IntelliHEALTH Reporting Everything you always wanted to know about by dfsdf224s

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									                 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 ‘multi-
  record 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, NACRS1)
      Falls across the lifespan (Vital Stats, DAD, NACRS1)
      Road and off-road safety (Vital Stats, DAD, NACRS1)
      Other areas of public health importance for the prevention of
       injuries (Vital Stats, DAD, NACRS1)
 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                                                    External Cause
     (e.g. head injury)                                                  (e.g. motor vehicle crash)
     ICD9 Chapter XVII (17)                                              ICD9 Chapter XIX (19)
     ICD10 Chapter XIX (19)                                              ICD10 Chapter XX (20)

     ICD9 Codes 800-999                                                  ICD9 E-Codes E800-E999
     ICD10 Codes S0-T99                                                  ICD10 Codes V0-Y99

     Can be EITHER MRDx1 or All Dx1                                      Can ONLY be All Dx1, NOT MRDx1


                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                                             External Cause
   (e.g. head injury)                                           (e.g. motor vehicle crash)
   Inpatient data - INCLUDED in ICD10                           Inpatient data – INCLUDED in ICD10
   Blocks & Lead Cause Groups (ISHMT)                           Blocks; EXCLUDED from Lead Cause

   Ambulatory data - INCLUDED in ICD10                          Ambulatory data – INCLUDED in ICD10
   Blocks & Lead Cause Groups (ISHMT)                           Blocks; EXCLUDED from Lead Cause

   Deaths – Available for ICD9; NOT                             Deaths1 – AVAILABLE for all years
   AVAILABLE for ICD10 (i.e. > 1999)

   Home Care – uses ICD9 codes                                  NOT AVAILABLE

     1Cause 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           DAD Key             Sex   Age        ICD10                 All Dx               ICD10             # Diagnosis     # Distinct
Number                                                MRDx                  Type                 All Dx             Records –    Discharges
                                                                                                                    ext. cause   - 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 Reports & Tools Unit
                         MOHLTC                             APHEO Workshop 2010: intelliHEALTH - Reporting External Cause of Injury    19
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