1 Session goal & Objectives : (By the end of the session, - - PDF document

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1 Session goal & Objectives : (By the end of the session, - - PDF document

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Utilize the Participants Summary Presentation (see template) to illustrate value of data. Inform students that next 2 days will focus on Injury Data, with three major blocks of instruction: 1. Review and morbidity/mortality coding

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  • Utilize the “Participants Summary Presentation” (see template) to illustrate value of data.
  • Inform students that next 2 days will focus on Injury Data, with three major blocks of instruction:

1. Review and morbidity/mortality coding (“Injury Data Introduction”) 2. Data Collection (“Data Collection”; “Data Collection Planning”; “Data Collection Lab”) 3. Basic Injury Epidemiology & Statistics (“Data Analysis”; “WISQARS”)

Introduction to Data Presentation Billings Area 2011: Injury Data Introduction

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Session goal & Objectives: (“By the end of the session, participants will be able to…)

  • Describe the uses of data including understanding an injury problem, guiding injury prevention

programming, and uses in evaluation

  • Define the term “injury” as used in data collection—we will introduce a systematic method of classifying

injury, the ICD

  • Define the types of data. We’ll include a review of some data terms we used in Introduction to IP, as well

as a few new terms

  • List general sources of data

Introduction to Data Presentation Billings Area 2011: Injury Data Introduction

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Open Floor Discussion (ask the questions to the students; engage them to provide personal experiences; consider using flip chart to facilitate discussion) Two Types of Data:

  • Qualitative data: used to understand people’s opinions/attitudes/beliefs; collected through interviews,

surveys, focus groups; gives insight on development of your program/messages/materials.

  • Quantitative data: raw numbers/counts; used indentify injury patterns. Collected through surveillance,
  • bservations, risk assessments; gives insight on setting program priorities and evaluating impact of your

program. Use of Data in IP:

  • Understand trends/patterns/risk factors/causes of injury in a population
  • Set priorities for prevention
  • Guide/persuade decision makers re: public health policy (i.e., community survey data re: passing a seat

belt law)

  • Develop program messages & materials (design of float coats in AK; safety message for a targeted group)
  • Justify needs/build your case for funding (i.e., grants)
  • Evaluate your program

What are some common sources of injury data?

  • Local IHS Severe Injury Surveillance System (SISS)
  • Resource and Patient Management System (RPMS)
  • Medical Records & Death Certificates
  • EMS & Police
  • Observations (i.e., seat belt surveys, home safety assessments)
  • Questionnaires/Surveys/Focus Groups/Key Informant Interviews

Introduction to Data Presentation Billings Area 2011: Injury Data Introduction

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Two Types of Data:

  • Qualitative data: used to understand people’s opinions/attitudes/beliefs; collected through interviews,

surveys, focus groups; gives insight on development of your program/messages/materials.

  • Quantitative data: raw numbers/counts; used indentify injury patterns. Collected through surveillance,
  • bservations, risk assessments; gives insight on setting program priorities and evaluating impact of your

program. Use of Data in IP:

  • Understand trends/patterns/risk factors/causes of injury in a population
  • Set priorities for prevention
  • Guide/persuade decision makers re: public health policy (i.e., community survey data re: passing a seat

belt law)

  • Develop program messages & materials (design of float coats in AK; safety message for a targeted group)
  • Justify needs/build your case for funding (i.e., grants)
  • Evaluate your program

What are some common sources of injury data?

  • Local IHS Severe Injury Surveillance System (SISS)
  • Resource and Patient Management System (RPMS)
  • Medical Records & Death Certificates
  • EMS & Police
  • Observations (i.e., seat belt surveys, home safety assessments)
  • Questionnaires/Surveys/Focus Groups/Key Informant Interviews

4

Introduction to Data Presentation Billings Area 2011: Injury Data Introduction

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Introduction to Data Presentation Billings Area 2011: Injury Data Introduction

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Introduction to Data Presentation Billings Area 2011: Injury Data Introduction

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Agents of Injury: (Remember from Level 1, the epi triangle, with host, agent, and environment?) Injuries, for the most part, result from short-term exposure to large concentrations of energy:

  • Mechanical: crushing injury in wringer washer, energy transferred during M/V crash
  • Thermal: heat injuries—fire, hot water scalding
  • Chemical: battery acid spill, poisoning
  • Electrical: lightening
  • Radiation: sunburn, overexposure to x-ray
  • Absence of oxygen: drowning, suffocation, smoke inhalation, carbon monoxide
  • Absence of heat: hypothermia, frostbite
  • Excess heat: heat stroke (hyperthermia)

