诊到另一个（或多个）机构的形式出现。
当收到新转入患者时，此组织可能会创建一个新的EpisodeOfCare。转入流程中的初始步骤通常涉及某种形式的评估、资格、能力、护理等级，这可能需要一些时间。 一旦转入过程完成，患者入院后通常会创建CarePlan资源。
EpisodeOfCare和Encounter之间的主要区别在于：Encounter记录与患者直接相关的活动细节，而EpisodeOfCare是一个容器，它可以按问题分组，将一系列的相关Encounter联系在一起。
下面的示例场景小节给出了一些较好的例子来说明何时使用EpisodeOfCare资源最合适。
这种关系和EpisodeOfCare资源与CarePlan资源的关系是相似的。EpisodeOfCare是跟踪性质的资源，而不是计划性质的资源。 EpisodeOfCare通常在CarePlan之前创建，所以使用EpisodeOfCare时并不依赖CarePlan资源。
患病治疗期资源（CareOfEpisode）将与患者健康状况或病症相关的一组连贯的活动（如遭遇）收集到一起。此资源通常是跨系统、跨机构共享的，它可以包含治疗期内相关的医疗细节信息，也可以在没有任何医疗活动信息的情况下存在。
它所需的最少信息是一个患者和用于关联后续流程的一个状态信息。
另一种使用患病治疗期资源的场景是将追踪的患者治疗信息上报政府或用于生成账单。
This resource is referenced by ChargeItem, Contract, DocumentReference, Encounter, MedicationAdministration, MedicationDispense and MedicationStatement
Structure
| Name | Flags | Card. | Type | Description & Constraints |
|---|---|---|---|---|
  EpisodeOfCare | TU | DomainResource | An association of a Patient with an Organization and Healthcare Provider(s) for a period of time that the Organization assumes some level of responsibility Elements defined in Ancestors: id, meta, implicitRules, language, text, contained, extension, modifierExtension | |
  identifier | 0..* | Identifier | Business Identifier(s) relevant for this EpisodeOfCare | |
 status | ?!Σ | 1..1 | code | planned | waitlist | active | onhold | finished | cancelled | entered-in-error EpisodeOfCareStatus (Required) |
 statusHistory | 0..* | BackboneElement | Past list of status codes (the current status may be included to cover the start date of the status) | |
 status | 1..1 | code | planned | waitlist | active | onhold | finished | cancelled | entered-in-error EpisodeOfCareStatus (Required) | |
 period | 1..1 | Period | Duration the EpisodeOfCare was in the specified status | |
| type | Σ | 0..* | CodeableConcept | Type/class - e.g. specialist referral, disease management Episode of care type (Example) |
| diagnosis | Σ | 0..* | BackboneElement | The list of diagnosis relevant to this episode of care |
 condition | Σ | 1..1 | Reference(Condition) | Conditions/problems/diagnoses this episode of care is for |
| role | Σ | 0..1 | CodeableConcept | Role that this diagnosis has within the episode of care (e.g. admission, billing, discharge …) DiagnosisRole (Preferred) |
| rank | Σ | 0..1 | positiveInt | Ranking of the diagnosis (for each role type) |
| patient | Σ | 1..1 | Reference(Patient) | The patient who is the focus of this episode of care |
| managingOrganization | Σ | 0..1 | Reference(Organization) | Organization that assumes care |
| period | Σ | 0..1 | Period | Interval during responsibility is assumed |
| referralRequest | 0..* | Reference(ServiceRequest) | Originating Referral Request(s) | |
| careManager | 0..1 | Reference(Practitioner | PractitionerRole) | Care manager/care coordinator for the patient | |
| team | 0..* | Reference(CareTeam) | Other practitioners facilitating this episode of care | |
| account | 0..* | Reference(Account) | The set of accounts that may be used for billing for this EpisodeOfCare | |
| Documentation for this format | ||||
UML Diagram (Legend)
XML Template
<EpisodeOfCare xmlns="http://hl7.org/fhir"><!-- from Resource: id, meta, implicitRules, and language --> <!-- from DomainResource: text, contained, extension, and modifierExtension --> <identifier><!-- 0..* Identifier Business Identifier(s) relevant for this EpisodeOfCare --></identifier> <status value="[code]"/><!-- 1..1 planned | waitlist | active | onhold | finished | cancelled | entered-in-error --> <statusHistory> <!-- 0..* Past list of status codes (the current status may be included to cover the start date of the status) --> <status value="[code]"/><!-- 1..1 planned | waitlist | active | onhold | finished | cancelled | entered-in-error --> <period><!