2018–2019 Changes for DAD and NACRS
Update on changes to data collection requirements
Canadian Institute for Health Information
June 2017
cihi.ca
@cihi_icis
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
2
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 2017
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
February 2018
2018–2019 DAD/CMG+ and NACRS/CACS systems go live
3
April 2018
DAD and NACRS changes
4
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
5
New valid Visit Disposition legend
Category
Transfer
Home
Leave
Died
Cadaveric Donor
Stillbirth
Description
Inpatient care
ED and ambulatory
Residential care
Group/supportive living
Correctional facility
Private home
AWOL or leave post-registration
LAMA or leave post–initial treatment
Left after triage
Left after initial assessment
Code
01
20
30
40
90
05
61
62
63
64
Database
DAD and NACRS
DAD and NACRS
DAD and NACRS
DAD and NACRS
DAD and NACRS
DAD and NACRS
DAD and NACRS
DAD and NACRS
NACRS only
NACRS only
Did not return from leave
65
DAD only
Died while on pass/leave
66
DAD only
Suicide out of facility
67
DAD only
Death on arrival
Died in facility
71
72
NACRS only
DAD and NACRS
MAID
Suicide in facility
Cadaveric donor
Stillbirth
73
74
08
09
DAD and NACRS
DAD and NACRS
DAD only
DAD only
6
New Institution Type legend
Category
Inpatient Care
Institution/Facility Type description
Acute inpatient care
Inpatient rehabilitation
Inpatient CCC
Inpatient mental health
Inpatient palliative care
Sub-acute
Residential Care
Nursing stations
Long-term care (24-hour nursing care)
Hospice/palliative care facility
Mental health and/or addiction treatment centre
Group living/supportive housing
Transitional housing
ED and Ambulatory Care Day surgery
Ambulatory care clinic
Emergency department
Community-Based Care Community-based clinic
Home care program
Community mental health and addiction services
Other
Other health facility
Correctional facility
Other non-health facility
Unknown facility
7
Code
1
2
3
5
9
S
6
4
P (new)
T (new)
G (new)
H (new)
A
N
E
0
8
M
F (new)
C
J (new)
U (new)
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 (communitybased 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)
8
Improve mental health data
• New data elements (DAD and NACRS)
• DAD: Retired Group 15 data elements
‒ 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
9
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
Group 15: DAD abstract layout
Change from
Source of
Referral
Method of
Admission
Change in Legal
Status From
Admission
AWOL
Suicide
02
03
04
05
06
ECT
Treatment
Number of ECT
Treatments
09
1
Previous
Psychiatric
Admission
Referred
To
07
08
Employment
Status
Education
0
12
Financial
Support
13
14
Change to
Change in Legal Status From
Admission
04
Previous
Psychiatric
Admission
Number of
ECT
Treatments
Legal Status Upon
Arrival to ED
Legal Status
at Admission
07
1
1
1
0
10
5
6
Type of
Restraint
1
17
Frequency of
Restraint
1
2
2
3
3
4
4
1
8
Legal Status Upon Arrival to ED and at Admission
Code Definition
Upon Arrival to ED At Admission
10
Voluntary
DAD only
DAD only
20
Involuntary psychiatric assessment
n/a
DAD only
30
Orders for assessment/apprehension
DAD and NACRS
n/a
39
Community treatment order (CTO)
DAD and NACRS
n/a
40
Drug treatment court
DAD and NACRS
DAD only
50
Forensic admission
DAD and NACRS
DAD only
60
Consent to admission
DAD and NACRS
DAD only
70
Inmates
DAD and NACRS
DAD only
80
Other
DAD and NACRS
DAD only
99
Unknown
DAD only
DAD only
11
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
C
Constant
D
Day or night only
I
Intermittent — used occasionally
U
Frequency of use unknown/not documented
N
None
12
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
13
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
14
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
15
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
NACRS: 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
•
•
•
•
•
•
•
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)
16
DAD-only changes
17
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)
18
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
19
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
099.– series is recorded on the DAD abstract
• Rationale
‒ Ensure proper coding of pregnancy-related complication(s) and provide
additional valuable obstetrics information
20
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
21
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
22
NACRS-only changes
23
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
24
Vendor engagement
Vendor specifications
25
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
26
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@cihi_icis