CDC Conference Call – Manual Review

April 1, 2013

Attendees:

  • Participants
  • Bridget Canniff
  • Celeste Davis
  • Jason Hymer
  • Siona Willie
  • Jon Peabody
  • Debby Chavez-Bird
  • Organizers
  • Marguerite Carroll
  • Basla Andolsun
  • Holly Billie

Items Discussed:

  1. Organization of manual
  2. Marguerite: It will be separated with tabs. Does it work with instructor notes, then slides, then content?
  3. Holly: Took me a while to get used to how it was organized. Different from normal IHS format. Normal is slides with all the talking points under it, including points in participants manual.
  4. Jon: Yes, it’s different. I’m familiar with the way Holly said, but maybe we could test it this way and see what the instructors say.
  5. Marguerite: Please elaborate on what IHS usually does.
  6. Specific instructions on slides’ notes
  7. Info just for teacher
  8. Some of stuff from beginning on instructor notes, then specific info on exercises, for instance, how to do, how long it takes, etc.
  9. Include talking points participants have access to, then specific points for instructors
  10. Holly: I’d prefer instructions on how to administer the exercises
  11. Purpose of exercise, specific instructions
  12. Example: suggest instructor works through first 2 examples, let class do the rest.
  13. Provide key
  14. Question - Celeste: Is the idea that this is core instruction and they can insert locally appropriate information?
  15. Marguerite: This is core. I didn’t put anything about inserting locally appropriate material, but can.
  16. All: Yes, please.
  17. General Comments
  18. Holly: Hard to tell on parts of it if it’s what we were going for. Is this what we envisioned? One big concern – Is this what a surveillance course should be?
  19. Jon: what we have here meets expectations, what we collectively pursued. Participants will have to give feedback on if what we came up with was the best.
  20. Debby: I was wondering if participants will think it’s too much of a repeat if it isn’t tailored specifically.
  21. Holly: you think it’s too much of a repeat?
  22. Debby: Yes, it’s good info, but worried about repeat.
  23. Marguerite: I was concerned about that too, but feeling was some of materials were important for repeating when we talked about it on calls.
  24. Jon: No guarantee that people have taken courses recently, which is why we wanted refresher.
  25. Holly: That will be an important question during evaluation. How helpful is repeat info? Did it just seem like expanded review? What’s real difference? What did we learn?
  26. From L2, how to do a chart review was useful to me. Hoping this isn’t just expanded reviews. If so, we should discuss now.
  27. Marguerite: How to combine CDC and IHS course best. Is there information we should add back in? Or information from other sources to add in? Is there anything folks think we should add?
  28. Holly: Paragraph on access to data, whether it’s a request to police department, health department, etc. How do you ask for data, provide a sample request, reassuring folks about identifiers, etc.
  29. Marguerite: There was a sample letter on IHS protocol we could use.
  30. Note that it’s important and point people to sample letter in IHS protocol.
  31. Jon: I like the appendix, it’s thorough.
  32. Holly: Agree that is has good variety, but we could reduce bulk.
  33. Ex: Bristol Bay Slides - make into multiple slide pages
  34. Jason: Provider issue part can be cut down. Save the date, job announcements can be left out.
  35. Intro – Instructor’s Notes
  36. Holly: Helpful to add “at a glance” – sections covered, appropriate time frames, agenda
  37. Marguerite, Ok, with amount of content on each slides? Notes slides guiding instructors?
  38. Jason: I looked more at instructor’s notes than slides themselves, but I think they looked good.
  39. Jon: Agreed, some had few to no comments, but most did, and most instructors will elaborate.
  40. Holly: First slide: “creating an injury surveillance system for Indian Country” gives impression of one system for all of Indian Country
  41. Change to: “Creating Injury Surveillance SystemsinIndian Country”
  42. Holly: Last paragraph on intro page is important. Make it bold.
  43. Section 1 instructor’s notes: Comments.
  44. None
  45. Slides in Section 1?
  46. Holly: Generally, in some slides references for instructors would be nice.
  47. Example: p.2 – include reference for data (where from), how current data is (put date), in general need more citation for data
  48. Marguerite: Highlighted sections indicate material needs to be checked and updated whenever the course is offered.
  49. Holly: Reorder #7