-- 1..1 Period Duration the EpisodeOfCare was in the specified status --></period> </statusHistory> <type><!-- 0..* CodeableConcept Type/class - e.g. specialist referral, disease management --></type> <diagnosis> <!-- 0..* The list of diagnosis relevant to this episode of care --> <condition><!-- 1..1 Reference(Condition) Conditions/problems/diagnoses this episode of care is for --></condition> <role><!-- 0..1 CodeableConcept Role that this diagnosis has within the episode of care (e.g. admission, billing, discharge …) --></role> <rank value="[positiveInt]"/><!-- 0..1 Ranking of the diagnosis (for each role type) --> </diagnosis> <patient><!-- 1..1 Reference(Patient) The patient who is the focus of this episode of care --></patient> <managingOrganization><!-- 0..1 Reference(Organization) Organization that assumes care --></managingOrganization> <period><!-- 0..1 Period Interval during responsibility is assumed --></period> <referralRequest><!-- 0..* Reference(ServiceRequest) Originating Referral Request(s) --></referralRequest> <careManager><!-- 0..1 Reference(Practitioner|PractitionerRole) Care manager/care coordinator for the patient --></careManager> <team><!-- 0..* Reference(CareTeam) Other practitioners facilitating this episode of care --></team> <account><!-- 0..* Reference(Account) The set of accounts that may be used for billing for this EpisodeOfCare --></account> </EpisodeOfCare>
JSON Template
{
"resourceType" : "EpisodeOfCare",
// from Resource: id, meta, implicitRules, and language
// from DomainResource: text, contained, extension, and modifierExtension
"identifier" : [{ Identifier }], // Business Identifier(s) relevant for this EpisodeOfCare
"status" : "<code>", // R! planned | waitlist | active | onhold | finished | cancelled | entered-in-error
"statusHistory" : [{ // Past list of status codes (the current status may be included to cover the start date of the status)
"status" : "<code>", // R! planned | waitlist | active | onhold | finished | cancelled | entered-in-error
"period" : { Period } // R! Duration the EpisodeOfCare was in the specified status
}],
"type" : [{ CodeableConcept }], // Type/class - e.g. specialist referral, disease management
"diagnosis" : [{ // The list of diagnosis relevant to this episode of care
"condition" : { Reference(Condition) }, // R! Conditions/problems/diagnoses this episode of care is for
"role" : { CodeableConcept }, // Role that this diagnosis has within the episode of care (e.g. admission, billing, discharge …)
"rank" : "<positiveInt>" // Ranking of the diagnosis (for each role type)
}],
"patient" : { Reference(Patient) }, // R! The patient who is the focus of this episode of care
"managingOrganization" : { Reference(Organization) }, // Organization that assumes care
"period" : { Period }, // Interval during responsibility is assumed
"referralRequest" : [{ Reference(ServiceRequest) }], // Originating Referral Request(s)
"careManager" : { Reference(Practitioner|PractitionerRole) }, // Care manager/care coordinator for the patient
"team" : [{ Reference(CareTeam) }], // Other practitioners facilitating this episode of care
"account" : [{ Reference(Account) }] // The set of accounts that may be used for billing for this EpisodeOfCare
}
Turtle Template
@prefix fhir: <http://hl7.org/fhir/> .
Changes since R3
| EpisodeOfCare | |
| EpisodeOfCare.status |
|
| EpisodeOfCare.statusHistory.status |
|
| EpisodeOfCare.referralRequest |
|
| EpisodeOfCare.careManager |
|
See the Full Difference for further information
This analysis is available as XML or JSON.
See R3 <--> R4 Conversion Maps (status = 1 test that all execute ok. All tests pass round-trip testing and all r3 resources are valid.)
Structure
| Name | Flags | Card. | Type | Description & Constraints |
|---|---|---|---|---|
| EpisodeOfCare | TU | DomainResource | An association of a Patient with an Organization and Healthcare Provider(s) for a period of time that the Organization assumes some level of responsibility Elements defined in Ancestors: id, meta, implicitRules, language, text, contained, extension, modifierExtension | |
| identifier | 0..* | Identifier | Business Identifier(s) relevant for this EpisodeOfCare | |
| status | ?!Σ | 1..1 | code | planned | waitlist | active | onhold | finished | cancelled | entered-in-error EpisodeOfCareStatus (Required) |
| statusHistory | 0..* | BackboneElement | Past list of status codes (the current status may be included to cover the start date of the status) | |
| status | 1..1 | code | planned | waitlist | active | onhold | finished | cancelled | entered-in-error EpisodeOfCareStatus (Required) | |
| period | 1..1 | Period | Duration the EpisodeOfCare was in the specified status | |
| type | Σ | 0..* | CodeableConcept | Type/class - e.g. specialist referral, disease management Episode of care type (Example) |
| diagnosis | Σ | 0..* | BackboneElement | The list of diagnosis relevant to this episode of care |
| condition | Σ | 1..1 | Reference(Condition) | Conditions/problems/diagnoses this episode of care is for |
| role | Σ | 0..1 | CodeableConcept | Role that this diagnosis has within the episode of care (e.g. admission, billing, discharge …) DiagnosisRole (Preferred) |
| rank | Σ | 0..1 | positiveInt | Ranking of the diagnosis (for each role type) |
| patient | Σ | 1..1 | Reference(Patient) | The patient who is the focus of this episode of care |
| managingOrganization | Σ | 0..1 | Reference(Organization) | Organization that assumes care |
| period | Σ | 0..1 | Period | Interval during responsibility is assumed |
| referralRequest | 0..* | Reference(ServiceRequest) | Originating Referral Request(s) | |
| careManager | 0..1 | Reference(Practitioner | PractitionerRole) | Care manager/care coordinator for the patient | |
| team | 0..* | Reference(CareTeam) | Other practitioners facilitating this episode of care | |
| account | 0..* | Reference(Account) | The set of accounts that may be used for billing for this EpisodeOfCare | |
| Documentation for this format | ||||
XML Template
<EpisodeOfCare xmlns="http://hl7.org/fhir">
JSON Template
{
"resourceType" : "EpisodeOfCare",
// from Resource: id, meta, implicitRules, and language
// from DomainResource: text, contained, extension, and modifierExtension
"identifier" : [{ Identifier }], // Business Identifier(s) relevant for this EpisodeOfCare
"status" : "<code>", // R! planned | waitlist | active | onhold | finished | cancelled | entered-in-error
"statusHistory" : [{ // Past list of status codes (the current status may be included to cover the start date of the status)
"status" : "<code>", // R! planned | waitlist | active | onhold | finished | cancelled | entered-in-error
"period" : { Period } // R! Duration the EpisodeOfCare was in the specified status
}],
"type" : [{ CodeableConcept }], // Type/class - e.g. specialist referral, disease management
"diagnosis" : [{ // The list of diagnosis relevant to this episode of care
"condition" : { Reference(Condition) }, // R! Conditions/problems/diagnoses this episode of care is for
"role" : { CodeableConcept }, // Role that this diagnosis has within the episode of care (e.g. admission, billing, discharge …)
"rank" : "<positiveInt>" // Ranking of the diagnosis (for each role type)
}],
"patient" : { Reference(Patient) }, // R! The patient who is the focus of this episode of care
"managingOrganization" : { Reference(Organization) }, // Organization that assumes care
"period" : { Period }, // Interval during responsibility is assumed
"referralRequest" : [{ Reference(ServiceRequest) }], // Originating Referral Request(s)
"careManager" : { Reference(Practitioner|PractitionerRole) }, // Care manager/care coordinator for the patient
"team" : [{ Reference(CareTeam) }], // Other practitioners facilitating this episode of care
"account" : [{ Reference(Account) }] // The set of accounts that may be used for billing for this EpisodeOfCare
}
Turtle Template
@prefix fhir: <http://hl7.org/fhir/> .
Changes since Release 3
| EpisodeOfCare | |
| EpisodeOfCare.status |
|
| EpisodeOfCare.statusHistory.status |
|
| EpisodeOfCare.referralRequest |
|
| EpisodeOfCare.careManager |
|
See the Full Difference for further information
This analysis is available as XML or JSON.
