Mapping Injury Data to Inform Targeted

Approaches to Prevention

Dwayne Smith, M.Ed., M.C.H.E.S. Injury Prevention Program Manager Children’s Hospital Colorado

Disclosure I have no actual or potential conflict of interest in relation to this program/presentation.

The Injury Prevention Program at CHCO doesn’t generate revenue (yet), so we need to focus on prevention of uncompensated acute care costs to help demonstrate value to our organization.

How do we focus on helping the I.P. community see and understand their data, especially when they aren’t comfortable accessing or using data?

County-level datasets are insufficient to inform neighborhood-level interventions; this is especially true in population-dense areas.

2013 Population Estimates: Adams: 469,193 total 130,905 under age 18 Arapahoe: 607,070 149,946 Denver: 649,495 136,394 Douglas: 305,963 88,423 El Paso: 655,044 165,726 Jefferson: 551,798 116,981 788,375 *2.0 FTEs to this conduct outreach to this population

Within each county, we know what type of injuries are occurring, but not WHERE they are happening.

So how do we increase program efficiency without increasing costs? i.e., working smarter, not harder

“Share healthcare data to map patterns of … injury and create community improvements.” A Checklist of Strategies for Health Care-Community Prevention Integration, The Prevention Institute

The challenge: “… only with good data can (we) estimate the relative magnitude of problems in order to set priorities. Current data collection systems are imperfect and incomplete.” What we need: “… information that is local and community-specific.” The goal: “ … focus on E-codes to better understand the circumstances surrounding injuries.” National Action Plan for Child Injury Prevention, Centers for Disease Control and Prevention, National Center for Injury Prevention and Control

Trauma Registry Data Mapping

But what about the less severe injuries that occur with greater frequency and consume the majority of healthcare dollars?

2013 CO Hospital Association E.D. Visits for Injury

• Database built using Tableau software, a “data visualization product focused on business intelligence”

• Created using CDC’s Recommended framework of E-code groupings for presenting injury mortality and morbidity data

• Ages 0-19 • Mapped by zip code of residence • Includes volume, rate, and payer source by injury type • N = @111,000 • @ 160 hrs. to build frequency counts, another 20 hrs. to

convert data to rates/100,000

2013 E.D. Visits for All Injuries: Ages 0-19 - Downtown

80219, N=2,241 80204, N=1,212 80205, N=863

80229, N=66; 80601, N=42; 80233, N=41

2013 E.D. Visits for MVC Occupant Injuries: Ages 15-19

East Metro example: in 28.3% of incidents where hospitals provided emergency care to teenagers involved in MVCs, they were reimbursed for that care at less than 40 cents on the dollar.

Data to Action Example: Priority High Schools for TSB Challenge

80219 (SW Denver): Abraham Lincoln, Mullen 80013 (Aurora): Rangeview 80229 (Thornton): Mapleton, Thornton 80011 (Aurora): Hinkley, William Smith 80022 (Denver): Adams City, Lester Arnold 80239 (N. Denver): Collegiate Prep Academy, DCIS at Montbello, High Tech Early College, Noel Community Arts School, P.U.S.H. Academy 80012 (Aurora): Gateway, Overland 80015 (Aurora): Eaglecrest, Smoky Hill 80134 (Parker): Chaparral, Legend, Ponderosa 80221 (Denver): Northglenn, Iver C. Ranum, Skyview

Alignment with the Spectrum of Prevention

In 2015, we’ve strategically expand our efforts …

… to enable us to demonstrate valid program outcomes over the next five years, using Healthy People 2020

Objectives for Injury Prevention as a benchmark.

Selected Healthy People 2020 Objectives

IVP-1.3: Reduce Emergency Department visits for nonfatal injuries Baseline: 8,370.4 ED visits for nonfatal injuries per 100,000 population occurred in 2007 (age adjusted to the year 2000 standard population) Target: 7,453.4 ED visits per 100,000 population Target-Setting Method: 10 percent improvement

7,453 Target

Healthy People 2020 Objectives (cont.)

IVP-15: Increase use of safety belts Baseline: 84 percent of motor vehicle drivers and right-front seat passengers used safety belts in 2009 Target: 92 percent Target-Setting Method: 10 percent improvement

Sample Grant Objectives for TSB Challenge

Previously: Reduce the number of E.D. visits due to motor vehicle crash injuries among teenage occupants ages 15-19 residing in MHRETAC by 10%, from a baseline of 1,948 in 2015 to an improvement of 1,753, by September 30, 2018. Currently: Reduce the number of E.D. visits due to motor vehicle crash injuries among teenage occupants ages 15-19 residing in six targeted zip codes (80219, 80013, 80229, 80011, 80022, and 80239) by 10%, from a baseline of 435 in 2015 to an improvement of 391, by September 30, 2018.

Alignment with HRSA Maternal & Child Health Title V Block Grant Performance Measures

Within the Child Health category of the Title V performance measure domains, Measure #7 - “Injury Hospitalization” addresses injury-related hospital admissions per 100,000 children ages 0-9. Within the Adolescent Health category, Measure #7 “Injury Hospitalization” addresses injury-related hospital admissions per 100,000 children ages 10-19.

Moving Forward in 2015

• Convene stakeholders (CDOT OTS, CDPHE Prevention Services Division, RETACs, Drive Smart Colorado, etc.) to determine how these data capabilities can best inform their efforts

• Enter 2014 data and calculate volumes, rates • Employ processes and findings in larger CHCO Strategic

Plan for Population Health

Looking at 2016 and Beyond

Closing the Loop: Capturing and Reinvesting Revenues and Savings to Advance Health and Prevention; Larry Cohen and Anthony Iton, 2014.

Acknowledgements

Sean Reiter, M.B.A., Planning Analyst Children’s Hospital Colorado

Planning and Business Development

Questions?

dwayne.smith@childrenscolorado.org (720) 777-8412