  50. Midnight during curfew further down list because tribes have little control over that
  51. Holly: #11
  52. Include word “partnerships” in #3 of steps to developing injury surveillance systems. More about forming 1-2 strong partnerships than coalitions.
  53. Marguerite: coalitions and partnerships?
  54. Holly: Yes, can say “coalitions/partnership”
  55. Section 1: Comments
  56. Holly: was p. 1-4 2010 data included in updateable list?
  57. Marguerite: Yes
  58. Holly: since we’re adding word “partnership”, also include in sections: #3 p 1-11 and in circle p. 1-12
  59. Instructor notes section 2: Comments
  60. None
  61. Slides in Section 2: Comments
  62. Holly: Slide #3 – should law enforcement be combined rates than tribal police, BIA? Is state-level missing? Or is this focus on local forces?
  63. Make heading ‘Law Enforcement’, with sub categories Tribal Police, BIA
  64. Add category with state level circle
  65. Trauma registry, state health dept. , etc
  66. Add short blurb about state-level resources
  67. Content of Section 2: Comments
  68. Marguerite: I’ll make change to content we just talked about for slide #3
  69. Holly: 2-2 under outpatient visits. How does statement affect tribes that only have clinics? We don’t talk about contract health reports elsewhere. Can we really say it’s not the place to start?
  70. Celeste: Portland area only has clinics, so there is no hospital. We normally get hospital in-patient data from state. List contract health data as potential source of data.
  71. Bridget: We use state linkages.
  72. Holly: Need statement to cover this. I’ll take a crack at this (wordsmithing)
  73. Celeste: I will help
  74. Marguerite: We’ll look at this part, wordsmith, and get back to you.
  75. Jon: In larger populations, people may intentionally exclude out-patient data. Depends on what frame work is. Could be mentioned. Instructor discretion.
  76. Holly: Examples of possible data sources – put these under some of major headings p. 2-5
  77. Example: Main Category – (ex. State registries)
  78. One example under each major heading.
  79. Forensic medicine needs example
  80. Holly: Thoughts on duplication of data when linked? Included as disadvantage.
  81. Bridget: we eliminate duplicates, but it depends on how it’s done.
  82. Holly: Say: “if your data does not have personal identifiers you have to be careful about duplication”?
  83. Holly: Maybe doesn’t belong under linkages, but belongs somewhere in this section. Include another paragraph under this section for duplication.
  84. Holly: I can work on this with Bridget
  85. Holly: p. 2-7 – we should have 2010 data here.
  86. Marguerite: We used 2009 data to keep charts parallel
  87. Holly: Ok.
  88. Section 3 Instructor Notes: Comments
  89. None
  90. Section 3 PowerPoint: Comments
  91. Marguerite: Will add “coalitions to title”
  92. Question: Add partnerships to slide heading on slide 2?
  93. Holly: No changes in this section.
  94. Marguerite: content for manual, comments?
  95. Holly: Add “tribal council” to political on p. 3-2, table 1.
  96. Instructor’s Notes Section 4: Comments
  97. Question – Marguerite: Preference – I had handout included. Should they all be in appendix though? Or used as handout?
  98. Siona: In same tab as section/topic so you don’t have to thumb through. Could put at the end of section.
  99. Holly: Important to have instructions for the instructor here.
  100. Example: select 2 from this page to have group do.
  101. Include where they can get ICD-10 odes
  102. Provide key for this and other exercises.
  103. Marguerite: This came from L2. Is there a key? I’ll look back and see.
  104. Holly: # of scenarios to code – is 10 OK? Include note to instructor that this is a section they can pare down for time’s take if needed.
  105. Section 4 PowerPoint: Comments
  106. Holly: What objectives are should ordered earlier in couple slides called “What are Your Objectives” – keep here, but also address introduction of what course should be.
  107. Holly: 2014 for e-code transition on slide 11. Change this throughout.
  108. Jon: BAC as potential variable. In my experience, we rarely find this in a medical chart. Add a note that this would be nice to have, but is rarely there. (under “case definition” on p.4-5 and on slide 14)
  109. Section 4 Manual: Comments
  110. Marguerite: Coverage on e-codes – “define injury event..” needs transition here to explain e-codes briefly (in notes, 4-3 at bottom)
  111. Need instructions for exercise.
  112. Suggest to instructor to gauge familiarity of participants with e-codes
  113. Provide instructors with links to info
  114. CDC.gov/nchs
  115. Cms.gov
