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of public health epidemiology in Ontario

National Ambulatory Care Reporting System (NACRS)

National: The National Ambulatory Care Reporting System (NACRS) contains administrative, clinical, financial, and demographic data for ambulatory care visits in Canada.  

Ontario: The Ambulatory Visits folder in IntelliHEALTH is derived from the NACRS. The services included are emergency department visits, day procedures, medical day/night care, and high-cost ambulatory clinics including dialysis, cardiac catheterization, and oncology (including all regional cancer centres). 

(Copied from page 4 of the Health ANalysts Toolkit doc, both statements need to be referenced...)


Original Source:

National Ambulatory Care Reporting System (NACRS), Canadian Institute for Health Information (CIHI)
Distributed By:

Ontario Ministry of Health and Long-Term Care (MOHLTC): IntelliHEALTH ONTARIO (IntelliHEALTH)
Suggested Citation:

Ambulatory Emergency External Cause [years], Ontario Ministry of Health and Long-Term Care, IntelliHEALTH ONTARIO, Date Extracted: [date].

See Data Citation Notes.

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Related OPHS Standards

Chronic Disease Prevention and Well-Being Food Safety Healthy Environments Healthy Growth and Development Immunization Infectious and Communicable Diseases Prevention and Control Safe Water School Health Substance Use and Injury Prevention
 

Data Notes

Background
  • Ambulatory care visits are a source of morbidity information available through IntelliHEALTH beginning with the 2001/2002 fiscal (2002 calendar) year. Note that the fiscal year is the MOHLTC's fiscal year (April 1 - March 31).
  • Ambulatory visits include emergency visits as well as other hospital-based outpatient clinics (e.g., renal dialysis, day/night surgery). Other components of morbidity include hospitalizations (from CIHI) and medical services (from OHIP Approved Claims files). Both are also available through IntelliHEALTH.
  • The first areas or visit functional centres (VFCs) to report to NACRS in the fiscal year 2001/2002 (2002 calendar year) were the hospital emergency departments (ED) and urgent care centres (both considered ED).  The other VFCs (i.e. hospital-based outpatient units, such as day/night surgery and renal dialysis units) began reporting to NACRS in 2003/2004. Note that day/night surgery units reported to the DAD from the 1996/1997 to 2002/2003 fiscal years, but they were the only VFCs to do so.
  • Hospitals report data to CIHI and data can be reported by hospital but in general, these data should be reported by residence of the patient for the health unit reporting.
  • Both fiscal and calendar year are available in the IntelliHEALTH NACRS sources. Data are submitted by fiscal year but calendar year is generally used for the health unit reporting.



Analysis Checklist 

General Checklist for All Associated Indicators
  • The IntelliHEALTH licensing agreement does not require suppression of small cells, but caution should be used when reporting at a level that could identify individuals, (e.g. reporting at the postal code level by age and sex). Please note that privacy policies may vary by organization. Prior to releasing data, ensure adherence to the privacy policy of your organization.
  • Aggregation (e.g. combining years, age groups, categories) should also be considered when small numbers result in unstable rates. 
  • Variation in data collection procedures over time and/or geography may reduce the validity of time and/or place-specific comparisons
  • ICD-10 has a greater level of specificity and different code titles than ICD-9; forward conversion is not recommended.  Refer to the Core Indicators' International Classification of Diseases, 10th Revision (ICD-10) resource for more information.   
  • Note that there are no decimal places for ICD-10 codes in IntelliHEALTH  (i.e., Z37.1 is Z371).  
  • To select only unscheduled emergency visits, qualify Ambulatory Case Type = EMG (or select predefined filter ‘unscheduled ED visits'). Note that this case type is already selected in the Ambulatory Emergency  External Cause (Chapter 20) data source in IntelliHEALTH. The AM case type field is based on the Main Visit Functional Centre (VFC) for the visit. It is used to categorize NACRS visits into groups based on the functional area of the hospital. The types are: EMG - emergency Cases; EMS: Emergency schedule visits (i.e. ED is being used for non‐emergencies); DSU - day/night surgery; CCL: cardiac catherization clinic (outpatient); ONC - Oncology (outpatient); REN - renal Dialysis (outpatient); OTH - Other hospital-based outpatient units.
  • The "Main Problem" represents the patient's main problem or diagnosis as determined during the ED visit. All visits have one main problem and up to nine other problems. Unlike the inpatient data, the only diagnosis types available are ‘main' or ‘other'. Problems/diagnoses are reported using ICD-10-CA.
  • Beginning in 2003/2004 there is an indicator to identify the problem code that was considered to be the "Reason for the Visit" or the reason or symptom that caused the patient to visit the hospital in the first place. For example: whether a patient complains of chest pains on arrival in ED and is found to be suffering from an AMI (acute myocardial infarction/heart attack), the AMI would be coded as the "main problem" and the chest pain diagnosis is reported in both the ‘reason for the visit' and ‘other' diagnosis fields.
  • NACRS also contains a ‘Disposition Status' indicator - which indicates the flow of patients after they leave the emergency department, e.g. if the patient is discharged home or admitted to hospital.  Disposition status equal to 6 or 7 (transfers to inpatient care in the reporting hospital) can be used to provide more timely data on hospitalization rates since hospital stays are only reported at discharge. It also allows reporting of hospitalizations for patients that are admitted to an adult psychiatric bed.


 

Associated Indicators

Injury-Related Mortality Two Three Four Five

  

One Two Three Four Five

  

One Two Three Four Five

  

One Two Three Four Five
 

References

General References

Acknowledgements

Lead Authors

Suzanne Fegan, KFL&A Public Health (Subgroup Lead)

Contributing Authors

Injury and Substance Misuse Prevention Work Group: 

Christina Bradley, Niagara Region Public Health
Badal Dhar, Public Health Ontario
Jeremy Herring, Public Health Ontario
Natalie Greenidge, Public Health Ontario
Sean Marshall, Public Health Ontario
Jayne Morrish, Parachute
Lee-Ann Nalezyty, Northwestern Health Unit
Michelle Policarpio, Public Health Ontario
Narhari Timilshina, Toronto General Hospital

Reviewers

JoAnne Heale, Ministry of Health and Long-Term Care

  

Revision History

 This Core Indicator Product webpage is maintained by the Health Outcomes Subgroup.  
Date Review Type Author Changes PDF
July 19, 2012 Formal Review Suzanne Fegan
  • Added details about information available through IntelliHEALTH.
  • Added rationale for using NACRS to obtain hospitalization rates
October 14, 2019
Website Update:
No Content Review
Caitlyn Paget,
on behalf of the CIWG
    Migrated to new website structure and format, including:
  • Reorganized content to provide high-level information at a glance, and move in-depth analytic information into dedicated sections for users to access when needed.  
  • Added short data source description in header.  
  • Moved data-specific Analysis Checklist items from the indicator pages to reduce duplication.  
  • Crosslinked to relevant Core Indicators webpages including OPHS program standard(s) and associated indicator(s).
  • Added Revision History table, with PDF copy of previous version for reference.  
     
APHEO's Core Indicators Project has been developed through collaboration across the field of public health in Ontario, 
to provide standardized methodology for population health assessment, to measure complex concepts of individual and community health.
Please contact core.indicators@apheo.ca for further information.  
   
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