The current vignette for the readmission function provides some general rationale for the palliative and chemotherapy flag, but it says that the rationale for the chemo flag is the same as for the palliative flag.
Thus, it is not clear why palliative care is removed from both the numerator and denominator, whereas chemotherapy is only removed from the numerator:
We should add some additional clarification on why palliative care (but not chemotherapy) is removed from the denominator. Something along those lines (please edit & shorten):
The main distinction is that palliative care would usually result in death, and thus, we wouldn't want to check whether those encounters are readmitted again after an episode of care that involved palliative care. So in that sense, there is some overlap between the palliative and death flag (in neither case, checking for readmission would be fair because the patient by definition can't be readmitted). By contrast, episodes of care involving chemotherapy could in principle result in a subsequent readmission (but note that if that readmission itself involves chemotherapy, it wouldn't be counted as a readmission, otherwise, we'd likely be inflating readmission rates for cancer patients; however, if someone is readmitted for a non-chemotherapy encounter, that would count as a readmission)
Improve documentation
The current vignette for the readmission function provides some general rationale for the palliative and chemotherapy flag, but it says that the rationale for the chemo flag is the same as for the palliative flag.
Thus, it is not clear why palliative care is removed from both the numerator and denominator, whereas chemotherapy is only removed from the numerator:
We should add some additional clarification on why palliative care (but not chemotherapy) is removed from the denominator. Something along those lines (please edit & shorten):
The main distinction is that palliative care would usually result in death, and thus, we wouldn't want to check whether those encounters are readmitted again after an episode of care that involved palliative care. So in that sense, there is some overlap between the palliative and death flag (in neither case, checking for readmission would be fair because the patient by definition can't be readmitted). By contrast, episodes of care involving chemotherapy could in principle result in a subsequent readmission (but note that if that readmission itself involves chemotherapy, it wouldn't be counted as a readmission, otherwise, we'd likely be inflating readmission rates for cancer patients; however, if someone is readmitted for a non-chemotherapy encounter, that would count as a readmission)