  116. Marguerite: Add something to appendix on this as general overview?
  117. Holly: Sure. There are simple fact sheets we could add and give links too.
  118. Holly: 4-5 – Instructions on where to get coding book.
  119. Holly: 4-5 – BAC mentioned. 2nd sentence may not be accurate (about alcohol-involved related)
  120. When deciding if you want to use B.A.L. data:
  121. 2 things to consider if B.A.L. is available:
  122. How it’s determined
  123. Chemical
  124. Observation
  125. What is definition from source of alcohol involved or alcohol related. Are definitions different?
  126. Marguerite: Make sure you’re comparing same thing
  127. Holly: Variables to consider
  128. Lists of definitions from sources is important, but some of these are the same
  129. Nature of definition, n-code
  130. Jon: In reviewing charts, sometimes you don’t have e-code, but chart will say “patient fell” – sometimes don’t have e- or n-code.
  131. Holly: Either way, we need a list of definitions. Few people say “n-codes” now, for instance. If we keep n-codes, we can say “this is what it is, you may not come across it much anymore, but this is what it is”
  132. Holly: 4-7, 4th bullet – “keep it easy on the eye”
  133. I don’t know what that expression means. Change to “keep it easy to read” – Don’t use colloquialisms
  1. Section 5 Instructor’s Notes: Comments
  2. Holly: I am concerned about calculators, but most people have cell phones. Add notes that people can use them.
  3. Need key for exercises
  4. Marguerite: Does anyone know where this is?
  5. Jason: Don’t think there is one.
  6. Holly: I will look for it.
  7. Question – Marguerite: Rate exercise from Fellowship – should all of this be offered?
  8. Jon: Don’t remember from L2 how much we covered. It’s been my observation that people are scared of math. Getting them to do it is of value.
  9. Holly: Important to go through basic stuff
  10. Does any of this go beyond the basics? Beyond scope?
  11. Jon: Technically not related to collection of data. Interpretative, but that’s what we’re talking about here.
  12. Holly: keep it and then in the pilot ask if this belongs in this in course or not.
  13. Debby: If I weren’t taken through exercise, I’d be intimidated. I think it will be useful to do.
  14. Section 5 PowerPoint: Comments
  15. Holly: Some talking points need extra slide with visual.
  16. Ex. On slide 18 – K – important enough to have own slide
  17. Slide 28 – Examples from Aberdeen area we could use.
  18. Jon and Jason – Please send example
  19. Marguerite – contact someone from Aberdeen for example
  20. Section 5 of Manual: Comments
  21. Marguerite: 5-4 – “Calculating adjusted rate is complicated”
  22. True, but if they’re looking for national or state data, then can use a source like WISQARS. For local data, it’s important to contact a statistician like it says in notes.
  23. Holly: Many tribes use GIS? Use as bullet on 5-7?
  24. Yes
  25. Siona will draft bullet for 5-7 on GIS
  26. Holly: p. 5-9, last sentence – “recommendations…this is the most important step” - If that’s true, does it need more discussion? Or should we remove that phrase.
  27. Marguerite: Is this addressed in Section 6?
  28. Holly: Not specifically. Let’s strike “most important” and make it “An important”. Maybe add paragraph that there are many proven and effective strategies.
  29. Jon: Value of local surveillance in pointing to potential problems
  30. Ex: street light project helping reduce injuries.
  31. Holly: Jon, can you do this? 5-9 at bottom.
  32. Jon: Yes, I’ll add a sentence or so here
  33. Marguerite: Please send comments by e-mail on typos, small things, comments on 6-7. I will resend updated manual.
  34. Next Meeting – To discuss evaluation
  35. April 26, 2013 1:00 EDT

To Do:

All:

  • Please send comments on chapters 6 and 7 as well as any comments on typos and small changes to make throughout

Holly:

  • Page 2-2 under outpatient visits, wordsmith paragraph that addresses tribes that only have clinics (with Celeste)
  • Page 2-6 – include paragraph addressing duplication
  • Section 5 – locate key for exercises

Celeste:

  • Page 2-2 under outpatient visits, wordsmith paragraph that addresses tribes that only have clinics (with Holly)

Jon:

  • Section 5 Presentation, slide 28 – send an example to use
  • Page 5-9 at bottom, create sentence or so on the value of local surveillance in pointing to potential problems (ex: street light project)

Jason:

  • Section 5 Presentation, slide 28 – send an example to use

Siona:

  • Page 5-7 - Draft bullet point on GIS

Marguerite:

  • Section 5, slide 28 – contact someone from Aberdeen area to send an example to use

CDC Conference Call – Manual Review

4/1/13