DATA SET: DISCHARGE ABSTRACT DATABASE (HOSPITAL SEPARATIONS FILE)

Date Range: April 1, 1985 onwards (fiscal year)

Data Source: BC Ministry of Health Services

Description

Data on discharges, transfers and deaths of in-patients and day surgery patients from acute care hospitals in BC.

All Canadian hospitals (except those in Quebec) submit their separations records directly to the Canadian Institute of Health information (CIHI) for inclusion in the Discharge Abstract Database (DAD). The database contains demographic, administrative and clinical data for hospital discharges (inpatient acute, chronic, rehabilitation) and day surgeries. A provincial dataset, including various CIHI value-added elements (such as case mix groups, and resource intensity weights) is released on a monthly basis to the respective Ministries of Health. The DAD data files which Population Data BC receives include the CIHI variables. Population Data BC receives these data once per year.

Inclusions

Discharges, transfers and deaths of in-patients and day surgery patients (e.g. those undergoing scope procedures, cataract procedures, or other procedures requiring operating room time) from acute care hospitals.
Data on BC residents who are admitted to a hospital in another province or territory are included in the DAD data. Also included in the data files are data on non-BC residents who are admitted to a BC hospital, however these data are usually excluded from extractions for research projects.
The data include some records indicating the level of care is "extended". For the most part, these records refer to people who are in long-term care facilities that are attached to an acute care facility and should be excluded from analyses.

Exclusions

Abortion procedures, including those conducted in concert with other procedures, are unavailable from all applicable files. This is in accordance with the BC Freedom of Information and Protection of Privacy Act article 22.1. > more details
Visits to emergency rooms/departments are not recorded in the hospital files, though admissions to acute care via the emergency room are noted in the "entry code" field. The report by McKendry et al, 2002 provides more information on various methods for identifying emergency users.
Outpatient services like x-rays or blood work are not included in the hospital data.

Data Changes Over Time

Beginning in 1996/97, the mother's personal health number (PHN) was recorded on a baby's discharge record, so it became possible to link mothers and babies in the hospital files.
The format of the data changed significantly in 2001/02. Part of this change was due to the switch in BC from coding diagnoses in ICD9 codes to ICD10-CA codes, and from coding procedures/interventions in CCP procedure codes to CCI intervention codes. Beginning in 2001/02, some of the data fields have different names but the same meaning, and some fields may have the same name but contain subtly different data. Population Data BC has standardized the data fields and names across the years where possible.
From 2001/02 to 2006/07, i.e. until all provinces in Canada were coding in ICD10-CA and CCI, CIHI was providing both the originally coded diagnosis codes and intervention codes (i.e. ICD10-CA and CCI for BC) and back-coded versions of these codes (i.e. ICD9/CCP codes) in the DAD files. This stopped as of 2007/08.
Also as of April 2007, CIHI has redeveloped its acute care inpatient grouping methodology. The new CMG+ methodology is built on ICD10-CA/CCI activity and cost data and replaces the CMG/Plx methodology. CMG+ takes advantage of the increased specificity of the ICD10-CA/CCI classification standards and features several modifications and enhancements.

Quality / Accuracy of Information/Field Coding Source

The centralized data processing of the DAD records done by the Canadian Institute of Health information (CIHI) results in increased efficiency and standardization among the participating provinces.

Important Additional Information

These data files are grouped into fiscal years by separation date, not the date of admission.

References

Several references are available on the CIHI web site (www.cihi.ca) on the impact of CIHI's acute-care inpatient grouping methodology switch, including "Coping with the Introduction of ICD10-CA and CCI: Impact of New Classifications Systems on the Assignment of Case Mix Groups/Day Procedure Groups using Fiscal 2001/2002 Data" and "CMG+ Tool Kit: Transitioning to the new CMG+ Grouping Methodology".
McKendry R, Reid RJ, McGrail KM, Kerluke KJ. Emergency Rooms in British Columbia: A pilot project to Validate Current Data and Describe Users. Vancouver (BC): Centre for Health Services and Policy Research; December 2002. Available at: http://www.chspr.ubc.ca/files/publications/2002/hpru02-16D.pdf

