Objective 2 Outline – Approximately ?

Assess Injury Data Sources and Describe the Injury Problem

  • Identify the injury data sources strength and weaknesses
  • Identify the available data sources that can provide information to the surveillance system
  • Describe the size of the injury problem
  • Compare the frequency of injuries calculated with data from different sources
  1. Introduction
  2. Overview of data sources in an injury surveillance system
  3. Death certificates
  4. Police reports
  5. Reports on occupational injuries
  6. Local newspaper accounts
  7. Linked Databases
  8. Useful, but difficult to do. It would be ideal if you could validate the data, but just getting data in the first place is hard enough. This is a case where you have to let the ideal give way to the reality
  9. May be Costly
  10. May have Limited access
  11. Technical difficulties
  12. Determining the Strengths and Weaknesses of a Database
  13. Judging Strengths and weaknesses
  14. Usefulness for injury surveillance, research and practice
  15. Estimate the accuracy, completeness and representativeness
  16. Timeliness
  17. Resource and Requirements
  18. Simplicity
  19. Data Collection Strategy Exercise – 15 minutes
  20. Imagine you have recently learned the state health department has an injury hospitalization database. You have a meeting with the lead epidemiologist to learn more about this database and whether or not it might help you in your surveillance effort. What questions would you ask to determine the strengths or weaknesses of this database? Keep the above considerations in mind. Debrief by writing the questions down and discussing.
  21. Questions to Consider
  22. Are the data computerized or must they be manipulated manually?
  23. What period of time do the records span?
  24. How often are data collected: annually, monthly, continuously, periodically?
  25. Are the data disseminated regularly?
  26. How are data disseminated?
  27. Are the data available on the internet or CD-ROM?
  28. What is the most recent year of available data?
  29. Is there a report available with the latest results?
  30. Is reporting of data voluntary?
  31. How complete is the data?
  32. How much time is there between the date of the injury and its availability for surveillance purpose?
  33. Is there a code book that defines variables and coding of variables?
  34. Are analyses available on request?
  35. Can custom tabulation be done?
  36. Is access to original documents possible?
  37. Are there any restrictions on access to records?
  38. Is a memorandum of understanding required for access?
  39. Is there a fee for the data?
  40. To what level of geographic specificity are the data available: national, regional, state, county, city, census tract, zip code?
  41. What type of data is obtained: mortality, morbidity, incidence, prevalence, nature of injury, severity of injury, body region affected, treatment, length of hospitalization, level of impairment or disability, expected source of payment, cost/charge information, surgical and medical procedures performed?
  42. What demographic information is available: age (actual years or group categories), date of birth, sex, race, ethnicity, marital status, occupation, industry, education, income, place of residence?
  43. What data are available on the circumstances surrounding the injury event: date of injury, time of injury, place of occurrence (home, school, work), intent, product involved, type of weapon involved, and external cause of injury code?
  44. What activities were associated with the injury: sports, work, day care, boating, home, recreation, farm, domestic violence, child neglect or abuse?
  45. Is a narrative description available?
  46. Area data included on contributing behaviors: seatbelt use, airbag installation, smoke detector installation, drug and alcohol involvement, riding with a drinking driver, bicycle helmet use, motorcycle helmet use, protective equipment for sports, unsupervised swimming, swimming pool fencing, swimming ability, firearm storage, weapons carrying, physical fighting, mental health treatment, previous suicide attempt?
  47. What other barriers are there to the use of these data?
  48. What is the quality of the data
  49. Graphic of common data sources for a fatal injury surveillance system in Indian Country
  50. Forensic Medicine
  51. Transportation office
  52. BIA Law Enforcement
  53. Transportation Office
  54. EMS
  55. District Attorney
  56. Police
  57. Describe Data Collection Method and Data Flow
  58. General information to include
  59. General description of data flow when a death occurs every state different
  60. Three types of death certificate data
  61. Death Certificate may be available within 30 days
  62. Preliminary electronic data
  63. Final death certificate data – clean and fully coded may take up to a year or more
  64. Process for investigating an injury death in IC. Open it up to the class for discussion because every tribe is different. Include a paragraph or two about some general investigative practices.
  65. Identify Data Sources to Include in a Surveillance System
  66. Take advantage of existing data sources. There may be some limitations depending on the intent of the data collection, but almost all data sources have limitations. Existing data sources can save you time and resources.
  67. Injury events determine which data sources are necessary to provide information.
  68. Table: Possible Data Sources in an Injury Surveillance System – these entities may have data at the national, state or local level.
  69. National data provides the big picture in the US and may be in the states. Generally not sufficient for community program development.
  70. State and local data more likely to reflect a local injury problem. Problems: not always computerized, lag time, race not always specified.
  71. WISQARS a source of data, allows mapping, etc. – more explanation needed, sum this up in a paragraph or two. Mention new features, tutorial that is being developed
  72. Data Source Matrix for IC – needs to be developed

