IntelliHEALTH Reporting Everything you always wanted to know about reporting external cause data (but didn t know what to ask) September 21, 2010 Presented to: APHEO Workshop Presented by: JoAnn Heale
Topics Ontario Public Health Standards and external cause of injury External cause of injury vs. nature of injury Data sources to use in intellihealth Avoiding the perils of reporting from multirecord per event sources Example: motor vehicle collision & seatbelt use Your turn now what do you want to know??? Health Analytics Branch, MOHLTC APHEO Workshop 2010: intellihealth - Reporting External Cause of Injury 2
Ontario Public Health Standards and External Causes Prevention of Injury and Substance Misuse Requirement 1. The board of health shall conduct epidemiological analysis of surveillance data, including monitoring trends over time, emerging trends, and priority populations, in accordance with the Population Health Assessment and Surveillance Protocol, 2008 (or as current), in the areas of: Alcohol and other substances (DAD, NACRS 1 ) Falls across the lifespan (Vital Stats, DAD, NACRS 1 ) Road and off-road safety (Vital Stats, DAD, NACRS 1 ) Other areas of public health importance for the prevention of injuries (Vital Stats, DAD, NACRS 1 ) 1 DAD Discharge Abstract Database (Inpatient Discharges); NACRS National Ambulatory Care Reporting System (Ambulatory Visits) Health Analytics Branch, MOHLTC APHEO Workshop 2010: intellihealth - Reporting External Cause of Injury 3
Diagnoses (Dx) for Nature of Injury vs. External Cause Nature of Injury (e.g. head injury) ICD9 Chapter XVII (17) ICD10 Chapter XIX (19) ICD9 Codes 800-999 ICD10 Codes S0-T99 External Cause (e.g. motor vehicle crash) ICD9 Chapter XIX (19) ICD10 Chapter XX (20) ICD9 E-Codes E800-E999 ICD10 Codes V0-Y99 Can be EITHER MRDx 1 or All Dx 1 Can ONLY be All Dx 1, NOT MRDx 1 This means that external causes (All Dx) are only included in data sources with multiple diagnosis records per event. 1 MRDx most responsible (DAD), or main problem (NACRS); All Dx any diagnosis reported for the event (there can be 20+ diagnoses reported per inpatient discharge or ambulatory visit) Health Analytics Branch, MOHLTC APHEO Workshop 2010: intellihealth - Reporting External Cause of Injury 4
External Cause Dx in Intellihealth Data Sources Nature of Injury (e.g. head injury) Inpatient data - INCLUDED in ICD10 Blocks & Lead Cause Groups (ISHMT) Ambulatory data - INCLUDED in ICD10 Blocks & Lead Cause Groups (ISHMT) Deaths Available for ICD9; NOT AVAILABLE for ICD10 (i.e. > 1999) Home Care uses ICD9 codes External Cause (e.g. motor vehicle crash) Inpatient data INCLUDED in ICD10 Blocks; EXCLUDED from Lead Cause Ambulatory data INCLUDED in ICD10 Blocks; EXCLUDED from Lead Cause Deaths 1 AVAILABLE for all years NOT AVAILABLE 1 Cause of death data are only available up to 2005 (calendar year). These data have been requested from Statistics Canada, as have the nature of injury data (beginning in 2000). Health Analytics Branch, MOHLTC APHEO Workshop 2010: intellihealth - Reporting External Cause of Injury 5
Groupings in inpatient, ambulatory data: ICD 10 Blocks for Nature of Injury Health Analytics Branch, MOHLTC APHEO Workshop 2010: intellihealth - Reporting External Cause of Injury 6
Groupings in inpatient, ambulatory data: ICD10 Blocks for External Causes These blocks are not included in external cause of injury analysis. Health Analytics Branch, MOHLTC APHEO Workshop 2010: intellihealth - Reporting External Cause of Injury 7
Groupings for external cause in Death source 1 These groupings are from Becker, et al., WHO, 2005, with modifications by the Core Indicators Working Group of APHEO (indicated by APHEO in the descriptions). Link to WHO Bulletin article: http://www.who.int/bulletin/volumes/84/4/297.pdf Health Analytics Branch, MOHLTC APHEO Workshop 2010: intellihealth - Reporting External Cause of Injury 8
intellihealth Data Sources for reporting External Causes Inpatient Diagnosis & External Cause (and interim source) Inpatient Discharge All Tables (and interim source) Ambulatory All Visit Problem (Dx) & External Cause (and interim source) Ambulatory All Visit All Tables (and interim source) AM ED External Cause Summary PHU CYear Death Death Summary Home Care (HCD) Diagnosis Continuum of Care data sources Since all these sources can have multiple records per health care event, e.g. emergency visits, usually distinct counts should be used. Health Analytics Branch, MOHLTC APHEO Workshop 2010: intellihealth - Reporting External Cause of Injury 9
The Perils of Reporting from Multi-record per Event Sources E.g. Data for a patient hospitalized twice in one fiscal year: once with a MRDx of fracture of the femur, with a fall and a MVC also reported; once with a MRDx of head injury, two different fall diagnoses also reported. Health Number DAD Key Sex Age ICD10 MRDx All Dx Type ICD10 All Dx # Diagnosis Records ext. cause # Distinct Discharges - ext. cause AAAAAA xxxxxx F 70 S70 M S70 1 1 AAAAAA xxxxxx F 70 S70 9 W01 1 1 AAAAAA xxxxxx F 70 S70 1 V01 1 1 AAAAAA yyyyyy F 70 S09 M S09 1 1 AAAAAA yyyyyy F 70 S09 9 W01 1 1 AAAAAA yyyyyy F 70 S09 1 W03 1 1 External Cause Totals 6 6 Health Analytics Branch, MOHLTC APHEO Workshop 2010: intellihealth - Reporting External Cause of Injury 10
