This report demonstrates the structure of the Clinical Context Coding Scheme (CCCS) with respect to the target cohort.

1 Environment

This section will introduce you to the linguistic environment of the report. Use this section for reference as you interpret the code and its output in the present document.

2 Cohort

The cohort of 4,067 persons was selected on the basis of transactional data. Specifically, persons were included if they had at least one encounter with any of the following VIHA programs*:

*Please note that these programs (~1,700) are what CCCS(6) groups into ~150 “service classes” using (6) dimensions of service description.

These criteria are ‘biased’ in favour of ensuring inclusion of persons who have serious/chronic problems with abuse of alcohol. However, by including the Sobering and Assessment Centre in the inclusion criteria for defining the cohort, there will be some cases where the person uses drugs other than alcohol. In future analyses, we can refine the inclusion/exclusion criteria on the basis of the Substance Use Profile from the Minimum Reporting Requirements (MRR).

3 Data

For each individual in the cohort, we have extracted the complete record of engagement with VIHA services for the period between January 1, 2007 and September 1, 2017. We call these records transactional data(1), because they keep track of patients’ encounters with the healthcare system. Encounter data for the Addiction cohort ( N = 4,067) were mapped onto 6 categories of CCCS(6) classification system (./manipulation/1-greeter-transactions.R), producing 124 distinct service classes, unique on the features of each CCCS(6) dimension.

extracted from VIHA’s CERNER-Millenium EHR system

Observations: 125
Variables: 11
$ service_class_code        <dbl> 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13...
$ service_class_description <chr> "Dedicated Psychiatric Emergency Settings...
$ beyond_ed_acute           <lgl> FALSE, TRUE, TRUE, TRUE, FALSE, FALSE, FA...
$ n_people                  <dbl> 564, 838, 165, 66, 447, 8, 1, 79, 2, 29, ...
$ n_encounters              <dbl> 940, 2085, 1103, 109, 754, 8, 1, 129, 2, ...
$ intensity_type            <chr> "ED, Urgent Care, Acute", "ED, Urgent Car...
$ intensity_severity_risk   <chr> "Emergent-Hospital", "Emergent-Community"...
$ population_age            <chr> "Mixed Ages", "Mixed Ages", "Adults, some...
$ service_location          <chr> "Hospital-ED", "Community", "Community", ...
$ clinical_focus            <chr> "MHSU", "MHSU", "MHSU", "Frailty, Non-Spe...
$ service_type              <chr> "ED-PES or Psychiatric Bed", "Crisis Resp...

In this data frame (ds):

4 CCCS

Let us ask this dataframe a few questions to better understand its structure and contents.

# A tibble: 1 x 1
      n
  <int>
1   124
cccs_dimension n_categories n_encounters
clinical_focus 43 160318
intensity_severity_risk 36 160318
intensity_type 14 160318
population_age 8 160318
service_location 14 160318
service_type 53 160318

Each dimension of CCCS(6) groups the same set of encounters into different number of categories.

4.1 Dimensions

  1. Intensity_Type - this is a set of categories that are used to classify the 1700 service locations into groups that are relatively homogeneous with respect to the manner in which service intensity would be coded. (e.g. “Ambulatory_Chronic” would refer to ambulatory services provided over an extended period of time)

  2. Intensity_Severity_Risk - this set of categories is nested within Intensity_Type and is used to characterize the intensity of services provided within an Intensity_Type class. (e.g. three levels of intensity within the “Ambulatory_Chronic” class)

  3. Population_Age - this set of categories refers to the age range of the patients/clients who access a particular service. (e.g. “Infants” or “Older Adults Exclusively” or “Mixed”)

  4. Service_Location - this set of categories refers to the physical location where a given service is provided. (e.g. “Ambulatory Clinic” or “Hospital” or “Home”)

  5. Clinical_Focus - this set of categories refers to the predominant clinical focus of a service associated with a location in the Cerner location build. (e.g. “Diabetes” or “Frailty/Neurocognitive, Psychiatric”)

  6. Service_Type - this set of categories refers to the type of service provided. (e.g. “Assertive Community Treatment” or “Acute Care - Tertiary”)

5 Custom views

beyond_ed_acute service_class_description service_location n_encounters
FALSE Acute Care - Children, Adolescents Hospital 46
FALSE Acute Care - Infants Hospital 1
FALSE Acute Care - Med-Surg - Mixed Ages Hospital 3320
FALSE Acute Care - Med-Surg ED - Mixed Ages Hospital-ED 89
TRUE Ambulatory Episodic - Treatment - Medical Day Care Ambulatory Clinic 103
TRUE Ambulatory Episodic - Urgent Assessment Ambulatory Clinic 184
TRUE Med-Surg - Ambulatory Episodic - Mixed Ages Ambulatory Clinic 371
TRUE Med-Surg - Ambulatory Mixed Episodic - Chronic - Child & Youth Ambulatory Clinic 24
TRUE Med-Surg - Ambulatory Mixed Episodic - Chronic - Mixed Ages Ambulatory Clinic 611
service_class_description service_location FALSE TRUE
Acute Care - Children, Adolescents Hospital 46 NA
Acute Care - Infants Hospital 1 NA
Acute Care - Med-Surg - Mixed Ages Hospital 3320 NA
Acute Care - Med-Surg ED - Mixed Ages Hospital-ED 89 NA
Ambulatory Episodic - Treatment - Medical Day Care Ambulatory Clinic NA 103
Ambulatory Episodic - Urgent Assessment Ambulatory Clinic NA 184
Med-Surg - Ambulatory Episodic - Mixed Ages Ambulatory Clinic NA 371
Med-Surg - Ambulatory Mixed Episodic - Chronic - Child & Youth Ambulatory Clinic NA 24
Med-Surg - Ambulatory Mixed Episodic - Chronic - Mixed Ages Ambulatory Clinic NA 611