Ch Childh ildhoo ood d Inj Injurie uries: s: Strategies from - - PowerPoint PPT Presentation
Us Using ing Qu Qualit ality Imp y Improveme ement t nt to o Pr Preven ent t Ch Childh ildhoo ood d Inj Injurie uries: s: Strategies from the Child Safety Collaborative Innovation and Improvement Network May 11, 2017, 3:00
May 11, 2017, 3:00 – 4:00 p.m. ET
Strategies from the Child Safety Collaborative Innovation and Improvement Network
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Ob Objec jectiv tives es
Continuous Quality Improvement
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Jenny Stern-Carusone, M.S.W. Technology Director Bekah Thomas, M.P.A. CS CoIIN Director Jen Leonardo, Ph.D. Improvement Advisor Laurin Kasehagen, Ph.D. CDC Assignee/Lead Epidemiologist Vermont Departments of Health and Mental Health Jessica Schultz, M.P.H Injury Prevention Epidemiologist Consultant Division of Trauma and Injury Prevention Indiana State Department of Health Kaci Wray, M.B.A. Child Passenger Safety Program Manager Indiana Criminal Justice Institute (ICJI).
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Bekah Thomas, M.P.A. CS CoIIN Director
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More children and adolescents ages 1-19 die from injuries and violence than from all diseases combined.
(National Center for Health Statistics, Multiple Cause of Death Data, 2010.)
De Deaths aths 12 12,4 ,483 83 Ho Hospital spitalizations izations 441,202 ,202 ED ED Vi Visit sits 7, 7,95 954, 4,167 67
2014 (Source: CDC WISQARS query April 2017)
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Rank ank Dea eaths ths 1 Motor Vehicle Overall (3,817) 2 Homicide (2,289) 3 Suicide (2.262) 4 Suffocation / Inhalation (1,220) 5 Drowning (892) Ran ank Hospi
talizations
1 Falls (42,364) 2 Motor Vehicle Overall (39,376) 3 Self-Harm (31,839) 4 Struck By/ Against (15,102) 5 Assault (13,984) Ran ank ED ED Vi Visit sits 1 Falls (2,437,301) 2 Struck By/ Against (1725409) 3 Motor Vehicle Overall (783,402) 4 Cut/Pierce (447,214) 5 Assault (275,988)
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Cru rude de ra rate pe per r 100 00,0 ,000 00
Source: WISQARS Fatal, April 13th, 2017
2 4 6 8 10 12 14 16 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
Child Passengers Teen Occupants Suicide and Self Harm Intpersonal Violence Falls
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Cru rude de ra rate pe per r 100 00,0 ,000 00
Source: WISQARS Non-fatal, April 13th, 2017
20 40 60 80 100 120 140 160 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014
Child Passengers Teen Occupants Suicide and Self Harm Intpersonal Violence Falls
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Cru rude de ra rate pe per r 100,0 ,000
Source: WISQARS Non-fatal, April 13th, 2017
500 1000 1500 2000 2500 3000 3500 4000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014
Child Passengers Teen Occupants Suicide and Self Harm Intpersonal Violence Falls
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Rat Rate e of
Injur jury y Ho Hosp spitaliz italizati ations,
ges s 10-19 19 by Se y Sex, x, 20 2013
Source: : 2013 Healthcare Utilization Project, Nationwide Inpatient Sample 20 40 60 80 100 120
By/Against Unint. Poisoning
Vehicle Occupant Self-Inflicted Assault Female Male
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for
sele lect ct ca cause ses s by a y age grou
p, 20 2013
Age:
Source: : 2013 Healthcare Utilization Project, Nationwide Inpatient Sample 10 20 30 40 50 60 70 80 90
0-9 10-19 0-9 10-19 0-9 10-19 0-9 10-19 0-9 10-19 0-9 10-19 Falls Struck By/Against Poisoning Motor Vehicle Occupant Self-Inflicted Assault
Urban/Metro Rural
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Rat Rate e of
Injur jury y Ho Hosp spitaliz italizati ations,
ge 10-19, 19, by Race/Ethnic y Race/Ethnicity ity for
sele lect ct ca causes uses, , 20 2013
Source2013 Healthcare Utilization Project, Nationwide Inpatient Sample 10 20 30 40 50 60 70 80
By/Against Unint. Poisoning
Vehicle Occupant Self-Inflicted Assault
White Black Hispanic Native Am
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Source ce: : NCHS HS, , Multipl tiple Cause of f Deat ath h File les
5 10 15 20 25 30 35 40 District of Columbia Maryland New Mexico Nebraska Wisconsin Ohio Michigan Indiana South Dakota Montana
2007-2009 2013-2015
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Integrate evidence-based child safety practices into relevant care settings Forge collaborative partnerships across silos and state lines Streamline child safety messages and activities Increase the adoption of effective child safety interventions at state and local levels
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Teen Driver Safety Child Passenger Safety Falls Prevention Interpersonal Violence Prevention Suicide and Self-Harm Prevention
Boldly Focusing on Leading Causes of Injury
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Jen Leonardo, Ph.D. Improvement Advisor
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What are we trying to accomplish? How will we know that a change is an improvement? What change can we make that will result in improvement?