Two Main Injury Categories: (An “agents of injury” isn’t a very specific way to categorize injuries for data collection and analysis)

  • Unintentional: Drowning, Fall, Fire/Burn, MVC, Poisoning, Other
  • Intentional: Suicide, Self-Harm, Assault (child abuse, elder abuse, domestic violence, etc)

Note to Instructor:

  • Transition from two main categories of injury to ICD-9
  • Consider statement similar to: “…In the medical field, injuries are classified with a standardized coding

system call the International Classification of Disease…”

Introduction to Data Presentation Billings Area 2011: Injury Data Introduction

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Agents of Injury: (Remember from Level 1, the epi triangle, with host, agent, and environment?) Injuries, for the most part, result from short-term exposure to large concentrations of energy:

  • Mechanical: crushing injury in wringer washer, energy transferred during M/V crash
  • Thermal: heat injuries—fire, hot water scalding
  • Chemical: battery acid spill, poisoning
  • Electrical: lightening
  • Radiation: sunburn, overexposure to x-ray
  • Absence of oxygen: drowning, suffocation, smoke inhalation, carbon monoxide
  • Absence of heat: hypothermia, frostbite
  • Excess heat: heat stroke (hyperthermia

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Introduction to Data Presentation Billings Area 2011: Injury Data Introduction

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Two Main Injury Categories: (An “agents of injury” isn’t a very specific way to categorize injuries for data collection and analysis)

  • Unintentional: Drowning, Fall, Fire/Burn, MVC, Poisoning, Other
  • Intentional: Suicide, Self-Harm, Assault (child abuse, elder abuse, domestic violence, etc)

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Introduction to Data Presentation Billings Area 2011: Injury Data Introduction

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Note to Instructor:

  • There are several very good online resources for ICD-9 (some are include on a PPT slide at the end of this

presentation)

  • The World Health Organization (WHO) is a very good resource: http://www.who.int/classifications/icd/en/

and includes a good “history lesson” at http://www.who.int/classifications/icd/en/HistoryOfICD.pdf.

  • The American Academy of Professional Coders (AAPC) is another good resource: http://www.aapc.com/.

Go to the “resources” tab for ICD-10 and ICD-9 info. Of particular interest is the “code translator.”

  • The purpose of this presentation is not to make students expert, certified coders; instead we’re providing a

general overview for students to have a good understanding of how injury is classified, how to query an existing database with ICD codes, and how to conduct a simple analysis of such a database. International Classification of Disease (general history & description):

  • History of ICD dates back to the 1850s (again, see WHO website for more on history)
  • Since 1948, World Health Organization (oversees the ICD
  • ICD is the international standard diagnostic classification system for all general epidemiological, many

health management purposes and clinical use (including billing).

  • ICD includes codes for diagnosis of disease and injury; and cause of injury codes
  • Codes are updated annually; so it’s important to understand that new codes will influence multi-year

analysis (example: Fall from skateboard introduced in year 3 of a 5 year dataset…if you didn’t know that was a new code, you would misinterpret that skateboard fall injuries didn’t start until yr3).

  • Since 1999 the United States has utilized two ICD versions:
  • ICD-9: Used to code non-fatal (i.e., doctor’s office visits and hospitalizations)
  • ICD-10: Used to code deaths
  • The two versions don’t directly correlate. One reason is that ICD-10 expands to 141,000 codes compared

to ICD-9’s 17,000

Introduction to Data Presentation Billings Area 2011: Injury Data Introduction

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  • ICD diagnosis codes for illness and nature of injury (some “old timers” might refer to them as “N-Codes)

Note to Instructor:

  • Describe differences between ICD-9 and ICD-10 diagnosis codes (as they related to injury prevention)
  • A good resource on ICD-10 overview is provided by the AAPC at http://www.aapc.com/ICD-10/icd-10.aspx.

ICD-9 (Diagnosis Codes)

  • Used exclusively in the US for coding diagnosis of non-fatal illness & injury (most other countries use ICD-

10 for both morbidity & mortality coding)

  • Diagnosis codes are required for medical billing.
  • Medical personnel may generically refer to diagnosis codes as ICD9 codes; although you will learn that

ICD9 includes more than just diagnosis codes.

