Implementation of Surveillance System in an Emergency Department for Injury Prevention and Public Health Surveillance 傷害監察系統在預防傷害及公共衛生的應用

Transcription

1 The Asian Pacific ICT 2009 Award in Melbourne - Merit Award in E Health Silver Award of the HKICT 2009 in the Category of Best Public Service Implementation of Surveillance System in an Emergency Department for Injury Prevention and Public Health Surveillance 傷害監察系統在預防傷害及公共衛生的應用 CB Chow, Leung Ming, Adela Lai, YH Chow, Albert Lit et al Centre for Safety Promotion and Injury Prevention Kwai Tsing Safe Community and Healthy City Princess Margaret Hospital

2 Content of Presentation 內容 Injury Statistics and Nature of Injuries 傷害數據 Injury Surveillance System 傷害監察系統 Kwai Tsing Safe Community & Healthy City 葵青安全社區及健康城市 Development of Injury Surveillance System 傷害監察系統的建立 Applications of the Injury Surveillance System 傷害監察系統的應用 Achievements 成果 Future Consideration 展望

3 Injury death rates by sex and age group, 2006 (HK) Injury Statistics 因受傷死亡的數據 - 5th causes of death, 3 rd burden, 9% GDP Non-Communicable Diseases Aware Volume 4 Issue 10 PRODUCTION LOSS >> HK$ 4,389 million<< 生產力的損失

4 Burden of hospital cost by injuries in HK 傷害對醫療費用的負擔 Trend analysis of injury related hospital cost Injury Statistics ED Attendance cost (HK$ million) Hospital bed day cost (HK$ million) ICU bed daycost (HK$ million) Totalcost (HK$ million) Average Annual Direct Medical Cost on Injury ~ HK$ 2,000 million

5 Nature of Injuries Injuries are NOT accidents.injuries can be prevented by 50-70% 受傷不等於意外受傷是可以避免的 ACCIDENT

6 Predicted cost reduction by % of injury related ED attendance 急室受傷個案的醫療費用預測 Predicted annual cost reduction on injury 1% 5% 10% 15% 20% Injury Statistics Reduced no. of ED attendance Reduced no. of Hospital admissions Reduced no. of emergency operations Reduced no. of Hospital Bed day consumptions Reduced no. of ICU bed day consumptions Injury cost saving (HK$ million) 減少受傷醫療費用 ( 百萬 )

7 以系統為主的預防傷害及暴力個案 (1) Gather info to identify problem and population Nature of Injuries (6) Evaluate and Revise (5) Implement the Plan A Systems Approach to Injury Control and Violence Prevention (4) Develop the Implementation Plan (2) Identify Strategies (3) Choose Strategies Source: Violence and INjury Control through Education, Networking and Training On the World Wide Web (VINCENT WEB)

8 有效的傷害預防的力量 Data (+) Key Stakeholders Nature of Injuries (-)) Key Stakeholders Existing Efforts Effective Injury Prevention Efforts Injury Prevention Strategy Exists Knowledge of how injuries are occurring Political Climate Target Audience Slide adopted from

9 Purposes of an Injury Surveillance System: 傷害監察系統的目的 Injury Surveillance System Information to support injury prevention & control - Support planning and policy-making - Guide targeting and priority-setting Risk population- Measuring and monitoring injury, its consequences, Risk mechanism injury risk-factors and exposure to them Risk environment - (Contributing to) evaluation of interventions Risk behaviour Epidemiology - incidence Pattern type, place, time Demographics especially those not directly observable Mortality Morbidity Disability COST

10 安全社區是預防傷害有效的模式 傷害監察系統是量度安全社區的指標 Injury Surveillance System Safe community is a proven intervention model to reduce injury in the community by engaging local community using local data Target high-risk groups and environments Promote safety for vulnerable groups Document the frequency and causes of injuries Evaluation measures It could be achieved by Injury Surveillance Regional Framework for Action on Injury Prevention The first core task of health sector recommended by WHO: Injury Surveillance

11 Kwai Tsing Safe Community Inaugurated in October 2000

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13 Designated by WHO to be the 73 rd Safe Community on 18 March 2003

