Using Data to Drive Prevention in Your Community Which t ypes of - - PDF document

Using Data to Drive Prevention in Your Community

Which t ypes of inj uries are prominent in your communit y? What inf ormat ion do you need bef ore planning, implement ing or evaluat ing an inj ury prevent ion program? How can you measure success? Dat a gives your prevent ion programs credibilit y! At t his workshop we will f ocus on t he import ance of dat a in support ing ef f ect ive inj ury prevent ion programming and securing f unding. We will ident if y easily accessible and reliable sources of dat a, and you will develop a worksheet t o t ake back t o your communit y det ailing t he st eps of t he inj ury prevent ion and evaluat ion cycle. Objectives

• int roduce t he st eps of t he inj ury prevent ion &

evaluat ion cycle (I P EC)

• describe t he roles of dat a in inj ury prevent ion

(based on I PEC)

• provide sources f or locat ing dat a/ inf ormat ion

(I nt ernet sources, agencies)

How Data Drives Injury Prevention

What is t he link bet ween dat a and prevent ion? What inf ormat ion is needed bef ore planning, implement ing or evaluat ing an inj ury prevent ion program? What kind of dat a is needed? Where can t hese dat a be f ound and is it reliable inf ormat ion? How is success monit ored? The I nj ury Prevent ion and Evaluat ion Cycle is a f ramework which describes t he st eps required t o answer t hese quest ions as well as highlight ing t he role

• f dat a.

IPEC The Injury Prevention and Evaluation Cycle

Burden of I nj ury Risk Fact ors & Condit ions

Ef f ect iveness Ef f ect iveness

Ef f iciency Ef f iciency P lanning &

I mplement at ion

Planning &

I mplement at ion

Monit oring Monit oring Reassessment Reassessment

DATA DATA

Injury Prevention & Evaluation Cycle

Step 1: Burden of Injury

Which t ypes of inj uries are prominent in t he communit y? I nj uries can be described in many dif f erent ways. Dat a current ly available

• n inj uries is sort ed by t he out come of t he inj ury, be it deat h,

hospit alizat ion, or a visit t o t he emergency depart ment . The I nj ury Pyramid represent s t he dif f erences in numbers and severit y of inj uries f or each of t hese levels.

• Deat hs: f ew numbers, ext reme severit y
• Hospit alizat ions: higher numbers, high severit y
• Emergency depart ment s: very high numbers, moderat e t o high

severit y I n Canada t here is nat ional program collect ing inj ury dat a f rom emergency depart ment s. This is t he Canadian Hospit als I nj ury Report ing and Prevent ion Program (CHI RPP), including 10 pediat ric and 6 general hospit als. This program provides det ails of t he inj ury event s, however it is not a represent at ive sample of Canada. I n Brit ish Columbia, t he BC Children' s Hospit al is t he only hospit al report ing t o CHI RPP. Theref ore t he dat a only include t he t ype of inj uries seen at t his hospit al. The inj uries seen in t he emergency depart ment s in t he Nort hern I nt erior may be very dif f erent in t erms of t he inj ury event s. A new init iat ive in Brit ish Columbia is t he Emergency Depart ment I nj ury Surveillance Syst em (EDI SS). This is a pilot proj ect t horough t he BC I nj ury Research & Prevent ion Unit , wit h f unding f rom t he BC Minist ry of Healt h, Healt h Canada, as well as t he part icipat ing regions and hospit als. I nj ury dat a

Injuries treated at home or injuries not treated Injuries requiring hospitalization Injuries resulting in death Injuries resulting in treatment in emergency rooms, physicians office, etc.

is current ly being collect ed in 10 hospit als in t he Thompson Healt h Region, t he Sout h Fraser Healt h Region, and t he Nort h West Healt h Services Societ y. The int ent ion is t o expand t his syst em across t he province, wit h t he possibilit y of expanding nat ionally. Aside f rom age, sex and region of t he pat ient , t his syst em is collect ing inf ormat ion t he act ual inj ury event : When did it happen? How did it happen? Where did it happen? What was t he person doing when t he inj ury happened? What were t he inj uries? These dat a are summarized t o present a pict ure of inj uries happening in t hese regions (see workshop: How t o I nt erpret I nj ury Dat a). Types of inj ury st at ist ics include:

• Frequency
• Rat e
• I nj ury t ype

We also want t o underst and t he cost s of inj ury. Cost s may include:

• Societ al: medical services, social services, gross nat ional product
• Personal: medical, loss of employment , physical & emot ional pain
• Disabilit y: short - or long-t erm

