1. 2018–2019 Changes for DAD and NACRS
Update on changes to data collection requirements
June 2017

2. Background
2018–2019 is a major change year in CIHI’s 3-year change cycle for the clinical administrative databases
Changes in the Discharge Abstract Database (DAD) and National Ambulatory Care Reporting System (NACRS) will be implemented in alignment with case mix and classifications (ICD-10-CA/CCI) changes
Changes selected for implementation are the culmination of an inclusive, consultative and considered process

3. High-level timelines and milestones
Milestone/task
Timeline
DAD and NACRS data collection and submission changes confirmed
October 2016
Preliminary vendor specs released (DAD and NACRS data changes only)
May 31, 2017
Vendor test system available (DAD and NACRS data element changes only)
August 31, 2017
Final vendor specs released (including classifications and case mix updates)
December 15, 2017
2018–2019 DAD and NACRS education products released
December to April 2018
Final DAD and NACRS systems available (including classifications and case mix updates) for vendor testing
February 1, 2018
2018–2019 DAD and NACRS manuals released
February 2018
v2018 ICD-10-CA/CCI Folio products released
2018–2019 DAD/CMG+ and NACRS/CACS systems go live
April 2018

4. DAD and NACRS changes

5. Improve care transitions data
Changes standardize codes and definitions across the DAD and NACRS, where applicable
Discharge Disposition
Added new codes to capture more details for Died (e.g., medical assistance in dying) and Leave (e.g., AWOL separate from left against medical advice)
Clarified definitions and aligned edits
Institution From/To numbers and types
Revised Institution and Analytic Institution Types with new categories and definitions to capture transitions to emerging post-acute care settings (e.g., hospice, community mental health, group living/supportive housing, transitional housing)
Revised and deleted hard edits to align with changes in institution types and definitions

6. New valid Visit Disposition legend
Category
Description
Code
Database
Transfer
Inpatient care 01
DAD and NACRS
ED and ambulatory 20
Residential care 30
Group/supportive living 40
Correctional facility 90
Home
Private home 05
Leave
AWOL or leave post-registration 61
LAMA or leave post–initial treatment 62
Left after triage 63
NACRS only
Left after initial assessment 64
Did not return from leave 65
DAD only
Died while on pass/leave 66
Suicide out of facility 67
Died
Death on arrival 71
Died in facility 72
MAID 73
Suicide in facility 74
Cadaveric Donor
Cadaveric donor 08
Stillbirth 09

7. New Institution Type legend
Category
Institution/Facility Type description
Code
Inpatient Care
Acute inpatient care 1
Inpatient rehabilitation 2
Inpatient CCC 3
Inpatient mental health 5
Inpatient palliative care 9
Sub-acute S
Residential Care
Nursing stations 6
Long-term care (24-hour nursing care) 4
Hospice/palliative care facility
P (new)
Mental health and/or addiction treatment centre
T (new)
Group living/supportive housing
G (new)
Transitional housing
H (new)
ED and Ambulatory Care
Day surgery A
Ambulatory care clinic N
Emergency department E
Community-Based Care
Community-based clinic
Home care program 8
Community mental health and addiction services M
Other
Other health facility
F (new)
Correctional facility C
Other non-health facility
J (new)
Unknown facility
U (new)

8. Improve care transitions data (cont’d)
Edit changes
If disposition is 01, 20, 30, 40 or 90 (i.e., transfer related), Institution To cannot be blank
If disposition is 05, Institution To must be blank or valid institution number with Institution Type From 8 (homecare), M (community mental health and addiction services), 0 (community- based clinic), F (other health facility), J (other non-health facility) or U (unknown facility)
Current edits with death codes updated to include new range of death dispositions
Next steps
Finalize list of visit dispositions and valid institution numbers including generic and institution type listing
Incorporate resources for data providers and users in manual; map between old and new codes; map local services to national institution types with generic numbers (September)

