Objective IV Outline

Determining the Appropriate Methodology for the Surveillance System

Learning Objectives

  • Define the Injury events and data elements to be included in the system
  • Develop the data collection instrument and determine data collection frequency
  • Plan for Systemization, Maintenance and Data Security
  • Define Key positions
  1. Introduction (will touch briefly on the following topics)
  2. Discussion of what people want in their system. – Comprehensive or specific – i.e. suicide, domestic violence, etc.
  3. Discuss ideal versus reality
  4. Size and type of injury problem
  5. Available data sources
  6. Feasibility of getting information
  7. Political aspects of getting information
  8. Potential for defining interventions
  9. Devine the injury events and determine the data elements to include in the system
  10. Case Definition (Pages 32-41)
  11. Injury pyramid
  12. Death (the tip)
  13. Data Readily accessible
  14. Cause of death from injury Consistently reported
  15. Rare event
  16. Not a good guide to ascertain the overall injury problem or medical consequences
  17. Influenced by small numbers, especially population
  18. Hospitalizations (below deaths)
  19. When combined with mortality data, provides a much better picture of injury problem
  20. Disability and health care costs can be better described
  21. Access to data more difficult (privacy, HIPAA, manual records)
  22. Incomplete or inconsistent coding of injury causation.
  23. Data collection consumes human resources
  24. ED visits (below Hospitalizations)
  25. When combined with death and hospitalization data, helps provide the big picture
  26. Small populations with limited injury mortality & hospitalization may benefit by casting the net wider to include ED visits
  27. ED visits data can be useful for specialized study
  28. Large number of cases may be difficult to manage
  29. Access to data may be difficult – manual records
  30. Inconsistent or incomplete identification of injury causation
  31. Outpatient visits – Bottom of the pyramid
  32. May be good for specialized injuries (sports related, eye injuries)
  33. Might be good supplemental information, but in general not the place to start with injury surveillance
  34. Difficult access (data highly protected by practitioners)
  35. Summary
  36. Don’t try to do everything at once
  37. Start small with deaths and most severe injuries
  38. Plan to expand or phase-in other levels of severity as your resources permit
  39. You can work on prevention projects without knowing everything about every injury in your community
  40. The use of e-codesin your system
  41. E-codes – the value of e-codes
  42. Allow the ability to identify tends
  43. Allows the ability to describe the specific causes and contributing factors associated with an injury.
  44. Limitations of e-code
  45. Records not always coded
  46. Miscoding or inconsistent coding
  47. Poor Chart info results in non-specific e-code
  48. Don’t always provide the desired specificity
  49. Must stay apprised of updates
  50. Reading an e-code and coding data -- exercise[MC1] – Note: 30 minutes was allotted for this exercise in IHS Course. The examples below were taken from IHS Material. Using ICD-9 (or 10?) code book, participants are asked to code the following events.
  51. Pedestrian run over by motor vehicle while walking in crosswalk at corner of Main Street and 3rd Avenue.
  52. Unrestrained passenger of pickup truck ejected when tire blew, driver lost control, ran off road, and overturned.
  53. 36 year old female diagnosed with depression attempted suicide by hanging.
  54. Boy admitted to hospital with BB gun shot to eye.
  55. Intoxicated individual fell out of bed of stationary pickup truck.
  56. Wife was assaulted and stabbed with knife by husband.
  57. Severe allergic reaction due to scorpion bite.
  58. Smoke inhalation from house fire that was caused by faulty wiring. There was no smoke detector in the home.
  59. Neck injury due to diving and striking head against bottom of swimming pool.
  60. Fall off bull during rodeo.
  1. Case definition exercise page 40 – Time ?
  2. Use the provided scenario to develop a case definition based on a real concern of someone in your group.
  3. The primary data you intend to use is hospital ED records and patient medical charts
  4. Considerations: person, place, time, intent, severity
  5. Debrief points:
  6. Do you think you will capture all injuries meeting case definition
  7. What additional data sources should you consider
  8. Group comments
  9. Case definition chart page 42 -- chart compares case definitions from the public health perspective (using ICD-10 codes) vs. the law enforcement perspective.
  1. Defining Variables
  2. General Discussion
  3. Keep the goal in mind – goal is intervention, prevention activity
  4. Be mindful of ideal vs. reality
  5. The simple form more likely to yield information, although it may not be everything you want to know.
  6. Consider subsequent forms to gather more details
  7. The variables you choose to include will depend on your locality, culture, etc. – rodeo injury related variables vs. snowmobile injury related variables
  8. Name – often not available, not used or not collected. Use hospital case number or DOB in lieu of name. Privacy/HIPAA issues.
  9. Age and sex –
  10. Education Level – consider the need for the information. Will the education level impact your intervention activities
  11. Employment Level – Same consideration as Education Level. Will it impact intervention. Why you might want it: Could help determine work related injuries.
  12. BAC – important variable, but not always available. May have to settle for Alcohol involved (needs to be defined) and Alcohol related (needs to be defined)
  13. Occupant Protection for Transportation – horses, skateboards, motorized vehicles, such as snow mobiles, boats – seat belts, helmets, life jackets, etc.
  14. Time Related variable:
  15. Date and time of injury event, ideally time the injury occurred. Realistically most of the time you only know the time of medical treatment. Choose one variant and go with it, even if it’s not the most accurate indication of when the injury occurred.
  16. A drawback: in some cases people don’t seek medical treatment until much later. For example, A Navajo clinic was getting a lot of people coming in for fall related injuries on Monday morning, but the injuries were occurring over the weekend.
  17. Place Related Variables:
  18. Place where injury occurred, residence of injured person.
  19. Injuries often occur when people travel to places for activities – hunting, fishing, drinking -- ideally you collect both. But sometimes the information is very general – such as the nearest village. Specifics are great, but if you can’t get them you work with what you have.
  20. Variables related to the event circumstances
  21. Relationship of victim to aggressor
  22. Mechanism
  23. Context
  24. Criminal history of victim and/or agressor
  25. Example: Phase 1/Phase 2 -- There’s value in collecting as much information as possible, but the more information you try to collect, the likely your form will be filled out accurately or at all. Some IHS areas have used a two phased approach. -- Phase 1 form used to collect basic information about injury, Phase 2 used to collect more detailed information based on the specific injury[MC2]
  26. Chart showing variables collected – IHS guidelines, Variables collected by small IC organization, Variables collected by large IC organization[MC3]
  1. Develop Data Collection Instrument and Determine Data Collection Frequency
  2. Now must determine how design a form to capture the data/variables, we’ve decided to include.
  3. Data Collection Planning – most data is record abstraction, gathering data from somebody, recording what you need. on-going surveillance –
  4. Discussion of length – page 50
  5. Keep it simple
  6. Only include the data you need and then use analysis to answer case definition questions later.
  7. The simpler the form, the greater its usefulness over a long period of time, the more likely you’ll be able to collect that data over a long time. There’s no right or wrong approach, but length is a consideration.
  8. Pre-test - page 51
  9. Pretesting done with a draft form of the instrument to allow changes to be made prior to a full investigation.
  10. Pretesting helps identify if the questions and format are appropriate, clear, relevant, and result in the appropriate data. Help determine if the case definition is accurate.
  11. Data Collection Planning Summary
  12. Decide what you want out of surveillance
  13. Identify your case definition
  14. Define your variables
  15. Develop your form
  16. Test it
  17. Frequency of Data Collection -- To be Discussed
  18. Determine the type of Surveillance System -- To Be Discussed
  19. Plan for Systemization, Maintenance and Data Security [MC4]– To be Discussed
  20. Define staff and key positions necessary – To be Discussed

1 / 7/10/12

[MC1] add some additional ones provided by WG

[MC2]Would be nice to show an example of a phase 1 form and a phase 2 form.

[MC3]Need to get this from the group

[MC4]Does IHS have a policy that should be included here?