DAD Research Analytic Files

1. DAD Research Analytic Files A collaboration between CIHI and Statistics Canada’s Data Liberation Initiative (DLI) April 2013

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 and to increase public awareness about factors affecting good health • 27 databases of linkable 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 Data Liberation Initiative (DLI) CIHI’s Data Access Strategy • Purpose: To improve timeliness and accessibility of data to users such as system planners, policy makers, and researchers by • Streamlining CIHI’s existing data dissemination channels • Exploring new, trusted data dissemination channels • Collaboration with Statistics Canada to make CIHI data more accessible to academic researchers using the DLI • Pilot project ending March 31 2014: provide CIHI data to be part of the DLI collection, along with complete documentation

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/territories capture day surgery. • More than 3 million records submitted to DAD annually • Data are received from all acute care facilities across Canada (except Quebec: data received from Quebec ministry of health added to a different database: Hospital Morbidity Database (HMDB) • Select chronic care, rehabilitation, and psychiatric facilities also submit data to DAD.

6. DAD data elements • Some DAD data elements groupings: • Length of hospital stay • Patient demographics (age, gender, province of residence,…) • Admission and discharge information • Patient services while in hospital • Service provider information • Diagnosis, special care and intervention information Only select data elements from the above are included in the DAD DLI Sample Files.

7. DAD Sample Files in the DLI

8. Facts about the DAD DLI Sample Files • DAD sample data files for the DLI include acute inpatient cases from all provinces/territories except Quebec and British Columbia • Files are designed to maintain balance between patient privacy and usefulness of data • 10% sample ensures privacy, and combining two years of data enhances richness • 2 DAD-DLI files: one with more clinical detail, one with more geographic detail • Documentation accompanies the data files

9. DAD’s Patient-oriented Approach • DAD-DLI sample files allow for greater analysis potential when the sequence of care for an individual can be followed over time • All discharge records belonging to these patients over a two-year period are included in the DAD-DLI files • Separate, non-overlapping 10% samples of persons are created for the ‘clinical’ and ‘geographic’ files

10. Contents of DAD DLI Sample Files • To protect patient privacy: • Less clinical detail in the geographic file • Less geographic detail in the clinical file • Collapsed data for privacy protection • Age in years (not birth date) • Length of stay (in days not date of stays) • Newborn weights by size groupings • Gestation weeks at delivery in four categories

11. Common DAD DLI Sample Data Elements • Person identifier (meaningless except to identify discharge records for the same person within the files) • Facility province (territories are combined) • Discharge information (relative to reference date) • Admission information (relative to confidential reference day based on collapsed total length of stay • Gender • Age groups (newborn, less than 1 year, 1-7, 8-12, etc.) • Admission/discharge information

12. Clinical detail file (DAD DLI Sample File) • Clinical details: • Diagnoses based on ICD–CA classification codes and type • Interventions: CCI codes, type, status, location, anaesthetic techniques • Special care unit visits: type/number and hours • Length of stay in days • Newborn weights by size groupings • Gestation weeks at delivery in four categories

13. Geographic detail file (DAD DLI Sample File) • Health Region • Resource Utilization by diagnosis and use of health care services • Length of Stay: three categories (0, 1-2, 3+ days)

14. Documentation for DAD DLI Sample Files • File specifications containing methodological notes • Data layout with definitions 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

15. Key Uses of the DAD DLI Sample Files • Researchers can become familiar with the structure and content of data • Researchers can explore relationships among data elements (e.g. diagnoses and interventions) • Researchers can perform preliminary analyses and data mining, and test hypotheses Provides researchers with an opportunity to work with the data and clarify data requirements before making a formal data request to CIHI

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

17. Accessing data from CIHI • CIHI website • Free, pre-formatted, aggregate-level data including “Quick Stats” (data tables) and Analytic Reports • Customized data requests • Aggregate-level • Record-level • Graduate Student Data Access Program

18. Graduate Student Data Access Program • CIHI provides data to qualifying graduate students at no cost through the GSDAP (please visit www.CIHI.ca) • 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 used by the student to fulfill graduate requirements • The research project was reviewed by a research ethics boardand will support CIHI’s mandate

19. Customized Data 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 on patients, who may have more than one record in the database • De-identified data limited to meeting the project’s needs • Format (SAS, comma-delimited)

20. Accessing data from CIHI 1) Determining your own data requirement • Are the data required available elsewhere on CIHI website?If not, contact CIHI for a customized data request 2) Contact CIHI • Complete Online Data Inquiry Form 3) CIHI’s initial assessment of data request • Forwarded to appropriate database area and request evaluated based on the requirements provided on the form 4) Further documentation • 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)

21. Service Standard for Custom Data Requests

22. For more information • Explore CIHI’s website at www.cihi.ca for existing sources of data and information • For more information on the STC-DLI, please contact Statistics Canada at dli-idd@statcan.gc.ca