Aim Measures Changes
Plan Do Study Act
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Aim
By May 2018, we will reduce deaths, hospitalizations, and emergency department (ED) visits resulting from child passenger safety, falls, interpersonal violence, suicide and self harm and teen driving, in children ages 0 through 9 and in adolescents ages 10 through 19. Our goals are to: Decrease the rate of injury-related mortality among 0-19 year
3% relative to the participating state/jurisdiction baseline rate for the CS CoIIN topic areas.
Deaths
Decrease the rate of injury-related hospitalizations among 0-19 year olds by 3.81% 1% relative to the participating state/jurisdiction baseline rate for the CS CoIIN topic areas.
Hospitalizatio ns
Decrease the rate of injury-related ED visits among 0-19 year
4% relative to the participating state/jurisdiction baseline rate for the CS CoIIN topic areas.
ED Visits
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Process Measures
5-7 measures From the Topic Team measurement strategy Flexibility to create new measures
Outcome Measures
Fatalities Hospitalizations ED Visits
PDSA Measures
Relate to the cycle
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Outcome Primary Driver Changes
If I want to _______I need to focus on ________, one way(s) to do that is_________
Develop a theory of change using the Change Packages & your current Strategic Plan(s).
Source: National Board for the Certification of Teachers, Lisa Clark
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If I want to reduce teen fatalities from motor vehicle crashes, I need to focus on enforcing graduated drivers licensing policies. One way to do that is to leverage incentives for completion of teen driver safety programs/interventions.
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PD2 D2:
Organizational level
Or Orga ganiza nization ion al po policies icies and d pr proced edures ures su supp pport t th the e cul ultu ture e and pr practice ctice of tee een n driver er sa safety ty SD1: Enforced GDL policies, programs, and best practices
procedures to ensure teens are in compliance with state GDL law
safety programs/interventions
develop evaluation plans
Primary Drivers Secondary Drivers Change Ideas
tracking, and reporting systems
implement standard procedures for health care professionals to provide anticipatory guidance on teen driver safety to teens and parents/caregivers at adolescent wellness visits
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Develop, Test, Implement, and Spread
Source: The Institute for Healthcare Improvement
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an improvement process. For the CS CoIIN, these relate to injury-related ED visits, hospitalizations, and deaths (outcome measures). They exist for the overarching CS CoIIN, for each Topic Team, and for each Strategy Team.
Aim Statement
improvement aim you are trying to achieve. Primary drivers are typically major processes, operating rules, or structures. Secondary drivers are often system components necessary to impact primary drivers.
Drivers
A change idea can be tested and measured so a decision can be made to adapt, adopt, or abandon the idea.
Change Ideas
ideas selected
Measurement Strategy
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Stat tate e or Ju Jurisd sdiction iction Cause ause of Injur ury De Death ath Hosp sp. ED ED Visi sits ts Florida Interpersonal Violence Prevention √ √ √ Indiana Child Passenger √ √ Indiana Interpersonal Violence √ √ Kentucky Interpersonal Violence √ Kentucky Child Passenger √ Massachusetts Suicide and Self Harm √ √ Tennessee Falls Prevention √ √
States Reporting Real-Time Outcome Data
A two or more year delay before data becomes available to practitioners is typical
Innovative Data Sources
Ambulance Usage Records Traumatic Brain Injury Registries Medicaid Trauma Registries
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a group of complementary projects with a common goal
Source: The Improvement Guide, Pg. 321
Strategic Initiatives Portfolio of Improvement Projects
What you are doing to achieve your
purpose Issues you must address for the strategic initiative to succeed
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Strategic Initiatives Portfolio of Improvement Projects
Specific Infographics
Statistics
Congress
CheckPoints
up and completion of CheckPoints
collection on adherence to GDL collected by Law Enforcement Teen Driver Safety
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Develop
changing how work or activity gets accomplished
Test
trial of a new approach or a new process (change)
Implement
change a permanent part
tested under a wide variety of conditions, that demonstrate improvement, should be implemented
Spread
systematic expansion of the number and type of people, units,
implementing the change
LAURIN KASEHAGEN, MA, PHD CDC ASSIGNEE TO VERMONT DEPARTMENTS OF HEALTH & MENTAL HEALTH MAY 8, 2017
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Background 1: Injury morbidity among Vermonters, Vermont Vital Statistics System, 2010-2014