14 Reduction in injuries attending AED via general and targeted public education and setting approach Age vs 02 < % % % % % % >= % Total %

15 Development of Injury Surveillance System Injury Surveillance System 傷害監察系統 Piloted in AED of PMH in 2003 Analyzed 2000 cases Funded by OSHC, collaborated with HK Poly U, An Injury Surveillance System was designed To integrate existing system with coding of data All injured cases were assessed by triage nurse Injury data input paper form web form Injury databases ICD-9 CM, AIS and ISS AEIS demographics, 8 categories, triage priorities for treatment, sick leave, outcome/disposal, XR ICECI intent, place, activity, mechanism, nature, type, severity score, drugs, TRAFFIC, ASSUALT linked to CMS/CDARS - cost

16 Development of Injury Surveillance System Paper entry form before the web-based input system

17 Development of Injury Surveillance System Data capture at the Triage Station of AED

18 Development of Injury Surveillance System Triage station and Computer System for data input 分流站及電腦系統 integrated into work flow

19 Development of Injury Surveillance System The 3 rd version system with GIS and Body Mapping Simple & Non-distracted user interface Customizable data field Minimal stages for data entry Fit the actual situation of ED triage process Simple and efficiency Time needed: 25 seconds 簡單易用的介面 只需 25 秒 Facilitated input of data

20 Development of Injury Surveillance System 國際受傷分類系統及代碼自動化 Place Activities Intent Mechanism Nature of Injury Site of Injury Standardization of injury definitions ICECI international classification of external cause of injury Automatic mapping to ICECI Time saving of 15 mins per case in average

21 Development of Injury Surveillance System GIS interface for event location Outdoor injuries as a major portion 33.41% Traffic Injury/ Falls Injury is the Leading cause. 事故發生地點以地理資訊介面輸入

22 Development of Injury Surveillance System Interactive body mapping for injury coding International Disease Coding ICD 10 & AIS 05 身體圖像受傷部位輸入 Support real time diagnosis coding Time saving of 8 mins per case in average

23 Development of Injury Surveillance System User Oriented Reporting Modules Trend Monitoring, Spatial Clustering and Scenario Based Search Functionalities 預設各類型報告設計 Standard reporting preset format Reporting by ICD injury coding Reporting by AIS scale Injury charts

24 不同地區的受傷個案 Development of Injury Surveillance System 受傷個案的身體部位

25 公共屋邨的受傷個案及年齡分佈

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27 Applications of Injury Surveillance System Correlation studies. digitalized geo-coding of injury events Spatial analysis by maps tools. Clustering and evaluate the relationship to the location of polygons/facilities. Inferential statistics will be employed to identify the identification of clusters of excess or clustered of deficit given by road casualty weighted road density exposure. 採用各種地理資訊分析工具 Buffer analysis Map overlay Proximities analysis Network analysis

28 Applications of Injury Surveillance System Real time connection to GIS Analysis Tools - Exploratory Spatial Analysis Mapping to useful attributes: Social contextual factors Weather Seasonality 即時數據分析及圖表報告

29 Achievements 2 nd Hospital Implementation Caritas Medical Center 明愛醫院 Falls in U Chau Selfharms

30 Achievements 3 rd Hospital Implementation Sports injury Tseung Kwan O Hospital 將軍澳醫院 Bicycl e

31 Applications of Injury Surveillance System Collaboration model of Targeted Injury Prevention & Control Injury surveillance Data analysis Fall injury Child injury Elderly injury Other injury.. Safe Community Coalition Safety Specialist Government Agencies/Agency Prevention program Prevention program Prevention program Prevention program.. 傷害預防及監測的協作模式

32 Applications of Injury Surveillance System Clustering of Elderly Injuries 老人跌倒 high costs

33 Inclusion criteria: by case volume and number of residents Intervention RCHE 1 & 2 Two Control RCHE s Site assessment and plan development Optional interventions, plan implementation, reporting system and regular review meeting 1 st measurement 2 st measurement 3 rd measurement Site assessment and evaluation Evaluation on data only