Data Sources
Events / Police / Forensic
Medicine / Public
Health / CHR/Health care Delivery / Family/
Community / Child Protective Services
Fatal Injuries
Homicide
Suicide
Transport-
Relateddeaths
Other
Unintentional
Deaths
Nonfatal Injuries
Homicide
Attempt
Suicide
Attempt
Transport-
Related
Injuries
Other
Unintentional
Injuries
Domestic
Violence
Child
Maltreatment
ElderlyAbuse
  1. Case Definition/Data Source – The same material is Covered in Objective 4 under case definition
  2. Death –
  3. Readily accessible
  4. Cause of death from injury is inconsistently reported. A lot of holes in fatality reporting printouts. Form is standard, but it doesn’t always contain the information you need.
  5. Not a good picture of overall injury problem
  6. Limited information
  7. Influenced by small numbers
  8. Hospitalization
  9. Better picture of the overall problem
  10. Describes disability & healthcare costs
  11. Access to data more difficult
  12. Inconsistent or incomplete coding
  13. Data collection, particularly manual review of records, time-consuming
  14. ED Visits
  15. Helps provide big picture when combined with death and hospitalization records
  16. Useful with smaller populations as it may cast a wider net
  17. Can be useful for specialized studies and injury … for example child burns at San Carlos
  18. Access to data may be difficult
  19. Large number of cases may be difficult to manage; going through the records may be too time-consuming
  20. Incomplete or inconsistent identification of cause of injury
  21. Outpatient Visits
  22. Not the place to start with injury surveillance
  23. May be useful for specialized visits
  24. Good supplemental data
  25. Difficult access
  26. Linkage with other data sources
  27. It is unlikely for a single source to contain all the information desired for your surveillance system.
  28. It would be ideal to be able to compare data sources, but form most in Indian Country it would not be practical or achievable.
  29. Advantages
  30. Supplemental data
  31. Comprehensive description
  32. Highlights completeness from each source
  33. Improve data quality
  34. Disadvantages
  35. Personal identifiers needed/confidentiality
  36. Interagency politics
  37. Different storage media
  38. Data quality
  39. Conduct Preliminary Data Analysis
  40. To understand the finer nuances of a data source’s completeness and adequacy it is often necessary to carry out data analysis
  41. Data identifies patterns and trends
  42. Observation data documents behavior
  43. Start with an analysis of a broad category, such as interpersonal violence, then go more in depth as possible, (for example domestic violence among women)
  44. Seek the assistance of epidemiologist. Seek them out from such places as state health departments, epi centers, academic institutions and graduate students (in the appendix provide a list of Epi Centers in Indian Country)
  45. Using Data to Define Injury Problem
  46. The collection of data is vital to defining the problem and identifying a solution
  47. Data will allow us to identify who is being injured, better identify the cause of severe injury, and how they are being injured
  48. Determine the frequency of the leading cause of death (see table 1, next page) knowing the leading cause of death makes it possible to rank injuries by frequency
  49. Determine the frequency of leading cause of Injury Deaths. (table 2 next page)
  50. Compare the frequency of injuries calculated with data from different sources