Step 2: Risk Factors and Conditions What are t he risk f act ors f or t his t ype of inj ury? Risks are het erogeneous bet ween dif f erent groups of people. That is, one populat ion will have dif f erent risks f or a cert ain t ype of inj ury t han a separat e populat ion. Theref ore dif f erent t arget populat ions require dif f erent prevent ion st rat egies. To f ind out what we already know about t he risk f act ors f or a cert ain t ype

• f inj ury, scient if ic lit erat ure must be accessed. The best source of

inf ormat ion is evidence-based. That is, t he evidence has been collect ed

t hrough rigorous met hods t o insure unbiased result s. Anecdot al evidence is not suf f icient . Web-based resources available include:

• Medline: available t hrough some libraries & f ree over t he int ernet

e.g. PubMed at ht t p:/ / www.ncbi.nlm.nih.gov/ ent rez/ query.f cgi

• Web-of -Science (available t hrough some libraries)

Risk f act ors are present at dif f erent levels, such as personal and societ al. Personal risks can include:

• age group
• sex
• cause
• social economic st at us (SES: educat ion, employment , income)
• geographic locat ion

Societ al risks can include:

• social environment
• behaviour & at t it udes
• physical environment
• economic prosperit y
• healt h care
• healt h (disease)
• well-being

Are t hese? I f inj uries are t o be prevent ed, t he risk f act ors need t o be underst ood, and be reduced or removed. Theref ore, t hese f act ors must be bot h measurable so t hat change can be quant if ied and modif iable so t hat t hese changes can happen.

What community injury prevention programs currently exist?

I nj ury prevent ion programs are t he result of a posit ive response f rom t he communit y based on t he assumpt ion t hat prevent ion will reduce inj ury.

What inj ury prevent ion programs are current ly running in t he communit y? Are t hese programs addressing real concerns? Do t hey have at t ainable goals? Are t hey reaching t heir goals? Who is t heir t arget audience? Are resources being well spent ? Should t hese programs be cont inued? Be modif ied? Be expanded? To answer t hese quest ions, t he ef f ect iveness and ef f iciency of t he programs need t o be assessed. Ef f ect iveness describes if t he program can do what it is designed t o do, f or example reduce t he number of f alls among t he elderly. Ef f iciency describes if t his program is using it s resources in t he best manner t o at t ain t he desired result s.

Steps 3 & 4: Effectiveness & Efficiency

I nj ury Prevent ion Program Evaluat ion (see workshop "How t o Plan and Evaluat e a Prevent ion Program)

• Process Evaluat ion: t he st eps of t he program
• Out come Evaluat ion: t he result s of t he program

To collect t he inf ormat ion and dat a needed t o evaluat e a prevent ion program, reliable & valid t ools may be required. Reliable means t hat t he t ool will produce similar result s under similar circumst ances. Valid means t hat t he t ool is really measuring what it is supposed t o be measuring. Met hods f or collect ing inf ormat ion include quant it at ive (quant it y = numbers) and qualit at ive (qualit y = descript ions). Quant it at ive Met hods:

• survey
• count ing
• document review (secondary dat a)

Qualit at ive Met hods:

• f ocus group
• personal int erview
• observat ion
• case st udies

Select ion of dat a element s can be inf luenced by many f act ors, including: et hical & privacy issues

• bj ect ivit y of invest igat ors

f inances, t ime, t echnical expert ise polit ical support Step 5: Planning & Implementation (see workshop "How t o Plan and Evaluat e a Prevent ion Program) I n order t o bot h plan & implement , as well as t o evaluat e a program, very clear goals and obj ect ives are needed. Obj ect ives need t o be: Specif ic Measurable Act ion-orient ed Realist ic Time-limit ed PLANNI NG The f ollowing t opics must be addressed: goals & obj ect ives cost s of running t he program social pref erences social expect at ions f easibilit y: t echnological, polit ical & f inancial I MPLEMENTI NG How will t he program be implement ed? What is t he program addressing? Examples: educat ion environment modif icat ion advocacy

Step 6: Monitoring / Surveillance Monit oring a prevent ion program can t ake bot h short - and long-t erm

• ut comes int o account . Ult imat ely t he impact t he program has had on t he

communit y is of int erest . Have inj uries or t he consequences of inj uries been reduced? EVALUATE Now comes t he t ime t o evaluat ion t he new program. This is t he same as st eps 3 & 4: Ef f ect iveness & Ef f iciency. The plan f or evaluat ion should be developed as part of t he program planning process so t hat t he required inf ormat ion will be collect ed, and t ime and resources f or t he evaluat ion allocat ed in t he budget . There are dif f erent t ypes of evaluat ion st rat egies t hat f ocus on dif f erent aspect s of t he program (see workshop "How t o Plan and Evaluat e a Prevent ion Program). These include process, impact , out come and ef f iciency. Evaluat ing t he delivery of t he program: Process Evaluat ion Was each st ep complet ed? Was t he t arget audience reached? Was t he inf ormat ion/ equipment delivered? What was t he: % populat ion covered? # program part icipant s? # recommendat ions developed? # new laws/ regulat ions creat ed? # persons t rained? Evaluat ing t he short -t erm out comes of t he program: I mpact Evaluat ion Was t here a change in: knowledge

at t it ude behaviour skill risk f act ors Evaluat ing t he long-t erm out comes of t he program: This st ep requires select ed markers represent at ive of t he issue surveillance syst em f or t he populat ion These can be provided by st andard dat a collect ion current ly available, such as mort alit y and hospit alizat ion dat a, or dat a collect ed by specif ic

