Dr. Jens Thomsen / Darren Joubert Occupational and Environmental Health Section Public Health Dept. Health Authority - Abu Dhabi Contact: Dr. Jens Thomsen 02-4193 467,
[email protected] Darren Joubert 02-4193 352,
[email protected]
Feb 22, 2011
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Why undertake Injury Surveillance? Attributes of a good Surveillance System Injury Surveillance versus Trauma Registry Developing an Injury and Poisoning Notification and Surveillance System for Abu Dhabi Emirate
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Definition ◦ “The ongoing, systematic collection, analysis and interpretation of Injury & Poisoning data essential to the planning, implementation and evaluation of public health practice, closely integrated with the timely dissemination of these data to those who need to know…” ◦ Application of these data to prevention and control 3
To prevent and reduce injuries in Abu Dhabi Emirate ◦ Is one of HAAD’s Top Ten Public Health Priorities
Enables definition of ‘problem’ in the first place ◦ Extent and nature of the problem (burden of disease) Incidence, geographic & demographic characteristics, risk factors, population at risk, patterns/trends, … (Epidemiology)
◦ In relation to other health problems ◦ Provides rationale for support from funders/stakeholders
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Provides information that facilitates development and implementation of interventions ◦ Information that assists in the design of interventions ◦ Who, what and where?
Injury Surveillance enables measurement of success in reducing/preventing injuries ◦ Baseline and follow-up information/KPIs ◦ Trends over time
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Active Surveillance ◦ Requires active identification of ‘cases’ as key activity
Passive Surveillance ◦ Relevant information collected in course of other activities ◦ Usually requires less expenditure of resources
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Defining the Injury Problem ◦ Geographically ◦ Nature and Severity of Injury ◦ Demographic characteristics ◦ Risk Factors
Defining and establishing the components of the Injury Surveillance System ◦ Data collection instruments and mechanisms ◦ Data management systems ◦ Data analysis and presentations 7
Establishing and managing the links between the data and the key stakeholders ◦ Data dissemination ◦ Engagement with stakeholders ◦ Efficient surveillance (IT) system
Sufficient and Sustainable Resources ◦ Financial ◦ People
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Simplicity ◦ Minimizes error and contributes to sustainability
Flexibility ◦ Ability to respond to changing needs – add/remove data points
Acceptability ◦ To both those operating the system and end users
Reliability ◦ Excellence and quality as inherent principles
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Utility ◦ Practical and affordable
Sustainability ◦ System must blend effortlessly with other ongoing activities and systems (e.g. CERNER)
Timeliness ◦ In both collection, and importantly presentation/feedback
Confidentiality ◦ Essential for ongoing viability
Security ◦ Access to data 10
Based on international best practice ◦ HAAD reviewed best practice examples of Surveillance Systems
Incorporating WHO/CDC recommendations ◦ Injury Surveillance Guidelines, WHO/CDC 2001 ◦ HAAD Draft System was reviewed by WHO HQ Geneva (CH) and EMRO office
Developed in collaboration with leading academic institutions ◦ Johns Hopkins University - School of Public Health, USA
Using advanced Business Process Automation and IT technologies ◦ Web-based IT system (Oracle) ◦ Business Intelligence Tool for Reports 11
Feedback to user systems
◦ Record search ◦ Multiple reports and Bi-Annual Injury Bulletins
Connectivity to other Health e-Systems ◦ ◦ ◦ ◦ ◦ ◦ ◦ ◦
CERNER (SEHA) Health Statistics (KEH, Knowledge Engine Health) Insurance Data (e-Claims) Trauma Registry PDIC (Poison & Drug Information Center) Medical Board (Disability assessment / Sick leave attestation) Police Traffic Injury System (TIMS) Ministry of Labour Occupational Injury Database 12
Patient Demographic information
Surveillance
General Injury information (Nature, Location, Time, Mechanism, Intent, Body site, Severity, … Extended Injury information (Occupational/road traffic/home/other injuries)
Registries
Trauma Registry (In-depth information, clinical and outcome data), including Burn Registry
Poisoning Registry In-depth information, Clinical & Outcome data
Other Registries (e.g. Disabilities/ Medical Board)
Fatal Injury Statistics
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Q1 2009 Kick-off workshop, supported by JHU-SPH Q2/3 2009 Review of international examples and WHO/CDC recommendations Formal Business Process Analysis Definition of System requirements Development of IT Platform, Forms etc. Q4 2009 Internal Testing of IT Surveillance System Q1 2010 Stakeholder review of ISS Feedback from selected hospitals Q2 2010 System modification Q4- 2010 Pilot test in one (private) hospital Q2 2011 Extended pilot in four hospitals Q3 2011 Official Launch (planned) 14
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www.haad.ae
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www.haad.ae E-Services
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Nature
Intention
Activity
Mechanism
Place
Time
Economic
Occupation
Severity
Disability
HCF
X
X
X
X
X
X
X
X
X
X
X
X
Gender
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
Nationality
X
X
Nature
X
X
X
X
Intention
X
X
X
X
Activity
X
X
Mechanism
X
X
Place / Time
X
X
Economic activity
X
X
X
X
X
Occupation
X
X
X
X
X
Severity
X
X
Body Site
X
Healthcare Facility
X
X
X
…
Nationality
Gender
Age
Age
By
X X X
X
X
X
X
X
X
X
X
X
X X
X
X
X
X
X
X
X
X
X
X X
…
Oracle Business Intelligence Tool
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Cases by Age and Gender:
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Cases by Activity at Time of Injury:
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Cases by Mechanism of Injury:
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Injury Surveillance is a key Element in preventing and reducing the global – and local – burden of injury Establishing a good injury surveillance system requires a planned and systematic approach Abu Dhabi is on the way of developing its own Injury Surveillance / Trauma Registry System
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[email protected] [email protected]
Feb 19, 2009
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Injury ◦ Physical Damage that results when a human body is suddenly or briefly exposed to intolerable levels of energy Excess (e.g. heat) or lack thereof (e.g. strangulation)
◦ Energy causing an injury can be
Mechanical Radiant Thermal Electrical Chemical
◦ ICD 9 CM codes 800-999 (For surveillance purposes) 2 6
Types of Injury ◦ Unintentional/Accidental E.g. road traffic injuries, falls, burns, drowning
◦ Intentional Self harm, e.g. suicide, attempted suicide Assault, e.g. Interpersonal violence
◦ Undetermined Awaiting results of investigation
◦ Other Legal interventions, Operations of war and civil insurrection
WHO/CDC Injury Surveillance Guidelines 2001
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No Injury
Mild
Moderate
Severe
Fatal
Household (community) surveys Health clinic records Family doctors’ records
ER records Ward admission records ICU admission records Death notifications/certificates
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For fatal injuries
◦ Autopsy/pathology reports ◦ Police reports
For severe non-fatal injuries ◦ Hospital in-patient records ◦ Trauma registries ◦ Ambulance or EMT records
For motor vehicle injuries ◦ Insurance records ◦ Police reports ◦ DOT records
For violent injuries ◦ Police reports
For occupational injuries ◦ Workplace records ◦ Workers comp ◦ Rehabilitation center 29
Case definitions should be based upon system objectives: Measure burden of care
Monitor incidence of injuries
Monitor incidence of injured persons
Any visit (first or repeat)
Injury presented by Individual for first time
First visit by individual
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