Sub-Domain: Additional Proposed Instruments
CRF:
CDE ID | CDE Name | Variable Name | Definition | Short Description | Additional Notes (Question Text) | Permissible Values | Description | Data Type | Disease Specific Instructions | Disease Specific Reference | Population | Classification (e.g., Core) | Version Number | Version Date | CRF Name (CRF Module / Guideline) | Sub Domain Name | Domain Name | Size | Input Restrictions | Min Value | Max Value | Measurement Type | Source | Form Set | Form | Field | Domain | CDASH Variable | CDASH Definition | CDASH Label | Controlled Terminology | Prompt | Essentiality | Question Text | CDASH imp guidance | SDTM IG target | csDSR | PhenX | Data Type | CRF Completion Inst | SDTMIG Target Var | SDTMIG Target Map | Codelist Name | PVs | Pre Pop Value | Query Display | List Style |
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C21666 | Diagnosis principal discharge stroke related ICD-10-CM code | DignsPrinDiscrgRelStrkICD10Cd | If the Principal ICD-10-CM diagnosis code is a stroke-related code, then enter it here. If it is not, then select the Secondary ICD-10 diagnosis code that is stroke-related, as determined by ICD-10-CM code recorded in the medical record. | If the Principal ICD-10-CM diagnosis code is a stroke-related code, then enter it here. If it is not, then select the Secondary ICD-10 diagnosis code that is stroke-related, as determined by ICD-10-CM code recorded in the medical record. | Principal discharge diagnosis | Alphanumeric |
The ICD-10 code should be recorded using the following format: _ _ _ . _ _ |
Get With The Guidelines (GWTG) Stroke Patient Management Tool Coding Instructions (Updated on 11/4/2009); Paul Coverdell National Acute Stroke Registry<br />See http://www.cdc.gov/nchs/icd/icd10cm.htm#icd2016 for the ICD codes. | Adult;Pediatric | Proposed | 1.00 | 2016-04-19 00:00:00.0 | Hospital Discharge | Additional Proposed Instruments | general-data-protection-regulation-gdpr | 255 |
Free-Form Entry |
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C04804 | Hospital discharge date and time | HospitDischgDateTime | Date (and time, if applicable and known) the participant/subject was discharged from the hospital | Date (and time, if applicable and known) the participant/subject was discharged from the hospital | Date of discharge | Date or Date & Time |
Record the date/time according to the ISO 8601, the International Standard for the representation of dates and times (http://www.iso.org/iso/home.html). The date/time should be recorded to the level of granularity known (e.g., year, year and month, complete date plus hours and minutes, etc.). Supplemental - Highly Recommended based on study type, disease stage and disease type |
Get With The Guidelines (GWTG) Stroke Patient Management Tool Coding Instructions (Updated on 11/4/2009); Paul Coverdell National Acute Stroke Registry | Adult;Pediatric | Proposed | 3.00 | 2013-07-25 08:54:08.2 | Hospital Discharge | Additional Proposed Instruments | general-data-protection-regulation-gdpr |
Free-Form Entry |
DeBaun Forms | ||||||||||||||||||||||||||||||
C14213 | Diagnosis principal discharge text | DiagnosPrincipalDischrgTxt | The principal diagnosis is defined in the Uniform Hospital Discharge Data Set (UHDDS) as "that condition established after study to be chiefly responsible for occasioning the admission of the patient to the hospital for care." | The principal diagnosis is defined in the Uniform Hospital Discharge Data Set (UHDDS) as "that condition established after study to be chiefly responsible for occasioning the admission of the patient to the hospital for care." | Principal discharge diagnosis | Alphanumeric | Get With The Guidelines (GWTG) Stroke Patient Management Tool Coding Instructions (Updated on 11/4/2009); Paul Coverdell National Acute Stroke Registry<br />See http://www.cdc.gov/nchs/icd/icd9cm.htm for the ICD codes. | Adult;Pediatric | Proposed | 3.00 | 2013-06-21 00:00:00.0 | Hospital Discharge | Additional Proposed Instruments | general-data-protection-regulation-gdpr | 255 |
Free-Form Entry |
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C14215 | Diagnosis new indicator | DiagnosNewInd | Were there any new diagnoses (i.e., diagnosed for the first time) related to stroke risk factors during the hospital stay? | Were there any new diagnoses (i.e., diagnosed for the first time) related to stroke risk factors during the hospital stay? | Were any new diagnoses related to stroke risk factors made during the hospital stay | Yes;No;Unknown | Yes;No;Unknown | Alphanumeric |
Choose one |
No references available | Adult;Pediatric | Proposed | 3.00 | 2013-06-21 00:00:00.0 | Hospital Discharge | Additional Proposed Instruments | general-data-protection-regulation-gdpr |
Single Pre-Defined Value Selected |
