MONICA Manual, Part II, Section 2

	Medical Care Assessment Data INPATIENT MANAGEMENT OF ISCHAEMIC HEART DISEASE REPORTING FORM - HOSPITAL SEPARATIONS Form: UB        Version: 1    5.4.1989	FOR MDC USE ONLY Seq.no: Received: Filed:

Please print carefully or type the requested information. Please complete all blanks in accordance with the instructions provided. Complete one form for each MONICA Reporting Unit each year. If the data are not available for the Reporting Units, please complete the form for the smallest possible population, as indicated in item 4.

Instructions

The purpose of this form is to permit the monitoring of changes in the rates of hospital management of coronary heart disease in the populations of MONICA Reporting Units. Ideally the information provided on this form and on forms UC: Inpatient Management of Ischaemic Heart Disease Reporting Form - Aggregate Bed Days and UD: Inpatient Management of Ischaemic Heart Disease Procedure Reporting Form will permit the computation of age- and sex-specific and age standardized rates for various aspects of care within the age band 35-64 years.

In general the information will be derived from official hospital statistical systems, but where these do not exist useful information could be provided from registers of procedures or from selected departments of cardiology or cardiovascular surgery.

Whenever possible, tables should be provided for individual MONICA Reporting Units. This will be possible only if the unit records from which the data are obtained include a code for the usual residence of the patient which can be used to identify, with reasonable accuracy, the residents of specific MONICA Reporting Units.

When this is not possible for individual Reporting Units, tables should be provided for the smallest possible area within which the Reporting Unit(s) are located, for example, the full MONICA Centre or a defined Health Service Region for which population figures are also available. Where disaggregation even to this level is not possible, national data should be provided.

In all situations when data are being reported for defined areas other than individual Reporting Units, full explanation should be provided in the comments section of the form for the guidance of the MONICA Data Centre.

In some countries, statistics which systematically cover the populations of defined regions of the country as a whole are not available, but individual hospitals maintain statistical systems relating to their own admissions. MCCs to which this applies are encouraged to report data from these hospitals even if it is not possible to define precisely the population from which the admissions are derived. However a full description of the estimated coverage of the MONICA population in such data should be provided.

In particular this description should note changes from previous years which may affect the comparability and continuity of data. For example, the opening of a new hospital, department of Cardiology of department or Cardiac Surgery in a neighbouring area that would affect the previous referral patterns. It should also be indicated whether the data for these hospitals is likely to cover populations greater or smaller than the individual Reporting Units or the MONICA Centre as a whole.

This form is to be completed once each year (together with forms UC: Inpatient Management of Ischaemic Heart Disease Reporting Form - Aggregate Bed Days and UD: Inpatient Management of Ischaemic Heart Disease Procedure Reporting Form) and reported to the MONICA Data Centre (MDC), so that it is received there by 31 October each year. The information should be provided for the calendar year immediately preceding the year of reporting the data. For example, the data for 1988 should be reported by 31 October 1989. Please inform the MDC if there is any difficulty in meeting this schedule.

The first year for which the data should be provided is 1980. The forms for the years 1980 - 1988 should be reported to the MDC by 31 October 1989.

This form is to be completed by the MCC Principal Investigator or by someone officially designated to perform this task.

General instructions for completing form

This form can be completed either by typewriter or by hand. The recorded information should be examined carefully for both correctness and legibility. Further, since it may be necessary to photocopy the form, perhaps several times, as a routine part of processing and providing reserve copies it is essential that the recorded information be clear and dark. Hence, please use a dark ribbon if a typewriter is used or a dark ball-point pen if the form is completed by hand.

This form included blank spaces where you are to record the requested information. None of these spaces should be left blank unless specifically mentioned in the specific instructions.

If a mistake is made in entering information on the form, please draw a single line through the erroneous entry and provide the correct information in the immediate neighbourhood. If the number of corrections required has made the form difficult to read or perhaps confusing, please re-enter the information on a new copy and send this new copy of the form to the MDC. If this step is required, please check the final copy carefully to make sure that no new errors were made in the process of re-copying the numbers on to the new form.

A completed form with error corrections is enclosed at the end of the specific instructions.

Specific instructions for each item

These instructions should be followed carefully when completing the indicated version of the Inpatient Management of Ischaemic Heart Disease Reporting Form - Hospital Separations. Please ensure that the instructions are for the version of the form being completed. Specific instructions are listed by item below:

Item 1

Print or type the official MONICA Collaborating Centre name and code number in the spaces provided. Use the name and code number as they appear in Part I, Appendix 2: MONICA Collaborating Centres and Reporting Units.

Item 2

Print or type the official MONICA Reporting Unit name and code number in the spaces provided. Use the name and code number as they appear in Part I, Appendix 2. Even if your centre has only one Reporting Unit, please enter the appropriate name and code number here. This item can be left blank only if the population for which the data apply contains several reporting units or if the population does not contain any reporting units (see code 5 item 4). In such cases the Reporting Units included in the population should be given in item 9: Comments or reservations.

Item 3

Print or type the calendar year (1 January through 31 December) for which data are being provided. Please contact the MDC for instructions and note in Item 9 if the reporting period does not correspond to a calendar year as described above. Include all four digits of the year.

Item 4

Code here the population for which the data are being provided. (See the general instructions of this form for the choice of the population.) If you code 2, 4 or 5, please describe the population in Item 9.

Code 8 only if it is absolutely impossible or impractical to obtain the data requested in Item 6. Even in such case the form should be returned annually to the MDC.

Item 5

Code here the disease coding system used in the source from which the data provided in Item 6 was extracted.

The diagnostic codes in Item 6 relate to ICD-9 or ICD9-CM, as the majority of MCCs are using one of these systems. If ICD-8 is in use, the nearest equivalent codes, as detailed below, should be selected when requesting tables from the responsible Authority.

Item 6

Age Strata

Whenever possible provide the data for the five year age strata indicated in the table. If this is not possible the next lowest level of disaggregation should be used. If no age stratification is possible, as appears to be the case for procedures in some MCCs, total figures should be provided. The table should be modified by hand to indicate the age groups being used and a description of the age groups provided in Item 9.

Size of population

Print or type the best mid-year estimates of the counts of the indicated age and sex groups of the population indicted in Item 4. This column can be left blank only if item 4 was coded 7. If the forms concerns whole MONICA Reporting Unit, it is sufficient to write in the space: "Reported separately on POPULATION DEMOGRAPHIC REPORTING FORM".

Number of discharges from and deaths in hospital

Print or type the counts of hospital separations of members of the indicated age and sex groups of the population indicated in Item 4 during the calendar year being reported. The term "separations" means here the sum of discharges alive and deaths in hospital. Where more than one diagnostic field is present in the hospital records, the diagnosis defined by the responsible authority as the Main or Principal Diagnoses should be chosen for tabulation.

Item 7

This item was added as an attempt to help read handwritten entries that may appear elsewhere on this form. If you are entering data on this form by typewriter, leave this item blank. If you are completing the form by hand, please write, in your handwriting, each number above the digits as shown in the example below. Then compare the entries in the table and elsewhere on the form with those as written for this item and change those that may be confusing or unclear.

Item 8

Type or print the name of the person completing this form and the date completed in the spaces provided. Note that this form is to be completed by the Principal Investigator of the MCC or his or her designate.

Item 9

9. Comments or reservations about data provided:

Type or print any reservations or comments about the data provided on this form that may be helpful to the MDC in using the data or preparing summary reports. Attach additional sheets if necessary.

An example of a completed form: