1. Discharge Abstract Database (DAD)
A collaboration between CIHI and DLI
November 2012

2. Canadian Institute for Health Information (CIHI) - Overview
Mandate: To provide accurate and timely information required for
Sound health policy
Effective management of the health system
Public awareness about factors affecting good health
27 databases of comparable health information
Health care services: primary health care, hospital care, specialized services, community and pharmaceutical care
Health spending: by geography and by category
Health workforce: physicians, nurses, and other health care providers

3. Collaboration between CIHI and Statistics Canada’s DLI
CIHI recently developed a Data Access Strategy
Purpose: To improve timeliness and accessibility of data to users such as system planners, policy makers, and researchers
Streamlining CIHI’s existing data dissemination channels
Exploring new, trusted data dissemination channels
Resulted in a collaboration with Statistics Canada to make CIHI data more accessible to academic researchers using the DLI
CIHI has provided Discharge Abstract Database (DAD) sample files to be part of the DLI collection, along with complete documentation, for a pilot project ending March 31st, 2014

4. Overview of the Discharge Abstract Database (DAD)

5. What is the DAD?
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.
Currently, more than 3 million records are submitted to DAD annually.
Data are received from all acute care facilities across Canada (except Quebec)
Select chronic care, rehabilitation, and psychiatric facilities also submit data to DAD.
Data from Quebec is submitted to CIHI directly by the ministère de la Santé et des Services sociaux (MSSS). This data is appended to the DAD to create the Hospital Morbidity Database (HMDB).

6. DAD data elements - Groups
Data elements are organized into the following groups:
Abstract Identification
Length of Stay
Patient Demographics
Admission Data
Discharge Data
Patient Service Information
Service Transfers
Provider Information
Diagnosis Information
Intervention Information …continued on next slide

7. DAD data elements - Groups
Special Care Information
Blood Information
Reproductive Care Information
Not all of this information is included in the DLI sample files

8. DAD - DLI sample files

9. Regarding DAD-DLI files
DAD coverage for acute inpatient care is virtually complete for Canada, except Quebec (80% of all inpatient discharges in Canada)
DAD data files for DLI include acute inpatient cases from all provinces/territories except Quebec and British Columbia
Files were designed to maintain a balance between patient privacy and usefulness of data
10% sample ensures privacy, but reduces richness of data files
Combining two years of data enhances richness
Two DAD-DLI files: one with more clinical detail, one with more geographic detail
Documentation accompany the data files

10. Patient-oriented Approach
Analysis potential is greater when the sequence of care for an individual can be followed over time
The DAD-DLI files allow this
Separate, non-overlapping 10% samples of persons were created for the ‘clinical’ and ‘geographic’ files
Then, all discharge records belonging to these patients over a two-year period were included in the DAD-DLI files

11. Longitudinal information
Dates are not provided in the files (privacy)
Temporality of events is provided by the number of days as of a reference date (day zero)
This reference date is specific to each person in the data files
The reference dates are between March 1, 2009 and March 31, 2009, and are randomly assigned to the selected individuals
All discharges in the 730-day period starting with the reference day are included in the files

12. Contents of files
To protect patient privacy, there is less clinical detail in the geographic file, and vice versa
Also, some variables are made available in ‘collapsed’ form:
Age
Length of stay
Newborn weight
Gestation weeks at delivery

13. Common data elements
Person identifier (meaningless except to identify discharge records for the same person within the files)
Facility province (territories are combined)
Discharge day (relative to reference day)
Admission day (relative to reference day), calculated using the collapsed total length of stay
Gender
Age group (newborn, less than 1 year, 1-7, 8-12, 13-17, 18-24, 25-29, 30-34, … 75-79, 80+ years)
Admission/discharge variables

14. Clinical detail file Clinical details:
Diagnoses(1-25): code(ICD-10-CA) and type
Interventions(1-20): code(CCI), status, location, anaesthetic
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, , , , , grams)
Gestation weeks at delivery: four categories (under 32, 32-33, 34-36, 37+ weeks)

15. Geographic detail 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)

16. What is case mix?
“Mix of patient’s detailed characteristics” that are important in terms of both treatment and resource use
Classification of patients (‘grouping’)
Each class is homogeneous, with
Clinical coherence
Similar health care resource use
Manageable number of classes
Based on commonly available and relevant data elements 16

17. Uses of a case mix system
Provides a classification of patients that can be useful for health care facility/system:
Planning and budgeting
Performance evaluation
Utilization management
Quality improvement
Health services research
Funding 17

18. Case Mix Groups (CMG+) CMG+ released in 2007
For acute care inpatients
The classification is based primarily on diagnoses and interventions
21 major clinical categories, 562 CMGs
Within a CMG, ‘factors’ let further patient specific characteristics affect predicted resource use
Resource use variables: Resource Intensity Weight (RIW) and Expected Length Of Stay (ELOS) 18

19. DAD-DLI file formats ASCII with fixed width columns (.dat) SPSS (.sav)
Total file size: 340 MB (.dat), 190 MB (.sav)

20. DAD Documentation for DLI
File specifications containing methodological notes
Record layouts with field description and values
Data quality documentation
DAD Abstracting Manual
International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Canada (ICD-10-CA)
Canadian Classification of Health Interventions (CCI)
CMG+ Directory 2011
Available in both English and French

21. For your information – Other ways of accessing data from CIHI

22. Option for accessing data from CIHI
CIHI website
Quick Stats and Analytic Reports
Free, pre-formatted, aggregate-level data
Customized data request
Aggregate-level
Record-level
CIHI has a Graduate Student Data Access Program

23. Graduate Student Data Access Program
CIHI provides data to qualifying graduate students at no cost through the GSDAP (please visit
Objectives:
To build the capacity of graduate students to undertake health service research; and
To increase awareness of CIHI and CIHI’s data holdings, and the importance of data quality and privacy, as graduate students pursue health services research careers
Criteria:
Data are to be used by the student to fulfill graduate requirements
The research project was reviewed by a research ethics board
The research project will support CIHI’s mandate

24. Customized requests Aggregate Groups or summaries of data
E.g. Counts, means, median
Data table
Small cell sizes may be suppressed (counts<5)
Person-level
De-identified data, limited to meeting the project’s needs
Each record refers to data from an individual, who may have more than one record in the database
Format (SAS, comma-delimited)

25. Process of accessing data from CIHI
Step 1: Determining your own data requirement
Are the data required available on CIHI website
If not, contact CIHI for a customized data request
Step 2: Your first contact with CIHI
Online Data Inquiry Form
Step 3: Initial Assessment of data request by appropriate CIHI staff based on the requirements provided on the inquiry form
Step 4: Further documentation (e.g., signed Request Form), Specifications approval, data extraction and verification, and data release
Note: all data from CIHI are released to the users as per CIHI Privacy Policy (available on CIHI website)

26. Service standard for custom data requests
Nature of the request
Aggregate-level data
Record-level data
Standard request
10 working days
20 working days
Complex request
40 working days
Very complex
To be negotiated with the client

27. For more information Please visit CIHI’s website at www.cihi.ca
If you would like more information about CIHI or DAD, please contact us via DLI

28. Any questions or comments?

29. Thank you!