Exporting record level data from multi-record sources From previous example: Exporting and summing the distinct discharges column, results in the following incorrect totals: 6 discharges with an external cause of injury (there are only 2) 6 discharges for 70-year-old women (there is only 1) 3 discharges with a fall reported (there are only 2) 3 discharges with a hip fracture (there is only 1) 3 discharges with a head injury (there is only 1) Health Analytics Branch, MOHLTC APHEO Workshop 2010: intellihealth - Reporting External Cause of Injury 11
General tips for multi-record per event sources: To avoid counting errors: Group data at as high a level as possible, e.g. external cause blocks Hide items that result in counting multiple records per event, e.g. ICD 10 Codes Insert a text box with the dynamic distinct count item to give the correct count to use as a denominator To improve speed when reporting: Create separate sections in your report (e.g. seatbelt use in car crashes) Use predefined filters wherever possible (i.e. ICD10 All Dx Block) Use fiscal year (FYear) rather than calendar year (CYear) Schedule your report to run at night then it will run quickly the next time you run it Filter for the injury ICD10 blocks for the main problem or most responsible diagnosis Only include one report object (e.g. table or chart) on a report page Health Analytics Branch, MOHLTC APHEO Workshop 2010: intellihealth - Reporting External Cause of Injury 12
Is a distinct count measure always required? No If you are downloading data with one record per discharge, e.g. DAD key, patient PHU, patient age, sex, external cause block: You can use the # prob/dx measure, then add a column for # discharges (always 1) in your exported data (or count DAD keys) Note that downloading record level data could exceed the limits of your system, e.g. the 65,000 row limit in Excel If the distinct count is the same as the Dx count, e.g. some external causes will only be reported once per inpatient discharge: You can use the # prob/dx measure and it will be correct This usually doesn t apply to Falls, i.e. even for emergency visits there can be multiple falls diagnoses reported (see next slide) even with falls it would result in ~ 1% overcounting With simple counts (e.g. # prob/dx) crosstab or list reports can be created With distinct counts (e.g. # visits (D)) only list reports can be created Health Analytics Branch, MOHLTC APHEO Workshop 2010: intellihealth - Reporting External Cause of Injury 13
Number of diagnoses and visits, by external cause block Ontario emergency, 2009 (interim data) Total # visits = 1,247,580 Total # diagnoses = 1,260,838 For each of the external clause of injury blocks, there is 0 or < 1 % difference between the number of diagnoses and number of visits Note: these data exclude transfers from other institutions including nursing homes or homes for the aged. Health Analytics Branch, MOHLTC APHEO Workshop 2010: intellihealth - Reporting External Cause of Injury 14
Example external cause report seat belt use by motor vehicle occupants with neurotrauma Health Analytics Branch, MOHLTC APHEO Workshop 2010: intellihealth - Reporting External Cause of Injury 15
To filter for MV occupants, multiple ICD10 All Dx Code data items are required: Health Analytics Branch, MOHLTC APHEO Workshop 2010: intellihealth - Reporting External Cause of Injury 16
Advance combination filter is required: General Filters: FYear equal to 2008.0 AND ( AM Case Type equal to 'EMG' AND Patient Province equal to 'ON AND Age Group Type (pick ONE) equal to 10 YEAR AGE GROUPS, HEALTH STATUS REPORTING (00-09, 10-19, 20-29,...,70-79, 80+) AND Filter for motor vehicle occupants: ( ( ICD10 Block V30-V79 equal to V30-V39, V40-V49, V50-V59, V60-V69, V70-V79 AND ( ICD10.4 matches pattern 4 OR ICD10.5 matches pattern 5 OR ICD10.6 matches pattern 6 OR ICD10.7 matches pattern 7 OR ICD10.8 matches pattern 8 OR ICD10.9 matches pattern 9 ) ) OR ICD10 other MVC 4 char equal to V811, V821, V830, V831, V832, V833, V840, V841, V842, V843, V850, V851, V852, V853, V860, V861, V862, V863 ) AND Filter for neurotrauma: ( ICD10 (3 char) Main Dx Code ONLY equal to S06 OR ICD10-CA Main Dx Code ONLY equal to S1410, S1411, S1412, S1413, S1418, S1419, S2412, S2413, S2418, S2419, S2410, S2411, S3410, S3411, S3412, S3413, S3418, S3419, S3430, S3438 OR ICD10 (4 char) Main Dx Code ONLY equal to S020, S021, S023, S027, S028, S029, T902, T905, F072, S071, S140, S240, S340, T060, T061 ) ) Health Analytics Branch, MOHLTC APHEO Workshop 2010: intellihealth - Reporting External Cause of Injury 17
Example report for MVC and seatbelt use Hide all the MV occupant data items Health Analytics Branch, MOHLTC APHEO Workshop 2010: intellihealth - Reporting External Cause of Injury 18
And now, your turn. Presenter Contact Info: Joann.heale@ontario.ca 416-212-4362 General IntelliHEALTH queries should be e-mailed to: intellihealthontario@ontario.ca Health Analytics Branch, Analytic MOHLTCReports & Tools Unit APHEO Workshop 2010: intellihealth - Reporting External Cause of Injury 19