Discharge Abstract Database (DAD) Product Review Alexandra Cooper Queen’s University DLI Ontario Training, November 2016

Background Originally developed in 1963, the Discharge Abstract Database (DAD) captures administrative, clinical and demographic information on hospital discharges (including deaths, sign-outs and transfers). Some provinces and territories also use the DAD to capture day surgery.

Background Data availability: Most recent full year – 2015-2016 Historical series – 1994-1995 to 2014-2015 Access to full database from CIHI Data request form Graduate Student Data Access Program Data request - $$$ CIHI does have publically accessible data (Quick Stats) and analytical publications – not DAD data but health care statistics DAD data is also used to populate other CIHI databases, including: The Hospital Morbidity Database (HMDB) The Hospital Mental Health Database (HMHDB)

Data Source Data is received directly from acute care facilities or their respective health/regional authority or ministry/department of health Facilities in all provinces and territories except Quebec are required to report. Data from Quebec is submitted to CIHI directly by the ministère de la Santé et des Services sociaux du Québec.

Data elements Abstract Identification Length of Stay Patient Demographics Admission Data Discharge Data Patient Service Information Service Transfers Provider Information Diagnosis Information Intervention Information Special Care Information Blood Information Reproductive Care Information Not all in DLI sample files

DLI DAD Sample Files 10% sampling of persons from the database Acute inpatient cases form all provinces/territories except Quebec and British Columbia Reference dates are randomly assigned to selected individuals 2 files received from CIHI - Clinical and Geographic Enhanced Clinical and Geographic Files – created by Vince Grey, Western University Key uses of the DAD Researchers can become familiar with the structure and content of DAD data Researchers can explore inter-relationships among DAD data elements (e.g. diagnoses and interventions, Case Mix information) Researchers can perform preliminary analyses and data mining Test hypotheses Reference question answered with DAD - economic burden of diabetic foot complication (foot ulcers and amputations) in Canada

DLI DAD Sample Files Fiscal years 2009-2010 to 2010-2011 2013-2014 2014-2015 Geography Province and Territory (grouped) Health Region DLI received first sample files in 2013 Excluded Stillbirths (ENT_CODE = S) Cadaveric donations (ADM_CAT = R) All therapeutic abortion (TA) records

DLI DAD Sample Files Access CIHI DAD Sample files are included in the DLI License as an appendix Download from the DLI EFT MAD_CIHI_ICIS_DAM folder (including the Vince’s Enhanced files) Download from <odesi> Before accessing files user must accept the license agreement

DLI DAD Sample Files Clinical Data File Clinical details: Diagnoses (1-25): code (ICD-10-CA) and type Interventions (1-20): code (CCI), status, location, anaesthetic technique Special care unit visits (1-6): type/number and hours Length of stay: seven categories (0, 1, 2, 3, 4-5, 6-9, 10+ days) Newborn weights: six categories (under 750, 750-999, 1000-1499, 1500-1999, 2000-2499, 2500+ grams) Gestation weeks at delivery: four categories (under 32, 32-33, 34-36, 37+ weeks)

DLI DAD Sample Files Geographic Data File Health Region Case Mix variables: Major Clinical Category (MCC) Case Mix Group (CMG) CMG age category Resource Intensity Weight (RIW) Expected Length Of Stay (ELOS) RIW Atypical code Resource Intensity Level Length of Stay: three categories (0, 1-2, 3+ days) Case-mix methodologies categorize patients into statistically and clinically homogeneous groups based on the collection of clinical and administrative data. for grouping acute care episodes captured in CIHI’s databases.

DLI DAD Sample Files Common Data Elements Person identifier – meaningless except to identify discharge records for same person within file Facility province or territories (grouped) Discharge day – relative to reference day Admission day – relative to reference day; calculated using collapsed total length of stay Gender (male or female only) Age group

DLI DAD Sample Files Enhanced Data File File created by Vince Grey, Western University, to address issue with ICD-10* and CCI* variables in CIHI files Documentation and Readme about Enhanced files available in <odesi> *ICD-10 - International Statistical Classification of Diseases and Related Health Problems, 10th revision *CCI – Canadian Classification of Health Interventions

DLI DAD Sample Files Enhanced Data File Problems in DAD files as distributed by CIHI Primarily string variables – poses analytical problems and problems for STATA users No value labels ICD10 and CCI variables have non-alphabetic characters stripped e.g. ICD-10 code of A05.80 is in distributed file as A0580; CCI code of 1.AB.86.ML-XX-A is recorded as 1AB86MLXXA Difficulties in matching codes to the documentation Files contain up to 25 ICD-10 classifications and up to 20 CCI classifications per record; users may have trouble identifying records in which they are interested Analytical problems - age when coded as a string may not be treated as an ordinal variable.

DLI DAD Sample Files Enhanced Data File Enhancements to address problems – Clinical file Creation of 435 flag variables – users can select records that have a broad category of ICD-10 and CCI codes, based on first three characters Created 2 variables that record the number of ICD-10 and CCI codes on each record (ICDCOUNT; CCICOUNT) Common disease names added to ICD-10 coding (e.g. chicken pox, measles) Values of the IDC-10 and CCI variables modified (punctuation added back) e.g ICD-10 code A0580 now is A05.80 Frequencies for ICD-10 and CCI variables provided

DLI DAD Sample Files Enhanced Data File Enhancements to address problems – Clinical and Geographic files String variables converted to code Value labels added

Questions