Fields Available

Field Name	Descriptions
Hospital Code	Indicates the hospital which submitted the discharge abstract.
Level of Care	Indicates the level of care provided by the facility, i.e. acute, day surgery, LTC holding bed, extended, rehabilitation, and DPU/GEAR.
Admission Date	The date the patient was admitted to hospital.
Admission Hour
Separation Date	The date the patient was discharged (separated) from the hospital or facility.
Separation Hour
Hospital Patient Number**	Chart number, assigned by hospital.
Sex
Province Issuing Health Coverage	Identifies the province patient is from (available from 91/92 onward).
Date of Birth**
Date of Birth Flag	Indicates whether patient is over age 100 at the time of admission.
Patient's Postal Code**
Patient Service Code	Identifies the patient service that contributes to the longest portion of a patient's stay.
Admission Category	Indicates the urgency of the admission, i.e. elective, urgent or emergency.
Entry Code	Indicates the patient's type or mode of entry to a facility, i.e. direct, emergency, or newborn (available from 90/01 onward).
Exit Code	Indicates the patient's type or mode of entry to a facility, i.e. direct, emergency, or newborn (available from 90/01 onward).
Exit Code Death Codes
Third Party Liability Form	Indicates whether a HLTH 1514 (HIA14) form was prepared.
Responsibility for Payment	Identifies the party responsible for a patient's hospitalization payment, i.e. hospital care, WCB, federal-DVA, federal-other, self, other agency, or other Province
Transferred From Hospital Code	Identifies the hospital a patient was transferred from when they require further treatment.
Transferred From Level of Care	Indicates the level of care a patient was transferred from, i.e. acute care, general rehabilitation facility, chronic care facility, nursing home facility, psychiatric facility, day surgery, emergency room, etc.
Transferred to Hospital Code	Identifies the hospital a patient was transferred to when they require further treatment.
Transferred to Level of Care	Indicates the level of care a patient was transferred to, i.e. acute care, general rehabilitation facility, chronic care facility, nursing home facility, psychiatric facility, day surgery, emergency room, etc.
Infant Birthweight (in grams)	Infant birth weight in grams. Captured for newborns and neonates (age < 29 days) only.
ICU Days	Indicates the number of days spent in an intensive care unit.
CCU Days	Indicates the number of days a patient spent in a coronary intensive care unit.
Rehabilitation Days	Indicates the number of days a patient spent in a rehabilitation care unit in an acute care hospital. It is not applicable to free standing rehab units.
Discharge Planning Unit Days	Indicates the number of days a patient spent in the discharge planning unit. This field should only be completed for hospitals with an approved DPU (available from 85/86 to 00/01).
Chronic Behaviour Disorder Unit Days	Indicates the number of days associated with a chronic behaviour disorder unit. These must be days spent in a facility designated to have a CBD unit.
In-hospital Service Transfers (x3)	Indicates an in-hospital service transfer has taken place, and describes a patient service other than the main patient service where a patient spent part of their hospitalization (available from 91/92 onward).
In-hospital Transfer Days (x3)	Indicates the number of days associated with an in-hospital service transfer(s) (available from 90/91 onward).
Long Term Care Assessment Code	Indicates the level of long term care the patient is assessed for. Completed only for long-term care patients occupying acute care beds (available from 85/86 to 95/96).
LTC Assessment For DPU Code	Indicates the level of LTC the patient is assessed for. Completed only for discharge planning unit patients (available from 85/86 to 95/96).
Physician Most Responsible - Number	Physician Identifies the provider (fee-for-service physician or surgeon, dentist, or oral surgeon) who was most responsible for the patient's care during hospitalization. [Replaced with a project-specific ID number.]
Physician Most Responsible - Service	Identifies the specialty or service of the most responsible physician (available from 90/91 onward). (Note - this is not the same as registered specialty.)
Physiotherapy	Indicates if the patient received physiotherapy (available from 85/86 to 00/01).
Occupational Therapy	Indicates if the patient received occupational therapy (available from 85/86 to 00/01).
