Transcript Conference Presentation

Understanding Injury:
What are the Indicators?
Ian Pike, PhD
Canadian Injury Indicators Team
Director. BC Injury Research and Prevention Unit
Asst. Professor, Pediatrics, UBC
Alison Macpherson, PhD
Canadian Injury Indicators Team
Asst. Professor, Kinesiology and Health Science, York
University
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Purpose of this Presentation
• To provide a brief introduction to Injury Indicators and
some of the work of the Canadian Injury Indicators Team
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Injury Indicator Definition
(Pencheon, 2008)
• Indicators are succinct summary measures that describe as
much about a system as possible
• Injury indicators provide a clear signal and help us understand
what is happening; they allow us to compare the injury situation
between groups and places, and over time
• Indicators are more than measures and signals; they must also
drive decision and action (i.e. they inform policy, practice and
research)
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Indicators are like a Dashboard
• Car Dashboard has several
indicators that are measures
that tell you your speed, how
much gas you have, engine
temp., what gear you are in,
engine revs., etc.
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Why Indicators?
•
Ready reference - easily
understood
•
Clear signal – in this case, they
signal what is happening in
regards to child and youth
injuries
•
Prompts action – gives an idea of
what to do
Inuksuit are indicators - different
forms have different purposes:
e.g. to show directions to
travelers, to warn of impending
danger, to mark a place of
respect, or to act as helpers in
the hunting of caribou
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There are hundreds of indicators…
Which ones are most useful?
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Child and Youth Injury Indicators: Work to Date
Burden of Injury
among Canadian
children & youth
National Child and
Youth Health Coalition
Initiative
The Canadian Injury Indicators Team:
a)
b)
c)
Previous
Research
d)
Injury Indicators for Canadian Children and Youth
Injury Indicators for Canadian First Nations and Inuit
Children and Youth
Injury Policy Indicators and their Associated Risk
Factors and Outcomes
CIHR Team in Child and Youth Injury Prevention
(LOI stage)
Canadian Injury Indicators
Development Team:
Child & Youth
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Canadian Injury Indicators Team
Principals
Co-investigators
Collaborators
Dr. Alison Macpherson, York
Dr. Ronald Barr, UBC
Health Canada
Dr. Ian Pike, UBC
Dr. Parminder Raina, Mac
Safe Kids Canada
Dr. Lynne Warda, UoM
Dr. Shelina Babul, UBC
SmartRisk Foundation
Dr. Natalie Yanchar, IWK
Dr. Ediriweera Desapriya, UBC
Canadian Collaborating
Centres for Injury Prevention
and Control
Ms. Allyson Hewitt, Safe Kids
Dr. Colin Macarthur, UoT
Public Health Agency of
Canada
Dr. Morad Hameed, UBC
Canadian Institute for Health
Information
Trauma Association of
Canada
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Methods
• Phase 1 – Defining Criteria and Establishing Domains
• Phase 2 – Literature Review
• Phase 3 – Selection of existing indicators and creation of new
ones: Expert panel meeting
• Phase 4 – Modified-Delphi Process
• Phase 5 – Specification of Indicators
• Phase 6 – Modified-Delphi II - Broader input through survey
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Criteria
(Rigby, et al., 2003)
• Evidence-based, underpinned by research
• Significant burden to society, the family and the
individual
• Representative of significant population groups
• Data availability
• Topic amenable to effective action
• Understandable to broad audience
• Regularity and repeatability to enable trend analysis
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34 Injury Indicators
• Outcome Indicators
– e.g. mortality, PYLL, hospitalization
• Risk Indicators
– e.g. child restraints, young drivers, drunk driving, rural,
residential swim pools
• Policy Indicators
– e.g. GDL, bicycle helmets, playground CSA standards,
window guards, hot water tank
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Definition & Specification of Indicators
•
Indicator Definition
•
Definition of Relevant Terms
•
Justification for this Indicator
•
Operational Definition of a Case
•
Method of Calculation
•
Numerator
•
Denominator
•
Data sources, availability and
quality/years represented
•
Units of measurement
•
Guide for Use
•
Scope of Indicator
•
Specification of Data Needed
•
Limitations
•
How to Use this Indicator
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Bicycle Helmet Legislation
Sport and Rec/Motor
Vehicle Domains
Indicator #19
Policy
Indicator Definition
Percentage of provinces/territories with comprehensive laws requiring use of bicycle helmets that
meet the ‘best practice’ helmet laws, currently set by the one enacted in Nova Scotia (2007).
Definition of Relevant
Terms
‘Best practice’ means that the following law was adopted based on evidence (see justification for this
indicator).
