Mapping Injury Data to Inform Targeted Approaches to Prevention Dwayne Smith, M.Ed., M.C.H.E.S. Injury Prevention Program Manager Children’s Hospital Colorado
Mapping Injury Data to Inform Targeted
Approaches to Prevention
Dwayne Smith, M.Ed., M.C.H.E.S. Injury Prevention Program Manager Children’s Hospital Colorado
Disclosure I have no actual or potential conflict of interest in relation to this program/presentation.
The Injury Prevention Program at CHCO doesn’t generate revenue (yet), so we need to focus on prevention of uncompensated acute care costs to help demonstrate value to our organization.
How do we focus on helping the I.P. community see and understand their data, especially when they aren’t comfortable accessing or using data?
County-level datasets are insufficient to inform neighborhood-level interventions; this is especially true in population-dense areas.
2013 Population Estimates: Adams: 469,193 total 130,905 under age 18 Arapahoe: 607,070 149,946 Denver: 649,495 136,394 Douglas: 305,963 88,423 El Paso: 655,044 165,726 Jefferson: 551,798 116,981 788,375 *2.0 FTEs to this conduct outreach to this population
So how do we increase program efficiency without increasing costs? i.e., working smarter, not harder
“Share healthcare data to map patterns of … injury and create community improvements.” A Checklist of Strategies for Health Care-Community Prevention Integration, The Prevention Institute
The challenge: “… only with good data can (we) estimate the relative magnitude of problems in order to set priorities. Current data collection systems are imperfect and incomplete.” What we need: “… information that is local and community-specific.” The goal: “ … focus on E-codes to better understand the circumstances surrounding injuries.” National Action Plan for Child Injury Prevention, Centers for Disease Control and Prevention, National Center for Injury Prevention and Control
But what about the less severe injuries that occur with greater frequency and consume the majority of healthcare dollars?
2013 CO Hospital Association E.D. Visits for Injury
• Database built using Tableau software, a “data visualization product focused on business intelligence”
• Created using CDC’s Recommended framework of E-code groupings for presenting injury mortality and morbidity data
• Ages 0-19 • Mapped by zip code of residence • Includes volume, rate, and payer source by injury type • N = @111,000 • @ 160 hrs. to build frequency counts, another 20 hrs. to
convert data to rates/100,000
East Metro example: in 28.3% of incidents where hospitals provided emergency care to teenagers involved in MVCs, they were reimbursed for that care at less than 40 cents on the dollar.
Data to Action Example: Priority High Schools for TSB Challenge
80219 (SW Denver): Abraham Lincoln, Mullen 80013 (Aurora): Rangeview 80229 (Thornton): Mapleton, Thornton 80011 (Aurora): Hinkley, William Smith 80022 (Denver): Adams City, Lester Arnold 80239 (N. Denver): Collegiate Prep Academy, DCIS at Montbello, High Tech Early College, Noel Community Arts School, P.U.S.H. Academy 80012 (Aurora): Gateway, Overland 80015 (Aurora): Eaglecrest, Smoky Hill 80134 (Parker): Chaparral, Legend, Ponderosa 80221 (Denver): Northglenn, Iver C. Ranum, Skyview
… to enable us to demonstrate valid program outcomes over the next five years, using Healthy People 2020
Objectives for Injury Prevention as a benchmark.
Selected Healthy People 2020 Objectives
IVP-1.3: Reduce Emergency Department visits for nonfatal injuries Baseline: 8,370.4 ED visits for nonfatal injuries per 100,000 population occurred in 2007 (age adjusted to the year 2000 standard population) Target: 7,453.4 ED visits per 100,000 population Target-Setting Method: 10 percent improvement
Healthy People 2020 Objectives (cont.)
IVP-15: Increase use of safety belts Baseline: 84 percent of motor vehicle drivers and right-front seat passengers used safety belts in 2009 Target: 92 percent Target-Setting Method: 10 percent improvement
Sample Grant Objectives for TSB Challenge
Previously: Reduce the number of E.D. visits due to motor vehicle crash injuries among teenage occupants ages 15-19 residing in MHRETAC by 10%, from a baseline of 1,948 in 2015 to an improvement of 1,753, by September 30, 2018. Currently: Reduce the number of E.D. visits due to motor vehicle crash injuries among teenage occupants ages 15-19 residing in six targeted zip codes (80219, 80013, 80229, 80011, 80022, and 80239) by 10%, from a baseline of 435 in 2015 to an improvement of 391, by September 30, 2018.
Alignment with HRSA Maternal & Child Health Title V Block Grant Performance Measures
Within the Child Health category of the Title V performance measure domains, Measure #7 - “Injury Hospitalization” addresses injury-related hospital admissions per 100,000 children ages 0-9. Within the Adolescent Health category, Measure #7 “Injury Hospitalization” addresses injury-related hospital admissions per 100,000 children ages 10-19.
Moving Forward in 2015
• Convene stakeholders (CDOT OTS, CDPHE Prevention Services Division, RETACs, Drive Smart Colorado, etc.) to determine how these data capabilities can best inform their efforts
• Enter 2014 data and calculate volumes, rates • Employ processes and findings in larger CHCO Strategic
Plan for Population Health
Looking at 2016 and Beyond
Closing the Loop: Capturing and Reinvesting Revenues and Savings to Advance Health and Prevention; Larry Cohen and Anthony Iton, 2014.
Acknowledgements
Sean Reiter, M.B.A., Planning Analyst Children’s Hospital Colorado
Planning and Business Development