9. Improve mental health data
New data elements (DAD and NACRS)
Legal Status Upon Arrival to ED
Type of Restraint
Frequency of Restraint Use
New data elements (DAD only)
Legal Status at Admission
Data elements kept (DAD)
Change in Legal Status From Admission
Previous Psychiatric Admissions
Number of ECT Treatments
Added new and deleted existing hard edits to align with reporting changes
DAD: Retired Group 15 data elements
Source of Referral
Method of Admission
AWOL
Suicide
Referred To
ECT Treatment
Education
Employment Status
Financial Support
Mental Health flag retired from Facility Institution File

10. Group 15: DAD abstract layout
Change from
Source of Referral
Method of Admission
Change in Legal Status From Admission
AWOL
Suicide
Previous Psychiatric Admission
Referred To 02 03 04 05 06 07 08
ECT Treatment
Number of ECT Treatments
Education
Employment Status
Financial Support 09 1 12 13 14
Change to
Change in Legal Status From Admission
Previous Psychiatric Admission
Number of ECT Treatments
Legal Status Upon Arrival to ED
Legal Status at Admission
Type of Restraint
Frequency of Restraint 04 07 1 5 6 17 8 2 3 4

11. Legal Status Upon Arrival to ED and at Admission
Code
Definition
Upon Arrival to ED
At Admission 10
Voluntary
DAD only 20
Involuntary psychiatric assessment
n/a 30
Orders for assessment/apprehension
DAD and NACRS 39
Community treatment order (CTO) 40
Drug treatment court 50
Forensic admission 60
Consent to admission 70
Inmates 80
Other 99
Unknown

12. Type and Frequency of Restraint Use
Type of Restraint M
Mechanical restraint C
Chair P
Physical or manual restraint by staff S
Seclusion room N
None
Frequency of Restraint Use
Constant D
Day or night only I
Intermittent — used occasionally U
Frequency of use unknown/not documented

13. Improve mental health data (cont’d)
Edit changes
To ensure new data reported for acute and psych submitting institutions for records with Main Patient Service or Transfer Service of 64/65
Legal Status on Arrival to ED (for all provinces/territories except Ontario, Alberta and Yukon)
Legal Status Upon Admission
Type and Frequency of Restraint Use
New data elements will be validated against corresponding valid values
Multiple occurrences of Type and Frequency applied for consistency across restraint use fields (e.g., if “N — None” reported for Type, frequency is also “N — None”)
Next steps
Update manuals with definitions and province-/territory-specific mapping to local terms
Confirm mental health and addiction patient definition to be used for monitoring coverage of new fields in the DAD and NACRS

14. Updated Blood Transfusion Products list
New blood products
Cryoprecipitate plasma
Cryosupernatant plasma
Intravenous/subcutaneous immune globulin (IVIG/SCIG)
Fibrinogen
Prothrombin complex concentrate (PCC)
Anti-inhibitor coagulant (FEIBA)
Antithrombin III
C1 inhibitor
Protein C/other factors
Plasma renamed Plasma — other and unspecified
Standardized edit across provinces/territories to allow mandatory collection of Blood Transfusion Indicator for acute care records (excluding stillborn and cadavers)
Rationale
Blood Transfusion Indicator data is integral to the calculation of the Hospital Harm indicator
Comprehensive and current product listing

15. Implement open-year quality checks in edits
DAD
Incorporated current open-year quality tests into new hard edits and data quality warning messages to promote high-quality data collection in the following areas
Diagnosis typing
Interventions and attributes
Diagnosis codes that require other codes to describe complications or external causes
Project 340 Canadian Stroke Strategy Performance Improvement dates/times
NACRS
Implemented new core hard edit and data quality warning messages to enforce correct date/time recording in Project 340 Canadian Stroke Strategy