Bike Helmet Law:
July 1, 1997—Bike helmet use is required for all ages. ($25 fine)
May 30, 2002—Anyone using inline skates, scooters and skateboards is required to wear a
safety helmet. (minimum $25 fine)
Justification for this
indicator
Helmet laws have been shown to be effective in increasing the use of bicycle helmets and reducing the
incidence of bicycle-related head injuries (Macpherson et al, 2000). Helmet laws that require bicyclists of
all ages to wear helmets, as well as those using in-line skates and scooters, are now considered to be the
‘best practice’ laws.
About 50 Canadian children and adolescents die each year from bicycle-related injuries, and 75% of all
bicycle-related deaths are due to head injuries. Although the use of helmets can reduce the risk of head
injury by 85%, the rate of voluntary helmet use continues to be low (LeBlanc, 2002).
Operational
Definition of a Case
Each province/territory is a case.
Method of Calculation
(Number of provinces and territories in each category/total number of provinces and territories) x
100
Numerator
Province or territory in each category
Injury Indicators for Children and Youth
All Domains Indicators
Mortality Rate
Years of Life Lost
Sport, Recreation, and
Leisure Injury Indicators
Cost of Sport and Recreation Injuries
Hospital Separations Rate
Overall Health Service
Implications Indicators
Diagnosis-Specific Hospital Separations
Percentage of Sport Specific Injuries
(Participation Rates)
Hospital Admission, Injury Severity 1
Requirements that Playgrounds Meet CSA
Standards
Hospital Admission, Injury Severity 2
Legislation Requiring Pool Fencing
Length of Stay in Hospital
Motor Vehicle Injury
Indicators
Bicycle Helmet Laws
Other Policy Indicators
Provincial Stand for Hot Water Tap Temp
Cost of Motor Vehicle Injuries
Violent Crime Rate
Crash Rate
Inflicted Childhood Neurotrauma Rate
Intersection Crash Rate
Suicide Prevention
Rural Roadways
Drunk Driving
Speed
Young Drivers
Graduated Driver Licensing
Child Restraints
Unrestrained Injuries
Child Restraint Laws
Window Guard By-law
Anti-Violence/Anti-Bullying Policies
Trauma Care, Quality and
Outcomes Indicators
Access to Pediatric Level I Trauma
Care/Centre (PTC)
Appropriate Use of Pediatric Level I
Trauma Care/Centre (PTC)
Quality of Trauma System
Pre-hospital Transport Time
Presence of a Coordinated Pediatric
Trauma System
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Rating of Overall Indicators
9
Rating of Overall Indicators
Usefulness
Actionability
8
7
Average Rating
6
5
4
3
2
1
0
Mortality rate
Dx-specific hospital
separations
Hospital admission
severity
Hospital separations
PYLL
Length of stay
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Rating of Motor Vehicle Indicators
Motor Vehicle Specific Indicator Ratings
Usefulness
9
Actionability
8
Average Rating
7
6
5
4
3
2
1
0
Drunk driver
crashes
Unrestrained
passengers
crashes
Young driver
crashes
Child restraint
use
M otor vehicle
crash rate
Speed related
crashes
Cost of
crashes
Graduated
licensing
Rural
roadways
Booster seat
law
Intersection
crash rate
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Rating of Violence Indicators
Violence Ratings
9
Usefulness
Actionability
8
7
Average Rating
6
5
4
3
2
1
0
Violent crime rates
Inflicted childhood neurotrauma
rate
Schools w ith bullying prevention
programs
Schools w ith suicide prevention
programs
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Rating of Policy Indicators
Policy Indicator Ratings
9
Usefulness
8
Actionability
7
Average Rating
6
5
4
3
2
1
0
Presence of
graduated
licensing
Bicycle helmet
law
Presence of a
booster seat
law
Presence of a Law requiring
pediatric trauma playgrounds to
system
meet CSA
standards
Legislation
requiring pool
fencing
Provincial
standards for
hot w ater
temperature
Window guard
by-law s
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Results
• From the initial list of 51 indicators, a refined list of 34
indicators was established
• Indicators were grouped into Policy Indicators, Risk Factor
Indicators, and Outcome indicators
• In general, indicators related to motor vehicle crashes and
overall injury indicators ranked the highest
• Indicators related to violence and trauma care ranked lower
for usefulness and much lower in their ability to prompt
action
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Related Projects: Policy Indicators (CIHR)
GOALS:
• A greater understanding of the elements related to
successful injury prevention policies and their interaction
with injury risk factors and outcomes
• Improved injury-related policies across Canada
• Reduced injury among Canadian children and youth
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Related Projects: Injury Indicators for First Nations and Inuit
children and youth
•
•
•
Health Canada’s First Nations and Inuit Health Branch supported a parallel
development of indicators
Mirrored same process as original project
33 indicators defined and specified in the following domains:
- Indicators that will be measured across all injury areas
- Animal Bites
- Hypothermia/Frostbite
- Violent/Inflicted Injury
- Burns and Falls
- Drowning
- Suicide
- Motorized Vehicle Collisions
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Project Goal
• To use an evidence-informed approach to develop a list of
injury indicators for First Nations and Inuit children and
youth
• Final list of indicators must be useful in prompting action to
prevent injuries among First Nations and Inuit children and
youth
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Methods
• Phase 1 – Literature search
• Phase 2 – Advisory Group brainstormed list of indicators
• Phase 3 – Refinement of indicators using a modified Delphi
process: we asked groups to give feedback and to rank indicators
based on criteria
• Phase 4 – Indicator specifications written
• Phase 5 – Feedback on specifications
• Future – Planning for validation and implementation of indicators
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Injury Indicators for First Nations and Inuit Children and Youth
INDICATORS
THAT WILL BE
MEASURED
ACROSS ALL
INJURY AREAS
Mortality Rate: Number of deaths due to each
injury area
BURNS AND
FALLS
Presence of working smoke detectors and tested fire
extinguishers in homes
Proportion of self-reported burns to children and youth
as well as the self-reported circumstantial details of each
case
Number of children/youth hospitalized due to
each injury area
Number of Substance Use Related Injuries
Number of communities that have culturally
appropriate alcohol /drug programs available for
community members
Presence of a disaster communication plan for
community (i.e. Flooding, fires, blizzards, etc.)