• rganizat ions, e.g. drowning dat a collect ed by t he Red Cross.

Out come Evaluat ion Did t he program achieve: reduced mort alit y (deat hs) reduced morbidit y (hospit alizat ions) reduced healt h care cost s reduced personal cost s reduced disabilit y

Step 7: Re-evaluation

What changes in t he Burden of I nj ury have occurred? Should t he program cont inue as is? Adopt changes? End? Finally, t he ef f iciency of t he program needs t o be assessed and re-assessed. I f t he program is ongoing, t hen t he ef f iciency will need t o be assessed

• periodically. A program t hat is ef f icient in it s f irst mont h or year may not be

ef f icient in f ive years. Ef f iciency select perspect ive: government , societ y est imat e cost s of int ervent ion and ef f ect on out comes describe cost s & benef it s t hat could not be measured

Sources of Data

BC Vital Statistics

http://www.vs.gov.bc.ca/

• Mortality Data

Dave.ONeil@gems8.gov.bc.ca

BC Ministry of Health

• Hospitalization Data

Office for Injury Prevention: Nader Farid: nader.farid@moh.hnet.bc.ca

• Health Care Providers Data

Karlic Ho Information and Analysis, BC Ministry of Health karlic.ho@moh.hnet.bc.ca

• Ambulance Services

www.hlth.gov.bc.ca/bcas telephone: (250) 952-0888

• BC Ministry of Health

http://www.gov.bc.ca/hlth/ Preventive Health Programs (Injury Prevention) Health Files – facts about injury rates, risks, prevention tips, other links Child Care – preventing injuries in a child care setting Publications – government reports/publications Provincial Health Officer Annual Report

• Health Data Warehouse

http://www.hdw.moh.hnet.bc.ca/hdw/index.htm *see "Access to the Health Data Warehouse"

BC Stats:

http://www.bcstats.gov.bc.ca/ *see attachment Quick Facts About BC Community Fact Sheets Provincial Electoral District Profile

BC Drug & Poison Information Centre

• St. Paul's Hospital

1081 Burrard St. Vancouver BC V6Z 1Y6 1-800-567-8911 (604) 682-5050 (local) (604) 631-5262 Fax e-mail: daws@dpk.bc.ca http://www.vcn.bc.ca/dpic/ *see attachment

Red Cross

http://www.redcross.ca/ drowning research

ICBC:

http://www/icbc.com Road Safety Geared 2 Youth Auto crime & Fraud Commercial Vehicles In Your Community

WCB

http://www.worksafebc.com Occupational safety Youth

Municipal Statistics

Ministry of Municipal Affairs publication: “Municipal Statistics, Including Regional Districts” Ministry of Municipal Affairs – www.gov.bc.ca/marh Statutes – www.qp.gov.bc.ca/stat_reg/sup-acts.htm distance and types of roads area of parks, playgrounds water supply sewer services

Library Branches

Ministry of Municipal Affairs, Library Services Branch www.marh.gov.bc.ca/library/types.html types and locations of library branches

Sports Areas, Community Centres

BC Recreation and Parks Association www.bcrpa.bc.ca publications, e.g. BC Recreation and Sports Guide (hardcopy publication)

• ther resources ie., BCRPA Arena Survey, Aquatic Facility Survey

BC Chamber of Commerce – www.bcchamber.org

Liquor Distribution

British Columbia Liquor Distribution Branch, Annual Report, Ministry of Attorney General (hardcopy publication) www.gov.bc.ca/ag Annual Sales

Elections BC

http://www.elections.bc.ca/

General Helpful Source

Vancouver Public Library, Social Sciences Research Department

Product Recalls

CBC "Marketplace" http://cbc.ca/consumers/market http://www.babyresource.com/recalls.htm http://notice.com (Canada & USA) http://www.safetyalerts.com/ Consumers' Reports http://www.consumerreports.org National Highway Traffic Safety Commission (USA) http://www.nhtsa.dot.gov/cars/problems/recalls/recmmy1.cfm http://familyeducation.com/topic/front/0,1156,1-3508,00.html http://www.hipimplantlaw.com/product_nos.htm http://www.findarticles.com/m3289/3_169/61759523/p1/article.jhtml Good Housekeeping http://goodhousekeeping.women.com/gh/buysmart/recalls/00reca21.htm Food Safety and Inspection Service (USA) http://www.fsis.usda.gov/OA/news/xrecalls.htm Consumer Product Safety Commission http://www.cpsc.gov/cpscpub/prerel/category/topic.html http://www.keepkidshealthy.com/welcome/recalls.html