Injury data are commonly collected for different purposes according to the mission of each institution. Identifying the goal behind each and comparing the goals with the objectives of the surveillance system will help explain differences in numbers. (mention racial misclassifications in some data bases) See Table 3

Page 7 (note: even though this table does not compare suicides reported from different data sources, it does compare mv crashes reported from different data sources. Please let me know if you think it is a suitable replacement for the table on page 35 of objective 2)

  1. Summary now that you’ve completed section you should be able to:
  2. Identify Injury Sources and the strength and weaknesses of each
  3. Identify available data sources that can provide information to the system
  4. Describe the size of the injury problem

Table 1: Total Deaths for the 10 Leading Causes of Death 2009
General US Population / American Indian/Alaska Native Population
Rank / Cause of Death / Rank / Cause of Death
1 / Diseases of heart / 599,413 / 1 / Diseases of heart / 1,591
2 / Malignant neoplasms / 567,628 / 2 / Malignant neoplasms / 1,381
3 / Chronic lower respiratory diseases / 137,353 / 3 / Unintentional injuries / 1,150
4 / Cerebrovascular diseases / 128,842 / 4 / Diabetes mellitus / 418
5 / Unintentional injuries / 118,021 / 5 / Chronic liver disease and cirrhosis / 380
6 / Alzheimer's disease / 79,003 / 6 / Suicide / 313
7 / Diabetes mellitus / 68,705 / 7 / Chronic lower respiratory diseases / 287
8 / Influenza and pneumonia / 53,692 / 8 / Cerebrovascular diseases / 263
9 / Nephritis, nephrotic syndrome, and nephrosis / 48,935 / 9 / Influenza and pneumonia / 193
10 / Suicide / 36,909 / 10 / Homicide1 / 193
Other Causes / 598,662 / Other Causes / 1,936
Total / 2,437,163 / Total / 8,105
SOURCE: CDC/NCHS, National Vital Statistics System; Vital statistics of the United States, Vol II, mortality, part A, 1980. Health, United States, 2011 web updates / 1Homicide is tied with Influenza and pneumonia for the 9th rank in 2009.'Because of the tie, there is no 10th rank; Septicemia is the 11th rank with 127 deaths in 2009.

Table 2

Rank / Cause of Injury Deaths 2009 / Deaths
1 / Unintentional MV Traffic / 650
2 / Unintentional Poisoning / 533
3 / Suicide Suffocation / 188
4 / Suicide Firearm / 161
5 / Unintentional Fall / 152
6 / Homicide Firearm / 112
7 / Suicide Poisoning / 61
8 / Unintentional Natural/ Environment / 60
9 / Unintentional Drowning / 57
10 / Homicide Unspecified / 56

Source: WISQARS

Table 3. Motor Vehicle Crash-Related ED Visits and Emergency Transports, hospitalizations, and Fatalities by Data Source, 2001 for an unidentified IHS Service Unit
(1) IHS SISS = / (2) Tribal PD reports + IHS medical records / (3) Tribal EMS + IHS medical records + discharge planning records / (4) State’s Health Department Data / (5) IHS Contract Health Services / Total unduplicated cases from all data sources
ER log + IHS medical records
IHS ER visits – no record of emergency transport to another hospital / 0 / 24 / 25 / 0 / 0 / 29
Transport to IHS ER, subsequent transport to another hospital / 21 / 5 / 9 / 0 / 0 / 21
Direct transports from the scene to other hospitals, disposition unknown / 0 / 50 / 33 / 0 / 0 / 68
Hospitalizations / 0 / 2 / 9 / 0 / 0 / 11
Fatalities / 0 / 6 / 1 / 9 / 0 / 10

Source: The IHS Primary Care Provider February 2010, Vol. 35, No. 2

Note: not sure about the applicability of this chart as a replacement for chart on page 35 of objective 2.

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