16. Streamlined DAD and NACRS data collection
Retire poorly used data elements to reduce burden of data collection
No changes to submission layout to minimize system change impacts
DAD: Retired data elements
Group 01 Field 11 Second Chart or Register Number
Group 07 Field 04 Abstract Overflow
Group 10 Fields 05–11 Cancer Staging
Group 11 Field 08 Tissue Code
NACRS: Retired data elements
15 Ambulance Call Number
16 Living Arrangement
17 Residence Type
19 Ambulatory Visit Status
64–68 Units Transfused
104 Referral Date (from ED)
118, 119 Ambulance Arrival Date and Time (from day surgery and clinic care types)
120, 121 Ambulance Transfer of Care Process Date and Time (from day surgery and clinic care types)
Special Project 280 (Cancer staging)

17. DAD-only changes

18. Capture Canadian Joint Replacement Registry (CJRR) data
Change summary: Created new data elements to enable capture of CJRR data
Added new Group 20 Hip and Knee Prosthesis Information (CJRR)
New CJRR data elements to capture joint identifier, side, cement and component information, including manufacturer, product number and lot number (11 elements in total, multiple occurrences)
Capture up to 2 joint replacement interventions per abstract within defined CCI codes
Use of a barcode scanner strongly recommended to capture prosthesis information
Added 2 new data elements in Group 11 Intervention Information
Field 22 Intervention Joint Identifier and Field 23 Revision Reason added to link CJRR-specific interventions to the corresponding Group 20 prosthesis information
For all DAD abstracts: Added 2 new data elements in Group 03 Patient Demographics
Field 28 Height (optional) to collect height in centimetres
Field 29 Weight to collect data in kilograms for all patients; optional for adults; mandatory for newborns and neonates, replacing former Group 07 Field 03 Weight (in grams)
Rationale
Enable jurisdictions to submit CJRR information as part of hospitalization record, as an alternative to continuing to submit to the separate CJRR database (Note: CJRR web tool to be decommissioned)

19. Gestational age on all stillbirth records
Change summary
Implemented mandatory collection of gestational age on stillborn abstracts by adding new edit and revising existing edits
Rationale
Improves accuracy and completeness of valuable obstetrics information

20. Improve obstetrics information
Maternal morbidity: Capture appropriate I-code(s) in addition to the code O99.4 for all obstetric admissions for specific complication conditions
New edits enforcing recording of ICD-10-CA complication code when – series is recorded on the DAD abstract
Rationale
Ensure proper coding of pregnancy-related complication(s) and provide additional valuable obstetrics information

21. Improve SCU Admit Date/Time
New edits to ensure SCU Admit Date/Time is the same or after Date/Time Patient Left ED
Hard error: If SCU Admit Date/Time (first occurrence) are both coded and valid and Date/Time Patient Left ED are both coded and valid, and SCU Admit Time and Time Patient Left ED are both not 9999, then SCU Admit Date/Time (first occurrence) must be greater than or equal to Date/Time Patient Left ED
Date/Time Patient Left ED will be changed to Z in cases of hard error

22. Remove Nova Scotia Special Project 308
Change summary
Retired Special Project 308 (Psychiatric Information, Adult Protection Act) and all related edits
Rationale
The Nova Scotia ministry has confirmed that this project has been discontinued

23. NACRS-only changes

24. Emergency Department Intervention Pick-List
Change summary
Created 3 new data elements in NACRS for ED Level 2 submissions
173a–c ED Intervention Pick-List
174a–c ED Investigative Technology
175a–c Number of ED Investigative Technologies Performed
Added new hard edits to validate new ED intervention data elements
Rationale
Enables assignment of Case Mix Groups and Resource Intensity Weights for ED Level 2 submissions

25. Vendor engagement
Vendor specifications

26. Vendor engagement
CIHI has a broad, organizational vendor engagement strategy
Vendors want to be more responsive, provide good service and be efficient
Vendors want to collaborate and have a role to play in DAD and NACRS data submission and use
Starting with 2018–2019 data collection changes, CIHI will augment vendor data submission/edit specifications with recommended use cases and functionality (e.g., capture of weight fields, implementation of pick-list data, special project fields)
CIHI will meet with vendors to explore other common features designed to enhance user experience in data submission and to increase data quality