Diagnosis	ICD9 diagnosis codes (1-16) (available from 85/86 to 00/01); converted ICD9 diagnosis codes (1-25), converted from ICD10CA Diagnosis Codes (1-25) (available from 01/02 onwards); ICD10CA diagnosis codes (1-25) (available from 01/02 onward). (Note: must be used with Diagnosis Type codes, below.)
Diagnosis Type	A code which determines the relationship of the diagnosis to the patient's hospitalization (max. of 16 codes available in 85/86 to 00/01, and 25 codes from 01/02 onward).
Procedure Codes	Identifies an operative or non-operative procedure/intervention performed during the patient's hospital stay, using either CCP (Canadian Classification of Diagnostic, Therapeutic and Surgical Procedures) codes (max. of 12 codes available in 85/86 to 89/90, 10 codes in 90/91 to 00/01, and 20 codes in 01/02 onward) or CCI (Canadian Classification of Health Interventions) codes (max. of 20 codes available from 01/02 onward).
Procedure Dates	The date the procedure / intervention was performed on the patient (max. of 12 codes available in 85/86 to 89/90, 10 codes in 90/91 to 00/01, and 20 codes in 01/02 onward).
Procedure Anaesthetics	Indicates the type of anaesthesia used during a procedure or intervention (max. of 12 codes available in 85/86 to 89/90, 10 codes in 90/91 to 00/01, and 20 codes in 01/02 onward).
Procedure Anaesthetists	Indicates the anaesthetist associated with the performed intervention (max. of 12 codes available in 85/86 to 89/90, 10 codes in 90/91 to 00/01, and 20 codes in 01/02 onward). [Replaced with a project-specific ID number.]
Procedure Surgeons	Indicates the principal provider associated with the performed procedure or intervention (max. of 12 codes available in 85/86 to 89/90, 10 codes in 90/91 to 00/01, and 20 codes in 01/02 onward). [Replaced with a project-specific ID number.]
Procedure Surgeon's Service	Indicates the level of training or the specialty of the health care provider associated with a procedure or intervention (max. of 10 codes in 90/91 to 00/01, and 20 codes in 01/02 onward).
GVHS Code	This field is no longer available - do not request.
Ambulance	Indicates whether patient was brought to hospital by ambulance (available from 91/92 onward).
Neonatal ICU Level II Days	Number of days spent in Neonatal Intensive Care Unit (NICU) Level II (available from 93/94 onward).
Neonatal ICU Level III Days	Number of days spent in Neonatal Intensive Care Unit (NICU) Level III (available from 93/94 onward).
Out of Province (OOP) Province	Identifies the province or territory where the hospital of service is located (available from 91/92 onward).
Out of Province (OOP) Hospital	Identifies the out-of-province hospital (available from 91/92 onward).
Local Health Area (LHA3)	This field is no longer available.
Census Tract	This field is no longer available.
Procedure Short List	A grouping system developed by Statistics Canada identifying 151 surgical groups based on the CCP code (available from 91/92 onward).
Local Health Area (LHA2)	This field is no longer available.
Regional Hospital District (RHD)	This field is no longer available.
Residence Indicator	Indicates whether the patient is a BC resident or from out of province (available from 91/92 onward).
Race	This field is no longer available.
Hospital Size	Possible values include: 400+ beds, 200-399 beds, 100-199 beds, 50-99 beds, 25-49 beds, and <25 beds.
Service Group	Identifies patient service groups by patient service code for acute and rehabilitation care, i.e. adult/medical, adult/surgical, paediatric medical, paediatric surgical, maternity, psychiatry, or newborn. This field is NOT recommended for defining surgical cases.
Diagnostic Class	Groups principal diagnosis into 18 sub-categories (available from 91/92 onward).
Diagnostic Short List	A classification system developed by Statistics Canada, based on ICD9 coding, which groups ICD9 codes into 211 similar groups for ease of analyses (available from 90/91 onward).
Days of Care	(Acute/Rehab Days) Indicates the number of days a patient spent in acute or rehab care levels.
Length of Stay Group 1	Identifies 21 length of stay groups according to the number of days of patient stay in hospital.
Length of Stay Group 2	Identifies 11 length of stay groups according to the number of days of patient stay in hospital.
Operation Group 1 (1st procedure)	Groupings of procedures based on the first procedure. Uses the first two digits of the CCP code (available from 90/91 onward).
Operation Group 2 (2nd procedure)	Groupings of procedures based on the second procedure. Uses the first two digits of the CCP code (available from 90/91 onward).