  • Injuries are numeric codes in the range 800-999 of the ICD-9
  • Updated at least annually
  • The Dept of Health & Human Services has indicated on Oct. 1, 2013 the ICD-9 will be phased out for

coding of medical bills (Medicare reimbursement) and replaced with ICD-10. ICD-10 (Diagnosis Codes)

  • Used exclusively in the US for coding diagnosis of fatal illness & injury (most other countries use ICD-10

for both morbidity & mortality coding)

  • Basically, this is the “cause of death” on a death certificate
  • Injuries are alphanumeric codes in the range S00-T98 of the ICD-10
  • “S” are codes to a specific body part
  • “T” are codes to multiple body parts; burns; poisoning

Introduction to Data Presentation Billings Area 2011: Injury Data Introduction

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Note to Instructor:

  • Slide is intended to illustrate coding differences between ICD-9 and ICD-10
  • A big difference is ICD-9 code categories focus on the nature of injury (i.e., fracture or burn); while ICD-10

categories focus more on the injured body part

  • The example ICD-9 code illustrates the specificity of the coding where 800 refers to fx vault of skull; the 4th

digit (.0) refers to no intercranial injury; and the 5th digit (.x5) refers to mild loss of consciousness (LOC) defined by ICD-9 as less than 1 hr.

  • After brief overview, refer to ICD-9 and ICD-10 handouts for full listing of injury diagnosis groups.

Introduction to Data Presentation Billings Area 2011: Injury Data Introduction

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Note to Instructor:

  • Describe differences between ICD-9 and ICD-10 external cause of injury codes (as they related to injury

prevention)

  • A good resource on ICD-10 overview is provided by the AAPC at http://www.aapc.com/ICD-10/icd-10.aspx.

ICD-9 (External Cause of Injury Codes)

  • Used exclusively in the US for coding external cause of injury (most other countries use ICD-10 for both

morbidity & mortality coding)

  • Unlike diagnosis codes; are not required for medical billing.
  • Referred to as “E-Codes” due to naming format (numeric preceded by “E”)
  • Same numeric range as diagnosis codes
  • There are separate, supplemental E-codes to identify the place of injury (home, school, etc)…although

under-utilized

  • Also, updated at least annually
  • Also planned to be phased out on Oct. 1, 2013 the ICD-9 and replaced with ICD-10.
  • Per 2004 study (http://www.cste.org/pdffiles/newpdffiles/ECodeFinal3705.pdf) only 26 states require E-

coding for hospital discharges; enforcement varies, resulting in only about 40% of those states having hospital discharge E-code rates at above 90%.

  • IHS does a great job E-coding for hospital discharges when the d/c is from one of our facilities.
  • E-code rates are low for ambulatory (incl. emerg. Dept.) and for cases involving CHS. For example, a 2005

study in the Reno District (PHX Area) looked at E-code rates in 7 IHS & tribal clinics over a 4 year period (2000-2003) and found 0-97% (51% average) of injury cases had E-codes. What can be done to improve E- code rates? Reno District staff shared results with clinic administrators and discussed the important public health application of E-codes. A few clinics decided to implement policies to require E-coding. ICD-10 (External Cause of Injury Codes)…for the most part, same discussion/explanation as ICD-10 Diagnosis Codes

  • Used exclusively in the US for coding external cause of death on death certificates (most other countries

use ICD-10 for both morbidity & mortality coding)

  • Injuries are alphanumeric codes in the range V01-Y98
  • Like ICD-9, allows for coding for place; but also allows for code for activity (what person was doing prior to

death; i.e, physical activity, working)

Introduction to Data Presentation Billings Area 2011: Injury Data Introduction

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Note to Instructor:

  • Slide is intended to illustrate coding differences between ICD-9 and ICD-10
  • A big is that ICD-10 provides many more coding options, thus allowing for the ability to be much more

descriptive and specific for “research” purposes. For example, ICD-10 provides 20 codes for Falls; while ICD-9 provides only 9 codes for Falls (see Reference Handouts)

  • Again, emphasize ICD-9 and ICD-10 datasets shouldn’t be merged for analysis due to the significant

differences in coding and additional codes in ICD-10.

Introduction to Data Presentation Billings Area 2011: Injury Data Introduction

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Note to Instructor:

  • Because we’ll later be querying an ICD-10 dataset (WISQARS), the following slides and

exercise are intended to provide students a better understanding of ICD-9s E-codes.