DISTRIBUTION OF INJURY TYPE (%), BY AGE GROUP
74 21 18 49 7 29 1 1
20 40 60 80 100 <1 to 14* years 15-24 years Non-Injury-related Death Unintentional Injury Intentional Injury Undetermined
LEADING CAUSES OF DEATH AS A PERCENTAGE OF ALL INJURY DEATHS, BY INTENT 99 65 2 100 38 1 35 98 62
20 40 60 80 100 Falls (31%) Poisoning (19%) Firearm (15%) MV Traffic (12%) Suffocation (8%) Unintentional Intentional & Undetermined
5/10/2017 VERMONT DEPARTMENTS OF HEALTH & MENTAL HEALTH
33 *Please note these include residents who die of congenital anomalies and other conditions occurring in infants/newborns Data from VDH Injury Morbidity & Mortality Data Briefs, 2017
Background 2: Suicidal ideation, suicidal and undetermined self-directed violence, and medicinal poisonings, among Vermont Youth 10-24 Years Vermont Uniform Hospital Discharge Data, 2010-2014, n=6,008
OVERLAPPING EMERGENCY DEPARTMENT VISITS, BY TYPE OF EPISODE
236.9 228.2 133.3 225.9 824.3 290.1 322.7 163.7 271.8 1048.2
200 400 600 800 1000 1200 2010
CRUDE RATES OF SUICIDAL IDEATION, SELF-DIRECTED VIOLENCE (SDV), AND MEDICINAL POISONINGS PER 100,000 POPULATION AMONG VERMONT YOUTH 10-24 YEARS
34 n=1687 n=1755 n=990 n=9 n=1145 n=105 n=317
Figure Legend SI=suicidal ideation SDV=suicidal and undetermined self- directed violence MP=medicinal poisonings
If we want to prevent suicide, we need to move ‘upstream’ from mortality to look at morbidity and the systems issues and social determinants that play a role in suicide Suicide prevention is a priority for the community served by Northwestern Medical Center (NMC) and Northwestern Counseling & Support Services (NCSS)
Suicide prevention is a priority for Vermont
Take advantage of momentum nationally, statewide, and locally on suicide prevention
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Located in one of Vermont’s Zero Suicide pilot counties Small and progressive community hospital with hospital champions ED has an established relationship with Northwestern Counseling & Support Services (NCSS) for crisis services
SBIRT Team conducting work in ED around alcohol and drug use NMC data feed into 4 key data systems
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NMC provides an unique opportunity to
interpreting
services
directors across the state in their monthly meetings
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NMC Health Information Systems Staff
1. Increase accurate, consistent coding for suicidal ideation, suicidal self-directed violence, and medicinal poisonings
NMC Emergency Department Clinicians & Staff
1. Increase accurate, consistent coding for suicidal ideation, suicidal self-directed violence, and medicinal poisonings in emergency department settings 2. Increase the use of evidence-based screening and assessment instruments and protocols 3. Increase the use of referral protocols
NCSS
1. Increase the use of evidence-based screening and assessment instruments and protocols 2. Improve the ability of clinicians and healthcare systems to provide clinical evaluation and treatment to individuals who are identified through screening and assessment as being at-risk for suicide
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determination
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12-2015 CS CoIIN Kickoff & Hallway Conversation 1-2016 Posed Pilot Project to State Epidemiologist 2- to 3-2016 Internal VDH & VDMH discussions 3-2016 Identified $15,000 in Prevention Block Grant funds for pilot project use 4-2016 Approached NMC with Pilot Project Concept 4- to 8-2016 VDH, VDMH & NMC ED discussions and meetings
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9-2016 VDH & NMC enter into agreement 9-2016 Identified funding for and hired project assistant 10- to 12- 2016 Observed and documented ED processes (work flow) 1-2017 Determined how SBIRT screening in ED could be adapted to include suicide risk screening questions 1-2017 Determined which suicide risk questions to test 2-2017 Started implementing and testing PDSAs in varying conditions for suicide risk screening
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3-2017 Secured an additional $15,000 in Prevention Block Grant funds for project use 4-2017 Initiated
work on claims coding practices to improve accuracy and consistency in coding 3-2017 Roll
electronic health record system in ED 5-2017 Check in with ED on status of screening and preliminary impressions / findings 6-2017 Presentation on QI project at Vermont’s Suicide Prevention Symposium
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Testing the past 2 weeks
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PDSA Tests Test Cycle Conditions for Testing Reasons for Cycle 1-1 to 1-3 conducted 2-14-2017 through 2-27-2017
Friday
6 pm
available
not engaged with another ED patient
questions of Columbia Suicide Risk questions into the SBIRT alcohol and drug use screening instrument
screener
Columbia Suicide Risk Assessment questions
SBIRT screening process
increases patient wait time in the ED
counselor for patients who screen positive