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C14216 | Diagnosis new type | DiagnosNewTyp | If there were any new diagnoses related to stroke risk factors during hospital stay, describes those risk factors. | If there were any new diagnoses related to stroke risk factors during hospital stay, describes those risk factors. | New diagnosis type(s) | Diabetes;Hypertension;Hyperlipidemia;Artherosclerosis;Persistent or Paroxysmal Atrial Fibrillation/Flutter;Other, specify;Diabetes;Hypertension;Hyperlipidemia;Artherosclerosis;Persistent or Paroxysmal Atrial Fibrillation/Flutter;Other, specify | Diabetes;Hypertension;Hyperlipidemia;Artherosclerosis;Persistent or Paroxysmal Atrial Fibrillation/Flutter;Other, specify;Diabetes;Hypertension;Hyperlipidemia;Artherosclerosis;Persistent or Paroxysmal Atrial Fibrillation/Flutter;Other, specify | Alphanumeric |
Choose all that apply. |
No references available | Adult;Pediatric | Proposed | 3.00 | 2013-06-21 00:00:00.0 | Hospital Discharge | Additional Proposed Instruments | general-data-protection-regulation-gdpr |
Multiple Pre-Defined Values Selected |
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C14217 | Stroke service accredited discharge destination type | StrokSerAccDisDestTyp | Indicates if the discharge destination is certified by any of the following as a primary stroke center. | Indicates if the discharge destination is certified by any of the following as a primary stroke center. | Is the discharge destination certified by any of the following as a primary stroke center | Joint Commission accredited primary stroke center;Healthcare Facilities Accreditation Program (HFAP) accredited primary stroke center;State accredited primary stroke center;None of the above;Unknown | Joint Commission accredited primary stroke center;Healthcare Facilities Accreditation Program (HFAP) accredited primary stroke center;State accredited primary stroke center;None of the above;Unknown | Alphanumeric |
Choose all that apply. |
http://www.jointcommission.org/CertificationPrograms/PrimaryStrokeCenters/<br />http://www.hfap.org/AccreditationPrograms/accreditationProcess.aspx | Adult;Pediatric | Proposed | 3.00 | 2013-06-21 00:00:00.0 | Hospital Discharge | Additional Proposed Instruments | general-data-protection-regulation-gdpr |
Multiple Pre-Defined Values Selected |
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C14218 | Commission on Accreditation of Rehabilitation Facilities (CARF) - destination indicator | CARFDestInd | Indicates if the discharge destination is a rehabilitation center accredited by the Commission on Accreditation of Rehabilitation Facilities (CARF). | Indicates if the discharge destination is a rehabilitation center accredited by the Commission on Accreditation of Rehabilitation Facilities (CARF). | Is the discharge destination a rehabilitation center accredited by the Commission on Accreditation of Rehabilitation Facilities (CARF)? | Yes;No;Unknown | Yes;No;Unknown | Alphanumeric |
Choose one |
http://www.carf.org/ | Adult;Pediatric | Proposed | 3.00 | 2013-06-21 00:00:00.0 | Hospital Discharge | Additional Proposed Instruments | general-data-protection-regulation-gdpr |
Single Pre-Defined Value Selected |
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C14627 | Stroke initial residence or discharge destination type | StrokInResDisDestTyp | Participant's/ subject's discharge destination. The discharge destination is defined as where the patient is going for post-acute stay. | Participant's/ subject's discharge destination. The discharge destination is defined as where the patient is going for post-acute stay. | Initial residence/ Discharge destination | Discharged to home or self care (routine discharge);Discharged/ transferred to a short term/ general hospital for inpatient care;Discharged/ transferred to skilled nursing facility (SNF) with Medicare certification in anticipation of skilled care = patient received therapy less than 3 hours/day;Discharged/ transferred to a Designated Cancer Center or Children's Hospital;Discharged/ transferred to home under care of organized home health service organization;Expired;Discharged/ transferred to court/ law enforcement;Discharged/ transferred to a federal health care facility;Hospice- home;Hospice- medical facility (certified) providing hospice level of care;Discharged/ transferred to hospital-based Medicare approved swing bed;Discharged/ transferred to an inpatient rehabilitation facility (IRF) including rehabilitation distinct part units of a hospital;Discharged/ transferred to a nursing facility certified under Medicaid but not certified under Medicare;Discharged/ transferred to a psychiatric hospital or psychiatric distinct part unit of a hospital;Discharged/ transferred to a Medicare certified long term care hospital (LTCH);Discharged/ transferred to a Critical Access Hospital (CAH);Discharged/ transferred to another type of health care institution not defined elsewhere in this code list;Discharged to home or self care (routine discharge);Discharged/ transferred to a short term/ general hospital for inpatient care;Discharged/ transferred to