  • An E-code is a 4 (sometimes just 3) digit number preceded by the letter E.
  • The first 3 digits indicate the type of injury group.
  • The fourth digit, which follows the decimal point, provides additional descriptive information
  • r specificity of the injury event.

Introduction to Data Presentation Billings Area 2011: Injury Data Introduction

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  • Example E-code 813.2
  • The number 813 indicated the injury involved a motor vehicle traffic accident involving

collision with another vehicle.

  • The “.2” indicates the injured person was a motorcyclist.

Introduction to Data Presentation Billings Area 2011: Injury Data Introduction

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  • E-Codes allow ability to identify injury trends
  • This slide illustrates a listing of E-codes you might receive from query of a hospital

discharge database

  • One easy, low tech method of trying using E-codes to determine injury trends and identify

potential intervention strategies is to print the E-code listing from the database.

  • Draw lines to separate the groupings.
  • It is apparent that the 2 leading injury types for this community are MVCs and Falls.
  • But can we identify any further patterns or trends in injury with E-codes. Yes, when you

look up each code within the groupings you will note that there appears to be: (a) a possible MVC-pedestrian problem per the frequency of E814.7; and (b) a possible playground- equipment related fall problem per E884.0.

  • In summary, when injuries are E-coded you can determine trends in the general type of

injury (E-code range, E880-E888), as well as trends of specific types of injury (E-code, 884.0).

Introduction to Data Presentation Billings Area 2011: Injury Data Introduction

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  • E-coding allows the ability to describe specific causes and contributing factors associated

with an injury event.

  • For example, there are individual codes that allow for the coding of fall injuries associated

with…review slide.

Introduction to Data Presentation Billings Area 2011: Injury Data Introduction

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  • You might query a dataset and find the following listing of fall E-codes
  • A simple analysis method is to list them in order, draw a line to separate same codes
  • And you might be able to identify some trends
  • Beware…Unfortunately, we often find that vague or unspecific E-codes are used…resulting

in “Other/Unspecified” as the leading type of fall.

Introduction to Data Presentation Billings Area 2011: Injury Data Introduction

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While ICD-9 codes are very important and useful, there are some limitations associated with E-codes that you should be aware of:

  • Not always E-coded…especially contract care facilities.
  • Miscoding/Inconsistent coding…human error and interpretation problems. For example, fall from vehicle

might be coded as: E818 “Other noncollision motor vehicle traffic accident; fall from MV while in motion”

  • r E884.9 “Other fall from one level to another; from stationary vehicle, tree, embankment, haystack”.
  • Insufficient info…fell and fractured hip.
  • Not always desired specificity…E918…caught accidentally in or between objects. Must look at

narrative…in SC found these were wringer washer related.

  • Stay appraised of updates…pre-1997 no domestic violence code, reflected only weapon (E966; knife). In

1997 new E-code E967.3…adult abuse by spouse or partner. If unaware of update might be misled of DV epidemic beginning in 1997.

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  • Diagram illustrates how injuries are typically assigned ICD-9 or ICD-10 External Cause of Injury codes
  • Important Note: Coding requires Certification!

Introduction to Data Presentation Billings Area 2011: Injury Data Introduction

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  • A few ICD-9, ICD-10, and E-coding references
  • Note: A quick internet search will also result in several vendors for code books, as well as, several online

listings of codes.

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  • Online ICD-9 code lookup tool is at: http://icd9cm.chrisendres.com/index.php
  • But have students use hardcopy to get a feel for the codes and how they are structured.

E-code Exercise: (allow approx 30 minutes)

  • Use hardcopy of ICD-9 and the ICD-9 E-code listing (pg 2 of handout: “ICD 9 Summary of Codes”)
  • Students learn how to E-code a typical injury description that might be found in a medical record.
  • Students also learn potential for miscoding and importance of complete injury descriptions.
  • Students may work individually or in pairs.
  • Have half the class start with case description #1 and the other half start with #10 (to ensure all are coded

if time starts running out).

  • Using answer key, review answers and comments (provide copy of answer key to students after

discussion). Extra Credit E-Code Analysis Exercise: (for those that finish the E-code Exercise early)

  • Continue use of hardcopy of ICD-9 and the ICD-9 E-code listing (pg 2 of handout: “ICD 9 Summary of

Codes”)

  • Students identify main injury categories and conduct simple counts to answer the exercise questions.
  • Provide answer sheet for anyone that wants one.

Introduction to Data Presentation Billings Area 2011: Injury Data Introduction