Australian Injury Indicators

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Australian Injury Indicators

• James Harrison
• Malinda Steenkamp
• Research Centre for Injury Studies,
• Flinders University of South Australia
• Incorporating the AIHW National Injury
  Surveillance Unit

2
Background

• Injury - National Health Priority Area
• 34 Australian Injury Indicators
• NISU report on injury indicators
• Update data source developments
• Provide technical review and specification of
  indicators
• Identify actions and processes for further
  improvements

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Australian Injury Indicators

• 12 - deaths data
• Death rate (DR) for injury in total population
• DRRatio injury status of Indigenous
  non-Indigenous populations
• 11 - morbidity data
• Hospital separation rate (HSR) for falls -
  persons 65 yrs
• HSR for near drowning - children 0-4 yrs
• Rest - other data sources/not defined
• domestic pools with appropriate
  barriers/fencing
• Access of injury patients to optimal care

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Useful and valid injury indicators?

• Purposes and topics
• Specifications
• Data sources (not discussed)
• Data quality (not discussed)

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Purpose

• Process - Purpose(s) of indicators?
• Why specified purpose?
• To guide development and evaluation
• Information requirements
• Current set - no specific purpose
• Ambiguity in specification
• e.g. indicators based on hospital data measuring
• population incidence of serious injury?
• burden of injury on acute health care services?
• something else?

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Australian Injury Indicators

• Injury indicators based on national data
• 12 based on deaths data
• (e.g. Death rate for injury in total population)
• 11 based on morbidity data
• (e.g. Hospital separation rate for falls -
  persons 65 yrs)
• Rest - other data sources/not defined
• (Total number of Australian injury indicators34)

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Purpose(s) of injury indicators

• Indicators based on national data
• To measure, and monitor change in, the population
  incidence of serious injury in Australia
  (recommended)
• Remaining indicators
• Purpose not clear (not discussed further)

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Technical specifications (1)

• Translates purpose and topic - set of definitions
  and instructions
• Specification
• Definition of a measure
• Documenting definitions and instructions
• Criteria ( after Injury ICE, Cryer, Langley, et
  al)
• Define ito anatomical/physiological damage
• Included cases should be all/well-defined sample
• Case ascertainment independent

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Technical specifications (2)

• Defined ito anatomical/physiological damage?
• NO, based on external cause codes
• (e.g. Falls in 65 - ICD-9 E880-E888)
• Reflects data situation at time of definition
• Change in situation - deaths and hospital data
• ? Redefine injury ito ICD-10(-AM) S00-T89
• Includes Medical injury (T80-T88)
• Excludes Sequelae (T90-98)

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Technical specifications (3)

• Included cases all/well defined sample?
• National deaths data collection
• All supposed to be includedNo formal
  evaluations
• National Hospital Morbidity Data Base
• Nearly all cases - small number excluded
• No formal evaluations
• Private hospital coverage - 94.4
• Not all injuries - of various types not
  incl.?
• (changes in admission policies, etc.)

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Technical specifications (4)

• Ascertainment independent?
• National deaths data collection
• In general - probably YES, some queries
• Age-related variation in querying External cause
• National Hospital Morbidity Data Base
• Only some injuries result in admission
• Some admitted cases - more than one record
• Some injury occur in hospital
• Deaths in hospital data

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Draft Framework (1)
13
Draft Framework (2)
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Two models of specification

• Minimal change model
• Better specification based on more comprehensive
  criteria - replicate explicit and implicit
  specifications that underlie indicators as
  originally specified
• Technically revised model
• Recommended revisions - now feasiblewill
  improve national data for purpose of monitoring
  population incidence of serious injury

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Technically revised model

• Specification - set of technical criteria
• Restriction of cases with anatomical/physiological
  damage
• Omitting same day cases from hospital data
• Specifying mortality indicators ito date of death
• Re-specification of all indicators ito ICD-10
  codes

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Main points

• Part of national process, for review and testing
• Most indicators refer to injury occurrence
• Purpose Measure and monitor change in population
  incidence of serious injury in Australia
• Specific products
• Better technical specification of current
  indicators based on more comprehensive criteria
  (Minimal change model)
• Recommendations for improvements re monitoring
  population incidence of injury (Technically
  revised model)

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Further development

• Indicators of injury incidence
• Implement Technically revised model after
  discussion and testing
• Ensure enough system stability to enable
  monitoring
• Implement incremental technical refinement
• Develop indicators of severe injury incidence
• Review indicator specification periodically
• Undertake quality assurance
• Propose changes to data sources where necessary
• Remaining indicators
• Assess and specify purpose(s)
• Revise, develop, introduce relevant new ones
• Develop new data sources where possible