Bulletin | February 28, 2017
Introduction
Every 3 years, changes are applied to the Discharge Abstract Database (DAD) and to the National Ambulatory
Care Reporting System (NACRS) database to meet emerging information needs identified by stakeholder
requests and to improve the quality and utility of data collected. The Clinical Administrative Databases (CAD)
team at the Canadian Institute for Health Information (CIHI) has prepared this document to highlight confirmed
changes related to DAD and NACRS data collection for 2018–2019.
This document will enable clients to begin preparing for data collection and supporting system changes that
take effect as of April 1, 2018. It does not include changes required to align with v2018 ICD-10-CA/CCI,
changes in case mix (CMG+/CACS) or changes to reports from CIHI that will be available by fall 2017.
List of changes
DAD and NACRS changes ................................................................................................................................ 2
1.
Standardize and improve care transitions data ....................................................................................... 2
2.
Improve mental health data ..................................................................................................................... 2
3.
Improve Blood Transfusion Indicator/products list ................................................................................... 3
4.
Implement open-year quality checks in edits ........................................................................................... 4
5.
Streamline DAD and NACRS data collection .......................................................................................... 5
NACRS-only changes ........................................................................................................................................ 5
6.
Emergency department intervention pick-list ........................................................................................... 5
DAD-only changes............................................................................................................................................. 6
7.
Capture Canadian Joint Replacement Registry (CJRR) data .................................................................. 6
8.
Gestational age on all stillbirth records.................................................................................................... 6
9.
Remove Nova Scotia Special Project 308 ............................................................................................... 7
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DAD and NACRS changes
1. Standardize and improve care transitions data
Change summary:
Standardized disposition codes across DAD and NACRS and 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).
Revised CIHI-assigned Institution Type and Analytic Institution Type 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).
DAD:
Group 05 Field 05 Discharge Disposition — Revised and clarified definitions and
aligned hard edits.
Group 04 Field 04 Institution From and Group 05 Field 04 Institution To — Added,
revised and deleted hard edits to align with changes in institution types and definition.
NACRS:
35 Visit Disposition — Changed valid codes and definitions to align with the DAD and
revised hard errors accordingly.
32 Institution From and 39 Institution To — Revised and deleted hard edits to align
with new valid types.
Rationale:
Closes current data gaps on transitions between care settings.
2. Improve mental health data
Change summary:
Improved data available on use of restraints and legal status of mental
health patients.
DAD:
Retired following data elements
•
Group 15 Field 02 Source of Referral
•
Group 15 Field 03 Method of Admission (replaced by new data element)
•
Group 15 Field 05 AWOL (replaced by new code in disposition)
•
Group 15 Field 06 Suicide (replaced by added detail in disposition)
•
Group 15 Field 08 Referred To
•
Group 15 Field 09 ECT Treatment
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•
Group 15 Field 12 Education
•
Group 15 Field 13 Employment Status
•
Group 15 Field 14 Financial Support
Added following new data elements
•
Group 15 Field 15 Legal Status Upon Arrival to ED (Emergency Department)
•
Group 15 Field 16 Legal Status at Admission
•
Group 15 Field 17 Type of Restraint
•
Group 15 Field 18 Frequency of Restraint Use
Retired Mental Health Flag from the Facility Institution File.
Added new and deleted existing hard edits to align with reporting changes.
NACRS:
Added the following new data elements
•
170 Legal Status Upon Arrival to ED
•
171a–d Type of Restraint
•
172a–d Frequency of Restraint Use
Added new hard edits to confirm use of valid codes.
Rationale:
Responds to priority information needs for mental health related to access,
quality and patient safety.
3. Improve Blood Transfusion Indicator/products list
Change summary:
Added new DAD/NACRS data elements
•
DAD Group 17 Field 08/NACRS 177 Cryoprecipitate Plasma
•
DAD Group 17 Field 09/NACRS 178 Cryosupernatant Plasma
•
DAD Group 17 Field 10/NACRS 179 Intravenous/Subcutaneous Immune
Globulin (IVIG/SCIG)
•
DAD Group 17 Field 11/NACRS 180 Fibrinogen
•
DAD Group 17 Field 12/NACRS 181 Prothrombin Complex Concentrate (PCC)
•
DAD Group 17 Field 13/NACRS 182 Anti-Inhibitor Coagulant (FEIBA)
•
DAD Group 17 Field 14/NACRS 183 Antithrombin III
•
DAD Group 17 Field 15/NACRS 184 C1 Inhibitor
•
DAD Group 17 Field 16/NACRS 185 Protein C/Other Factors
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The following DAD/NACRS data elements have been renamed
•
DAD Group 17 Field 04/NACRS 60 Plasma renamed as Plasma —
Other and Unspecified
Added new edits and revised existing edits to enforce mandatory collection of
Blood Transfusion Indicator and accurate recording of new data elements.
Rationale:
Blood Transfusion Indicator data is integral to the calculation of the Hospital
Harm indicator.
Blood product listing has been made more comprehensive and current.
4. Implement open-year quality checks in edits
Change summary:
Implement current open-year data quality tests as edits or warnings
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;
•
SCU Admit Date/Time consistent with Patient Left ED Date/Time;
•
Proper coding of pregnancy-related complication(s) when ICD-10-CA code
O99– (indicating maternal complications) is coded; and
•
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.
Rationale:
Reduces burden of data correction, while promoting collection of high-quality data.
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5. Streamline DAD and NACRS data collection
Change summary:
Retire poorly used data elements without changes to submission layout to minimize
system change impacts.
DAD:
Retired the following data elements
NACRS:
Rationale:
•
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
Retired the following data elements
•
15 Ambulance Call Number
•
16 Living Arrangement
•
17 Residence Type
•
19 Ambulatory Visit Status
•
64, 65, 66, 67, 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)
Reduces data collection burden for reporting facilities.
NACRS-only changes
6. 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 group and Resource Intensity Weights for ED
Level 2 submissions.
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DAD-only changes
7. Capture Canadian Joint Replacement Registry
(CJRR) data
Change summary:
Created new data elements to enable capture of CJRR data
•
•
Added 2 new data elements in Group 03 Patient Demographics
-
Added optional new Field 28 Height to collect height in centimetres.
-
Added new Field 29 Weight added to collect data in kilograms for all patients.
Optional data for adults. This data element, which is mandatory to report for
newborns and neonates, replaces former Group 07 Field 03 Weight (in grams
for newborns and neonates).
Added 2 new data elements in Group 11 Intervention Information
-
•
Rationale:
Added new Group 11 Field 22 Intervention Joint Identifier and Field 23 Revision
Reason to link CJRR-specific interventions to the corresponding Group 20
prosthesis information.
Added Group 20 Hip and Knee Prosthesis Information (CJRR)
-
Added new group of 9 CJRR data elements (multiple occurrences) to capture
joint identifier, side, cement and component information, including manufacturer,
product number and lot number.
-
This group of data elements captures prosthesis information for up to 2 hip and
knee joint replacement interventions.
-
Clients currently capturing prosthesis information using a barcode scanner
should continue this practice.
Reduces duplicate data collection in registry while building capacity for future capture of
other prosthesis/medical device information.
8. 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.
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9. 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.
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