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Coding Variations in the Discharge Abstract Database (DAD) Data Core

Recent research conducted by CIHI, the Ontario Ministry of Health and Long-Term Care and the Ontario Joint Policy and Planning Committee (JPPC), identified unusual changes in reported acute care patient discharge abstract data for individual hospitals. The magnitude of some of these changes, particularly with respect to weighted cases, and the increasing use of Resource Intensity Weights or RIW weighted cases for hospital funding, has raised the question as to whether these changes reflect:

- changes in the clinical complexity of patients seen in hospital, or
- changes in comprehensiveness and quality of clinical documentation, or
- changes in hospital health records coding and abstracting practices.

The Ontario experience has prompted CIHI to closely examine its coding standards and grouping methodologies and to conduct a broader investigation of the potential variations in the comprehensiveness and comparability of the data in the Discharge Abstract Database (DAD). The quality assurance processes applied to the DAD are described in a recent CIHI publication (CIHI, Quality Assurance Processes Applied to the Discharge Abstract and Hospital Morbidity Databases, August 2002) and the results of the 2-year CIHI DAD re-abstraction study were recently published (CIHI, Discharge Abstract Database Data Quality Re-Abstraction Study. Combined Findings for Fiscal Years 1999/2000 and 2000/2001, December 2002). This report presents the results of the parallel investigation of variations in the DAD data.

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Coding Variations in the Discharge Abstract Database (DAD) Data
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