See R3 <--> R4 Conversion Maps (status = 1 test that all execute ok. All tests pass round-trip testing and all r3 resources are valid.)
See the Profiles & Extensions and the alternate definitions: Master Definition XML + JSON, XML Schema/Schematron + JSON Schema, ShEx (for Turtle) + see the extensions & the dependency analysis
| Path | Definition | Type | Reference |
|---|---|---|---|
| EpisodeOfCare.status EpisodeOfCare.statusHistory.status | The status of the episode of care. | Required | EpisodeOfCareStatus |
| EpisodeOfCare.type | The type of the episode of care. | Example | EpisodeOfCareType |
| EpisodeOfCare.diagnosis.role | The type of diagnosis this condition represents. | Preferred | DiagnosisRole |
When an organization assumes responsibility for a patient, then the EpisodeOfCare is created and a start date
entered to show when it has begun.
As the organization's responsibility changes, so does the status of the EpisodeOfCare.
This is described via an example below for an intake workflow.
With long term care there is often a concept of the provision of care being suspended for various reasons.
Many systems have extensive Leave Management/Tracking solutions which consider the complexities of this space,
however this EpisodeOfCare resource is NOT intended to provide this level of tracking.
Extension(s) may be used on the status/status history to track the on-hold reason, which can facilitate the processing.
A more complete Leave Management solution may have to deal with:
This example sequence demonstrates some status transitions and how other resources interact.
The context could be in a Community/Aged Care/Disability/Mental Health setting.
In some jurisdictions an Organization may be funded by a government body for the days that a patient is under
their care. These are known as "active days". This does not mean that they are actively receiving a service (an encounter),
but that the organization is responsible for managing their care.
This monthly reporting value can be easily extracted from the status history as described above.
The actual provision of services may also be funded separately, and this would be via the Encounters.
An Organization may perform analytics on their EpisodeOfCare resources to have an understanding of how their business is performing.
Observing that there was a 60/40 split of episodes being finished/cancelled is not very informative. The organization would
prefer to know the reason why the episodes are completing so that they can plan their business effectively.
They would be more interested in knowing whether it was due to services hitting their mandatory end date, client passing away,
client transitioning to a higher level of services provided by them or to another provider etc.
Currently there are no attributes on this resource to provide this information. This would be very specific to each implementation and usage, so it would be recommended to use extensions to achieve this functionality.
为了以回顾糖尿病患者的管理情况，全科医生希望以时间轴的形式查看其在院内的诊就信息和区域社区系统中的信息。
使用EpisodeOfCare资源使医生能够很容易的将糖尿病诊疗活动与心理健康问题的诊疗活动分开。
一个社区基层卫生组织通过随访与残疾患者相关的所有诊疗活动，并向向政府上报告其EpisodeOfCare资源，以申请资金补贴。
Search parameters for this resource. The common parameters also apply. See Searching for more information about searching in REST, messaging, and services.
| Name | Type | Description | Expression | In Common |
| care-manager | reference | Care manager/care coordinator for the patient | EpisodeOfCare.careManager.where(resolve() is Practitioner) (Practitioner) | |
| condition | reference | Conditions/problems/diagnoses this episode of care is for | EpisodeOfCare.diagnosis.condition (Condition) | |
| date | date | The provided date search value falls within the episode of care's period | EpisodeOfCare.period | 17 Resources |
| identifier | token | Business Identifier(s) relevant for this EpisodeOfCare | EpisodeOfCare.identifier | 30 Resources |
| incoming-referral | reference | Incoming Referral Request | EpisodeOfCare.referralRequest (ServiceRequest) | |
| organization | reference | The organization that has assumed the specific responsibilities of this EpisodeOfCare | EpisodeOfCare.managingOrganization (Organization) | |
| patient | reference | The patient who is the focus of this episode of care | EpisodeOfCare.patient (Patient) | 33 Resources |
| status | token | The current status of the Episode of Care as provided (does not check the status history collection) | EpisodeOfCare.status | |
| type | token | Type/class - e.g. specialist referral, disease management | EpisodeOfCare.type | 5 Resources |