skilled nursing facility (SNF) with Medicare certification in anticipation of skilled care = patient received therapy less than 3 hours/day;Discharged/ transferred to a Designated Cancer Center or Children's Hospital;Discharged/ transferred to home under care of organized home health service organization;Expired;Discharged/ transferred to court/ law enforcement;Discharged/ transferred to a federal health care facility;Hospice- home;Hospice- medical facility (certified) providing hospice level of care;Discharged/ transferred to hospital-based Medicare approved swing bed;Discharged/ transferred to an inpatient rehabilitation facility (IRF) including rehabilitation distinct part units of a hospital;Discharged/ transferred to a nursing facility certified under Medicaid but not certified under Medicare;Discharged/ transferred to a psychiatric hospital or psychiatric distinct part unit of a hospital;Discharged/ transferred to a Medicare certified long term care hospital (LTCH);Discharged/ transferred to a Critical Access Hospital (CAH);Discharged/ transferred to another type of health care institution not defined elsewhere in this code list | Discharged to home or self care (routine discharge);Discharged/ transferred to a short term/ general hospital for inpatient care;Discharged/ transferred to skilled nursing facility (SNF) with Medicare certification in anticipation of skilled care = patient received therapy less than 3 hours/day;Discharged/ transferred to a Designated Cancer Center or Children's Hospital;Discharged/ transferred to home under care of organized home health service organization;Expired;Discharged/ transferred to court/ law enforcement;Discharged/ transferred to a federal health care facility;Hospice- home;Hospice- medical facility (certified) providing hospice level of care;Discharged/ transferred to hospital-based Medicare approved swing bed;Discharged/ transferred to an inpatient rehabilitation facility (IRF) including rehabilitation distinct part units of a hospital;Discharged/ transferred to a nursing facility certified under Medicaid but not certified under Medicare;Discharged/ transferred to a psychiatric hospital or psychiatric distinct part unit of a hospital;Discharged/ transferred to a Medicare certified long term care hospital (LTCH);Discharged/ transferred to a Critical Access Hospital (CAH);Discharged/ transferred to another type of health care institution not defined elsewhere in this code list;Discharged to home or self care (routine discharge);Discharged/ transferred to a short term/ general hospital for inpatient care;Discharged/ transferred to skilled nursing facility (SNF) with Medicare certification in anticipation of skilled care = patient received therapy less than 3 hours/day;Discharged/ transferred to a Designated Cancer Center or Children's Hospital;Discharged/ transferred to home under care of organized home health service organization;Expired;Discharged/ transferred to court/ law enforcement;Discharged/ transferred to a federal health care facility;Hospice- home;Hospice- medical facility (certified) providing hospice level of care;Discharged/ transferred to hospital-based Medicare approved swing bed;Discharged/ transferred to an inpatient rehabilitation facility (IRF) including rehabilitation distinct part units of a hospital;Discharged/ transferred to a nursing facility certified under Medicaid but not certified under Medicare;Discharged/ transferred to a psychiatric hospital or psychiatric distinct part unit of a hospital;Discharged/ transferred to a Medicare certified long term care hospital (LTCH);Discharged/ transferred to a Critical Access Hospital (CAH);Discharged/ transferred to another type of health care institution not defined elsewhere in this code list | Alphanumeric |
Choose one Supplemental - Highly Recommended based on study type, disease stage and disease type |
Get With The Guidelines (GWTG) Stroke Patient Management Tool Coding Instructions (Updated on 11/4/2009); Paul Coverdell National Acute Stroke Registry; The Joint Commission | Adult;Pediatric | Proposed | 3.00 | 2013-06-21 00:00:00.0 | Hospital Discharge | Additional Proposed Instruments | general-data-protection-regulation-gdpr |
Single Pre-Defined Value Selected |
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C18908 | Diagnosis new other text | DiagnosNewOTH | The free-text field related to 'Diagnosis new type' specifying other text. If there were any new diagnoses related to stroke risk factors during hospital stay, describes those risk factors. | The free-text field related to 'Diagnosis new type' specifying other text. If there were any new diagnoses related to stroke risk factors during hospital stay, describes those risk factors. | Other, specify | Alphanumeric | No references available | Adult;Pediatric | Proposed | 3.00 | 2013-06-21 00:00:00.0 | Hospital Discharge | Additional Proposed Instruments | general-data-protection-regulation-gdpr | 4000 |
Free-Form Entry |