Symptom Management > Tobacco Use Survey

Entity

Data Element

Definition

Format

Valid Values

Purpose and Use

Changes

Tobacco Use Survey

Medical Record Number

Patient identifier code that is unique with the healthcare facility

CHAR 10 Alpha-numeric

Consistent with CIHI NACRS and DAD definition and format

Uniquely identifies a patient within a hospital site. Necessary to determine a case. Foundational to most measures and indicators.

Tobacco Use Survey

Health Card Number

Patient's most recent health insurance number assigned by their provincial government of residence.

CHAR 10 Alpha-numeric

The following values are only to be used when unable to provide a Health Card Number.
0 = insured resident of reporting province, but HCN not available.
1 = not applicable, includes: out of province resident with unavailable HCN, Out of Country, no health insurance coverage from province of residence.

Used to further identify unique patients and link to existing databases as well as determine if same patients are being treated across various sites. Will facilitate the linkage of the sites results.

Tobacco Use Survey

Assessment Date

Date assessment completed

YYYYMMDD

Valid dates only

Necessary to track patient changes over time.

Tobacco Use Survey

Last Smoked

Last time patient smoked a cigarette

CHAR 1 Numeric

1 = I have never smoked cigarettes
6= I smoked a cigarette in the past 7 days (at least one puff)
5= Between 7 and 30 days ago
4= Between 1 and 6 months ago
3= Between 6 months and 1 year ago
2= More than 1 year ago
0= I do not know

Report quit rates (e.g., 7-day, 30-day, 6-month and 1-year abstinence rates).

Identify current/recent smokers, who could benefit from a referral to tobacco use treatment or relapse prevention.

Tobacco Use Survey

Amount Smoked

Amount of cigarettes patient smoked per day

CHAR 1 Numeric

1= None
2= Less than 1 cigarette per day 
3= 1 to 5
4= 6 to 10
5= 11 to 20
6= 21 to 30
7= 31 or more
0= I do not know

Report # of cigarettes per day, and changes in # of cigarettes per day over time (e.g., reductions).

Tobacco Use Survey

Quit Methods

Methods patient used to cut down or quit smoking

CHAR Alpha-numeric (multiple response values separated by comma)

1= I have not tried to quit or cut down on smoking cigarettes
2= Nicotine patch, gum, lozenge, inhaler or spray
3= Prescription medication (varenicline, bupropion)
4= E-cigarette or vaping product
5= Quit smoking service at my cancer centre or hospital
6= Telephone quitline service (e.g., Telehealth Ontario) 
7=   I quit or cut down without any help
8= None of the above
9= I do not remember

Determine methods patients have used to quit or reduce smoking.

Tobacco Use Survey

Assessment Location

 
Location where assessment took place.

CHAR 2 Alpha-numeric

CP - Clinic - Paper

Required to measure where assessments are occurring for planning for electronic tool. For File Upload, only Paper Channel is valid value.