Improving How We Code Strokes In Cihi's Discharge Abstract Database

Strokes can be deadly and in many cases debilitating. In Canada alone, 47,500 people are hospitalized for stroke each year. Virtually all jurisdictions have stroke strategies in place to reduce the incidence of stroke and to improve the treatment and outcomes of those who experience one.

CIHI’s hospitalization data is a key resource to help us understand the populations who have strokes and to evaluate these stroke strategies. Over the past few years, there have been improvements in how strokes are coded in CIHI’s Discharge Abstract Database (DAD).

There are different types of stroke (i.e., ischemic and hemorrhagic), explains Maureen Kelly, CIHI’s manager of Data Quality. “Each type requires different treatment and resource use, so it’s important to know what type of stroke a person has had,” she says. “However, until recently, a quarter of stroke cases in the DAD were coded as unspecified, reducing the utility of the data.”

A focus on stroke

This was one of the factors that led CIHI to focus on stroke for its 2008–2009 DAD reabstraction study. The study found that the ICD-10-CA code for unspecified stroke was often assigned even though there was sufficient documentation available to capture a more specific (usually ischemic) stroke.

The reabstraction study results (released in 2011) led to the development of a new e-Learning course, Different Codes for Different Strokes, to assist health information management (HIM) professionals in selecting accurate ICD-10-CA codes for stroke cases.

Results are in

“When the potential impact of the reabstraction study and the e-Learning course was analyzed,” said Kelly, “we found the specificity of stroke coding in the DAD had improved.”

Overall, the use of the unspecified stroke code decreased from 25% in 2008–2009 to 8% in 2013–2014 (Figure 1). The use of unspecified stroke was lower in hospitals where HIM professionals had taken the e-Learning course or had participated in the reabstraction study.

Figure: Proportion of Unspecified Stroke Diagnoses, Discharge Abstract Database, 2008–2009 to 2013–2014

Discharge Abstract Database, Canadian Institute for Health Information.

Enhancing the quality and relevance of data

This is a great example of CIHI and our data providers working together to enhance the quality and relevance of the DAD data, says Kelly.

There is still room for improvement, she adds, since the rate of unspecified stroke coding continues to vary across jurisdictions and not all facilities have taken advantage of the e-Learning course. CIHI will continue to work with its data providers to monitor the data. There are also plans to add a data quality report to the DAD eReports to facilitate monitoring of open-year data.

Coming soon

CIHI is planning to do a new reabstraction study later this year for 2015–2016 open-year DAD data. Stay tuned for more updates.