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 & (I P EC) evaluat ion cycle • 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 of dat a. IPEC The Injury Prevention and Evaluation Cycle Injury Prevention & Evaluation Cycle Burden of I nj ury Risk Fact ors & Reassessment Reassessment Condit ions DATA DATA Monit oring Monit oring Ef f ect iveness Ef f ect iveness Planning & P lanning & Ef f iciency Ef f iciency I mplement at ion I mplement at ion
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 on 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. Injuries resulting in death Injuries requiring hospitalization Injuries resulting in treatment in emergency rooms, physicians office, etc. Injuries treated at home or injuries not treated • 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
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 of 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 � obj 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
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