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NOCC episode guidelines

The NOCC Technical Specifications require non-overlapping episodes. When the source data hasn’t been collected in this manner then some massaging could correct Sequence errors and reduce overall data loss. These guidelines are suggestions for possible ways to resolved some of these issues, but the details of the resolution used is best judged by the submitting jurisdictions in light of their collection systems and protocol.

Guidelines for Meeting the NOCC Protocol

This is a guide only. The suggestions should be evaluated for their applicability by each jurisdiction.

Sequence Short-hand

This document and images contain short codes to refer to sequences:

“A”, “R”, and “D” indicates Admission, Review and Discharge respectively.

“i”, “r”, and “a” indicates Inpatient, Residential and Ambulatory respectively.

So “Ai”, is an inpatient admission, “Rr” is a residential review and “Da” is an ambulatory discharge.

Administratively Added CODs

If data is being collected on overlapping episodes then it may be possible to insert “Administrative” admissions and discharges to produce a one-episode-at-a-time NOCC file. Whether this is applicable will depend on the nature of each jurisdiction’s data collection systems and processes.

For example, a sequence like Aa Ai Di Da, as illustrated, could be presumed to have overlapping episodes:



Sequence with overlapping episodes


Two “Administrative” COD records could be added to split the ambulatory episodes into the section before the inpatient episode and the section after. These are the new “Da” and “Aa” occasions.



Adding “Administrative” COD records to a sequence with overlapping episodes


(These images are available with the Validator from the individual COD record view by clicking “Person and Episode View”).

Date Adjustments

Sequence errors are commonly due to small date discrepancies. It may make sense to move an ambulatory discharge earlier so that it is on the same day as the inpatient admission, or similar changes in similar circumstances. This may depend on whether dates are being recorded accurately or are sometimes delayed.

For example, the Aa Ai Da Di sequence illustrated has the ambulatory discharge (Da) recorded 2 days after the inpatient admission (Ai):



Sequence with ambulatory discharge recorded 2 days after the inpatient admission


The Da could be re-dated two days earlier to match the Ai, resolving the Sequence error:



Ambulatory discharge has been red-dated two days earlier


Again, this may or may not be appropriate for your jurisdiction.

Another example sequence Aa Ai Ra Di Da:




Example sequence Aa Ai Ra Di Da


Could be resolved either by dropping the Ra:



Resolved by dropping the Ra


Or moving it outside of the inpatient episode:



Ra moved outside the inpatient episode


Dependent Measures

Administratively created COD records could have the measures from neighbouring CODs attached if appropriate.

For instance, an administratively created discharge from ambulatory care could be given a copy of the HONOS from the Inpatient admission occurring on the same day.

EpiId Handling

The COD record’s EpiId field should be unique, meaning if an episode is split by an intervening episode in another setting, then there should be two different EpiId values. See:

Our Episode Checking Process

The process we use to find Sequence errors has been of interest so a summary is included.

  1. Collect all CODs for a Person within an ORG

  2. Sort them by collection date

  3. Resolve same-day ordering by minimizing sequence errors and tie-break heuristics

However, we think focusing on the algorithm is not likely to be of benefit.

Our first principle is to not change the data you submit in any way, so any correction should be applied to submitted data. We would like to help with the generation of correct files.

Note that the EpiId is not used in our sequencing algorithms and tie-breaking heuristics.

Not all jurisdictions submit this identifier and our earlier investigations indicated that it did not resolve the majority of sequencing errors. It may, however, be useful at a jurisdictional level ‘pre-submission’.