screened
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PDSA Tests Test Cycle Conditions for Testing Reasons for Cycle 2-1 conducted 3-1-2017 through 4-4-2017
Friday
6 pm
available
Counselor on site
not engaged with another ED patient
questions of Columbia Suicide Risk questions into the SBIRT alcohol and drug use screening instrument
screener
Columbia Suicide Risk Assessment questions in the new EHR environment
SBIRT screening process
increases patient wait time in the ED
counselor for patients who screen positive
screened
Note: no screening occurred between 3-11 and 4-3-2017 due to scheduling problems, new EHR, unusually high ED surge
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PDSA Tests Test Cycle Conditions for Testing Reasons for Cycle 3-1 conducted 4-14-2017 to present
Friday
6 pm
available
Counselor on site and has dedicated time to QI project
for positive patients
Counselors handle ED patients
questions of Columbia Suicide Risk questions into the SBIRT alcohol and drug use screening instrument
screener
Columbia Suicide Risk Assessment questions in the new EHR environment
SBIRT screening process
increases patient wait time in the ED
patients who screen positive
should not be screened
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PDSA Tests
Test Cycle Conditions for Testing Reasons for Cycle 4-1 conducted 4-26-2017 to present
Friday
6 pm
available
available
not otherwise engaged with a patient in the ED
site
questions of Columbia Suicide Risk questions into the SBIRT alcohol and drug use screening instrument
screener
Columbia Suicide Risk Assessment questions in the new EHR environment
SBIRT screening process
screening into daily work
increases patient wait time in the ED
patients who screen positive
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PDSA Tests Test Cycle Conditions for Testing Reasons for Cycle 5-1 conducted 4-25-2017 to present
through Friday
and 6 pm
Counselor available
site
system
document suicide risk screening in daily work
significantly increases patient wait time in the ED
questions creates an overload of patients in the ED
104 patients screened 4 positive for 1 of first two questions 2 referred for services 1 already connected to services 1 refused services 3 positive for both questions 96 not positive 1 refused
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Note: only 1/104 screenings of an individual <20 years
1 referred for services 1 already connected to services 1 refused services
We “planned” We found that We predict that . . . To increase the use of accurate coding around suicidal behaviors in Vermont emergency departments
champions
environments, slow process -- from inception to on the ground took 10 months
with decision makers
commodity’, things will go a lot more smoothly and testing will be able to move forward
involve NMC key decision makers
“right” phrases / words in documenting for ICD- 10
tools
To provide a small amount
to participate
block grant funds x 2!
$30,000 was appreciated
data
funds To provide staff support to the hospital willing to take
project assistant for 1 year
selling point
to the QI work
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Kaci i Wray, M.B.A. Child Passenger Safety Program Manager Indiana Criminal Justice Institute (ICJI). Jes essic ica Schultz tz, , M.P.H Injury Prevention Epidemiologist Consultant Division of Trauma and Injury Prevention Indiana State Department of Health
– Katie Hokanson, Jessica Schultz, Preston Harness – Booster Bash and Child Passenger Safety Technician Scholarship Program
– Kaci Wray – State Program Manager for inspection stations – Oversee electronic application\website – Operation Kids: Next Generation
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– Dr. Bull, Dr. O'Neil, and Judith Talty – State coordinator of CPST classes – Provides opportunities for recertification – Provides educational handouts
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electronic application with funds from Title V and NHTSA
reports, access to forms, and data entry
Safety Check-up Application Presentation”
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begin an iTunes account (which is necessary to download application)
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– Would not have been to use the app without the distribution of tablets from ICJI
demographics
– Forms will track household income, education level, ethnicity, race, etc.
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Preston Harness, MPH CPST Injury Prevention Coordinator Indiana State Department of Health Division of Injury & Trauma Prevention PHarness@isdh.IN.gov (314)-232-3121 http://www.in.gov/isdh/19537.htm @INDTrauma
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Please enter your questions in the Q & A box
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Wha hat t We e Kn Know w about about It It an and Ho d How w to
Prevent ent It It Wed edne nesda sday, , Ma May 3 y 31st
st,
, 20 2017 7 2: 2:00 00 – 3: 3:00 00 p. p.m.
ET
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