Findings from yesterday

1
Findings from yesterdays discussion

• Definition of an indicator needed
• the injury indicator signals the occurrence of a
  phenomenon
• Precise definition of an injury needs to be
  included (the blue book?)
• Something about standardisation / comparability /
  harmonisation.
• Criteria should be split into gt1 dimension
• quality
• usefulness
• practicality of measurement
• Hierarchy of criteria needed
• how much fuzziness can we tolerate

2
Criteria for a sound indicator - No

• Replace by.
• Criteria for identifying an optimal indicator

3
Criteria

• Case definition anatomical or physiological
  damage - ?
• The injury cases ascertained should be important
  (eg. in terms of disablement and / or
  threat-to-life). - Replace
• Cases should be ascertained from routinely or
  easily collected data. - Reword
• The probability of a case being ascertained
  should be independent of extraneous factors. -
  Yes
• The indicator should capture all the events in
  universe that the indicator aims to
  reflect.-Reword

4
Criteria - 1

• (A) The indicator should reflect the occurrence
  of injury satisfying some case definition of
  anatomical or physiological damage.
• (B) The indicator should reflect a well defined
  information objective.
• (C) It should be possible to use existing data
  systems, or it should be practical to develop a
  new systems, to provide data for computing the
  indicator.

5
Criteria - 2

• (D) The probability of a case being ascertained
  should be independent of social, economic, and
  demographic factors, as well as health service
  supply and access factors.
• (E) The indicator should be derived from data
  that are inclusive or representative of the
  target population that the indicator aims to
  reflect.
• Note the intention is that (E) also implies not
  going beyond the bounds of the target population

6
What about one more?

• (F) The indicator should be based on events that
  are associated with significantly increased risk
  of impairment, functional limitation, disability,
  or death, decreased quality of life, or increased
  cost.

7
One (of many) possible case definition

• Any case that dies or an injury case (classified
  by ICD) that has a probability of death above a
  predefined level, eg. based on ICISS

8
Any case that dies or an injury case (classified
by ICD) that has a probability of death above a
predefined level, eg. based on ICISS

• (A) Anatomical / physiological damage - Yes
• (B) Reflect information objective - N/a
• (C) Existing or practical new systems - Yes
• (D) Unbiased - Yes (if severity threshold high
  enough)
• (E) Representative of the target population -
  Could be
• (F) Burden - Yes

9
What now?
10
What we need to resolve

• Who are the injury indicator group?
• Let me know if you want to continue your
  involvement
• Where can we get to before Montreal?
• criteria discussion
• examples of case definitions
• critique of a few key indicators
• more??
• Work to
• identify other possible case definitions
• examine some current indicators of common interest