34 Case identified from injury reporting system No intervention Recurrent incident Single Incident Host problem Check for host problem e.g. gait/balance/disease No problem Case identified from hospital injury surveillance system Injury evaluation Assessment includes Hx, disease, medications, vision, Gait and balance, Specific multi-fact oral intervention > optional interventions Mx algorithm for identified cases and referral

35 Achievements Cost Benefit Ratio = 1: 2.68 預防跌倒計劃 - 成本效益分析 Intervention subject 1 Intervention subject 2 Injury Total Cost Injury Saving Cost = HK$ Saving 268, = HK$ ( reduced 321, %)

36 Leading cause of death for aged years. Applications of Injury Surveillance System Traffic Injury 因交通意外受傷個案 Each year nearly people under 25 die on the world s roads on average more than 1000 a day. (WHO 2008)

37 Applications of Injury Surveillance System Road Safety Project 道路安全研究

38 Applications of Injury Surveillance System Road Safety Project

39 Achievements Stake holders to share the Traffic Safety Studies Police Experts from Australia Experts from Sweden Hospital University Transport Safety Professionals

40 Applications of Injury Surveillance System Suicide & Self-Harm 自殺及自殘 Every year, almost one million people die from suicide A "global" mortality rate of 16 per 100,000, or one death every 40 seconds. In the last 45 years suicide rates have increased by 60% worldwide. Suicide is among the three leading causes of death among those aged years

41 Applications of Injury Surveillance System Suicide & Self-Harm 自殺及自殘個案分析 Project title: A retrospective study on deliberate self-harm (DSH) behaviors in Kwai Tsing based on Injury Surveillance

42 Applications of Injury Surveillance System Trend Analysis of Drug Overdose _ suicide _977.9(3) by Age 吸毒個案趨勢分析 年齡組別 / /

43 Applications of Injury Surveillance System Understanding of Suicide & Self-Harm 增加對自殺及自殘個案的了解

44 Achievements Availability of GIS injury surveillance system Injury prevention could be more focused Injury Surveillance Studies 預防傷害的研究 IDSP program prevent unnecessary readmission of elderly Deliberated Self Harm study group for Kwai Tsing Domestic Violence study group for Kwai Tsing Traffic Safety Promotion Project Sport related injury in School Playground related injury prevention

45 Potentials for Public Health Surveillance 系統可轉用為公共衛生的監測 Gatekeeper for emerging ID outbreak 預測傳染病爆發 Disease outbreak alert.. adding attributes like fever, diarrhea, red eye Disease spread tracer 傳染病追蹤 Modeling and Prediction of disease spread in the community...identification of risk, demographic / geospatial determinant of disease spread Community health monitor 社區健康監測 Health status in terms of geographic. clusters/distribution of disease categories, hypertension, asthma, abnormal BMI Specialist in universal coding Body map concepts for other disease codlings.. ICD Procedure codes, Functions and Disability codes. Public health epidemiologist 公共衛生流行病學研究 Study of factors affecting the health and illness of populations Logic of interventions made in the interest of public health and preventive medicine

46 Centre for Safety Promotion and Injury Prevention 成立安全促進及傷害預防中心 The Centre is established in PMH It acts as the clearing house for injury data To provide data for injury prevention programs To collaborate with other institutes for safety research studies

47 Future consideration 展望 1. Standards 標準 For comparable & meaningful data 2. Outcomes 成效 Measure & describe outcomes of injury (in addition to death) 3. Linkage 連接 Illness service utilisation data, case data/event data, case data/population data 4. Denominators / exposure data 人口數據 Better population data; other denominators 5. Knowledge, attitudes, behaviour 知識 態度 行為 of concerning injury, injury prevention, interventions

48 Conclusion 總結 Support WHO initiative of safe communities. Could bear the WHO recommended first core task of health sector in injury prevention. Acts as a Key and Driver for Safety in the Public. Ready for replication to other safe communities local and abroad. High potential for extendibility to public health surveillance in turns to relive the burden of injury.

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50 Acknowledgement Kwai Tsing District Council WHO collaborating Centre on Safe Community, Occupational Health and Safety Council School of Nursing, Hong Kong Polytechnic University Transport Department Social Welfare Department Department of Social Work, The Hong Kong University Hospital Authority AED, IT, Trauma Team.

51 Thank you