Sources of Funding

Funding Opportunities http://fundingopps2.cos.com Charity Village http://www.charityvillage.com

Access to the Data Warehouse Because of a licensing agreement with BC STATS, access to the HDW is currently restricted to Ministry of Health and related staff in health authorities and Ministry for Children and Families. Public health nurses can register for free access to HDW (since they work for a health region). Basically, whenever anyone (e.g. health professionals, students, contractors, etc) request access to the service, we review their registration information -- particularly, their title, host organization, address -- and decide whether or not to grant access. If a person does not work for MOH, MCF, nor health authority, but is on contract with any of these organizations, they may be granted access upon sending more information regarding the contract (e.g. supervisor, phone number, duration of contract). Please follow the steps below to begin the registration process: Using a web browser (e.g. version 4 of Netscape, Internet Explorer):

• 1. Register at the Health Matters Web Site (http://admin.moh.hnet.bc.ca/) - 'New

Users Register Here!'

• 2. Using the user-id/password from the Health Matters registration (step 1) go to

the HDW web site registration page (http://admin.moh.hnet.bc.ca/hdw/regform.html), complete the form, and press 'Submit access request'. Confirmation of the access request will be returned by e-mail. Health Data Warehouse web support Ministry of Health hdw@moh.hnet.bc.ca

Prevent ion Program Work-Sheet

A single prevent ion program can not be ef f ect ive and ef f icient in every set t ing. I nj ury Prevent ion st rat egies must be specif ic t o t he issue and t he t arget populat ion! Prevent ion Programs need t o be cust om designed! J ust because somet hing worked in one communit y does not mean it is t he best plan f or you. The f ollowing worksheet will assist you in ident if ying prominent areas f or inj ury prevent ion in your communit y. You will be prompt ed t o consider t he t ype of inf ormat ion needed at each st ep, and pot ent ial sources f or t his inf ormat ion. The success of your program depends on how well it is planned out !

Burden of I nj ury Risk Fact ors & Condit ions

Ef f ect iveness Ef f ect iveness

Ef f iciency Ef f iciency P lanning &

I mplement at ion

Planning &

I mplement at ion

Monit oring Monit oring Reassessment Reassessment

DATA DATA

Injury Prevention & Evaluation Cycle

Which t ypes of inj ur ies are prominent in your communit y? What is t he bur den of inj ur y?

I nf ormat ion Needed Where t o f ind I nj ury St at ist ics

Injuries treated at home or injuries not treated Injuries requiring hospitalization Injuries resulting in death Injuries resulting in treatment in emergency rooms, physicians office, etc.

What ar e t he known or suspect ed risk f act ors f or t his t ype of inj ury? Are t hese measurable and modif iable?

Known or Suspect ed Risk Fact ors Where t o f ind Research Personal Societ al

What communit y pr event ion pr ogr ams cur r ent ly exist ?

Are t hese programs ef f ect ive and ef f icient ? Do t hese programs address real needs and concerns? Do t hese programs have goals & obj ect ives? Can t hese programs reach t heir goals? Who is t he t arget audience? Are resources being used wisely? Biggest bang f or t he buck? Should t hese programs be cont inued? Be modif ied? Be expanded? Det ails of Exist ing Programs Where t o f ind I nf ormat ion

What inf ormat ion do you need t o plan & implement a pr event ion program?

Are t here inj ury concerns t hat are not being addressed? Should a new prevent ion program be planned? What will be t he goals of t his new init iat ive? Are t hese goals measurable? New I nit iat ive Where t o f ind I nf ormat ion Plan I mplement

How will you evaluat e t he success of your init iat ive?

What are you t rying t o show? What inf ormat ion do you need t o measure change in t he communit y? I s t his inf ormat ion already being collect ed? Do you need t o collect t his inf ormat ion? Element s t o Evaluat e Where t o f ind I nf ormat ion Process I mpact Ef f iciency

How will you monit or your inj ury prevent ion program?

How long will your prevent ion program run? How quickly can you expect t o see a change in inj ury? How will you know when t he program is no longer needed? I s t his inf ormat ion already being collect ed? Prevent ion Program Out comes I nf ormat ion t o Measure Change Short -t erm Long-t erm

Who will f und your prevent ion program?

St rengt hs of your proposal Pot ent ial Funding Sources