Operation Group 3 (3rd procedure)	Groupings of procedures based on the third procedure. Uses the first two digits of the CCP code (available from 90/91 onward).
Age In Years
Age In Days**	Used for patients less than one year of age.
Age Groups 1-12	Identifies 12 age groupings.
Diagnosis #2 (primary) [Pre-admit Co-morbidity]	Indicates a condition arising at the beginning of the hospital's observation and/or treatment which influences the patient's length of stay and/or significantly influences the management/treatment of the patient while in hospital (available from 01/02 onward).
E Code 1 (1st occurrence)	This is the first occurrence of an ICD9 diagnostic code beginning with E (except E849), or an ICD10-CA diagnostic code where the first three characters are in the range V01 to Y98 inclusive, indicating a cause of injury code. (ICD9 e-codes available from 91/92 to 00/01, and ICD10-CA e-codes available from 01/02 onwards).
E Code 2 (2nd occurrence)	Ecode2 is the second occurrence of a cause of injury stated on the patient record (available from 01/02 to 00/01).
800/900 Code	Identifies the first injury code on a record, if applicable (available from 01/02 onward).
Procedure on Admission Day	Indicates whether a procedure or intervention was performed on the day of admission.
Total Days of Care	Indicates the total number of days the patient was hospitalized.
Alternate Level Care Days (ALC)	Indicates the number of days of alternate level of care (ALC) as a portion of the total days of a patient's hospitalization.
Gestational Age	Indicates the number of weeks of gestation for a newborn (available from 94/95 onward).
Tertiary Program Code	Identifies applicable tertiary program (available from 93/94 to 00/01).
Case Mix Group (original); Case Mix Group (new); Complexity CMG (original); Complexity CMG (rgrp)	Case Mix Groups (CMGs) are three digit codes developed by CIHI to categorize a group of ICD9 codes or diagnoses that have an anticipated similar clinical course and resource requirements, which are measured in days of patient care (available from 91/92 onward).
Major Clinical Category (original); Major Clinical Category (new); Complexity MCC (original); Complexity MCC (rgrp)	The Major Clinical Category (MCC) designating the body system assigned to the record based on the CIHI complexity grouping methodology (available from 91/92 onward).
Resource Intensity Weight (original); Resource Intensity Weight (new); Complexity RIW (original); Complexity RIW (rgrp)	Weighting value assigned to the record based on the CIHI grouping methodology (available from 91/92 onward).
Resource Intensity Weight Exclusion Factor (original); Resource Intensity Weight Exclusion Factor (new); Complexity RIW Exclusion Code (original)	Indicates status of the RIW assignment (available from 91/92 onward).
Day Procedure Group Number (original); Day Procedure Group Number (new)	Day Procedure Group assigned to the record by the CIHI grouping methodology (available from 91/92 onward).
Day Procedure Group Weight (original); Day Procedure Group Weight (new)	Day Procedure weighting value assigned to the record by the CIHI grouping methodology (available from 91/92 onward).
Complexity Level (original); Complexity Level (rgrp)	Identifies the Complexity Level assigned to the record based on the CIHI complexity grouping methodology (available from 91/92 onward).
Complexity ELOS (original); Complexity ELOS (rgrp)	Identifies the Expected Length of Stay based on the CIHI complexity grouping methodology (available from 91/92 onward).
Complexity Grade (original); Complexity Grade (rgrp)	Determines whether the medical or surgical grade list was used. Includes surgical partition grade list, medical partition grade list, complexity not assigned or all non-acute cases (available from 91/92 onward).
Complexity Age (original); Complexity Age (rgrp)	The Age Category assigned to the record based on the CIHI complexity grouping methodology. Age can be a factor in assigning complexity values (available from 91/92 onward).
Complexity ELOSM (original); Complexity ELOSM (rgrp)	Determines the expected length of stay.
Complexity Exclusion Factor (rgrp)	Same as complexity exclusion factor, regrouped to 98/99 complexity grouping.

** Data field which could potentially identify an individual, and which therefore is only released to researchers having a clear need for the data in order to accomplish their research project.

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