DROWNING
Number of self-governing features that exist in
the community
ANIMAL BITES
Proportion of community members who complete
culturally appropriate injury prevention training, by age
Number of communities with access to water safety
education / programs
Rate of injuries due to dog bites and maulings in a
community
Enforcement of laws related to water
Number of communities with Animal Control
Services
HYPOTHERMIA/
FROSTBITE
Rate of children and youth who experience
hypothermia or frostbite by age
VIOLENT/
INFLICTED
INJURY
The rate of police calls and charges involving
children and youth and related to violent injury
Number of water rescues by Emergency Response
Teams (such as Search and Rescue or Lifesaving
Society)
Number of children and/or youth (ages 0-19) drowning
in each body of water type each year
Percentage of children/youth (0-19) enrolled in ‘learn to
swim’ programs in a specific year
SUICIDE
The self-reported rate of inflicted injury (assault)
among First Nations/Inuit children and youth (not
self-inflicted)
Access to Mental Health Promotion Programs and
Traditional Healing: Number of communities with mental
health and wellness promotion programs
The rate of self-reported poor mental health among
children and youth
Percentage of violent offenders participating in
restorative justice
The rate of suicide attempts/self harm among First
Nations and Inuit children and youth
Availability of fire and ambulance services in a
community within a defined response time
The number (rate) of calls to suicide prevention crisis
telephone services, by geographical region
Where do falls to children and youth happen (this
refers to self-reported falls to children and youth
within the last 12 months)
MOTORIZED
VEHICLE
COLLISIONS
Number of motor vehicle collisions involving First
Child &
Nations or Inuit children and/or youth
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Injury Indicators for First Nations and Inuit Children and Youth
(continued)
MOTORIZED VEHICLE
COLLISIONS (continued)
Number and proportion of seriously
injured or killed First Nations or Inuit
occupants (0-19 years of age) who were
unrestrained (not wearing a seatbelt)
Youth access to Driver Education
Courses – skills for car, snowmobile,
boat, and ATV drivers
Percentage and proportion of proper use
of child vehicle restraints (carseats) and
booster seats
Age and sex of First Nation or Inuit
driver and occupants involved in a motor
vehicle crashes (including cars, ATVs,
and skidoos), as well as road user type
Presence of legislation of minimum age
to drive an ATV. Number of provinces
and territories with legislation of
minimum age to drive an ATV
Number and proportion of seriously
injured or killed children and youth (019 years of age) who were not wearing a
helmet while riding ATVs, snowmobiles,
and/or bicycles
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What Now?
• Continue work on policy indicators project
• Publish two plain-language summaries of injury indicators
1)First Nations and Inuit children and youth indicators and
2)Mainstream Canadian children and youth indicators
• Work toward validation of the indicators
• Work toward making a ‘dashboard’ of indicator data
available through a child and youth injury web portal
• Prepare future grant proposals to support community level
injury prevention surveillance
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For more information, please contact:
Alison Macpherson at York University
[email protected]
Ian Pike at BC Injury Research and Prevention Unit (BCIRPU)
[email protected]
Shannon Piedt at BC Injury Research and Prevention Unit
(BCIRPU)
[email protected]
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Acknowledgements
Funding:
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Thank you
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First Nations and Inuit Health Branch
Centre for Community Child Health Research
Child and Family Research Institute
Child Health BC
University of British Columbia
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