Where CDR Meets Injury Prevention - ncfrp.org · Where CDR Meets Injury Prevention: Strategies for...
Transcript of Where CDR Meets Injury Prevention - ncfrp.org · Where CDR Meets Injury Prevention: Strategies for...
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Where CDR Meets Injury Prevention:Strategies for Implementing Best Practices
Brian D. Johnston, MD MPH
Harborview Injury Prevention & Research CenterUniversity of Washington
Seattle, Washington
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What does CDR have to do
with injury prevention?
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we are getting good at learning what works
but we struggle to promote and implement best practices in real world settings
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implementationbest practice
+local assessment
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What are the functionsof child death review?
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Unexpected Child Death
Sentinel Event:
Unexpected Child Death
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Unexpected Child Death
Investigation
Investigative Function:
Can we verify the cause & manner of this death?
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Unexpected Child Death
Investigation
Quality Assurance
QA Function:
Did community systems function as anticipated?
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Unexpected Child Death
Unexpected Child Death
Investigation
Quality Assurance
Prevention
Prevention Function:
Can we learn from this death to prevent future deaths?
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The CDR process is incomplete until prevention is addressed.
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What kills children?
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Injury kills children.
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Unintentional injury is the major cause of mortality for children after age 1
‐ US data 2006
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Child Deaths, by Age & CauseUnited States ‐ 2006
0
2000
4000
6000
8000
10000
12000
14000
1‐4 yrs 5‐9 yrs 10‐14 yrs 15‐19 yrs
Age of Decedent
Num
ber
Unintentional Injury
Suicide
Homicide
Other
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We know how to prevent injuries.
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What is the role of CDR in injury prevention?
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Public health model:
PolicyDevelopment
Assurance
Assessment
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Epidemiologic Surveillance
Monitor rates & trendsPresume that someone responds
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CDR is different
intensely localindividual casesdetailed assessmentsno obvious recipient
for resultant data
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CDR is more like the NTSB than like the CDC
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“an independent agency charged with investigating every civil aviation accident in the US and issuing safety recommendations aimed at preventing future accidents”
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“ … the NTSB does not regulate equipment, personnel or operations, and does not initiate enforcement action, yet more than 82 percent of its recommendations have been adopted by those in a position to effect change.”
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Why do CDR teams have difficulty influencing injury prevention?
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Why do CDR teams have difficulty influencing injury prevention?
InadequateData
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Why do CDR teams have difficulty influencing injury prevention?
Narrow Team Membership
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Why do CDR teams have difficulty influencing injury prevention?
Restrictive Forms& Protocols
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Why do CDR teams have difficulty influencing injury prevention?
Lack of Resources
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Why do CDR teams have difficulty influencing injury prevention?
Uncertain Accountability
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Why do CDR teams have difficulty influencing injury prevention?
Poorly Framed Recommendations
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Recommendations: A Crucial Final Step
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Synthesize data Identify opportunities for improvement
Look for evidence‐based “best practices”
Promote implementation of desired solution
Recommendations: A Crucial Final Step
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“Babies should be properly restrained in cars.”
Recommendations:
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“Parents need to constantly supervise their children near swimming pools.”
Recommendations:
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“Rearview cameras allow drivers to see small children behind the vehicle before reversing.”
Recommendations:
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“The schools should provide free driver’s education to all teens.”
Recommendations:
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What makes a recommendation “good?”
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A good recommendation:
Refers to local data and contexts
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A good recommendation:
Refers to local data and contextsApplies knowledge of best practices
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A good recommendation:
Refers to local data and contextsApplies knowledge of best practicesIdentifies incremental next steps
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A good recommendation:
Refers to local data and contextsApplies knowledge of best practicesIdentifies incremental next stepsIs specific and actionable
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A good recommendation:
Refers to local data and contextsApplies knowledge of best practicesIdentifies incremental next stepsIs specific and actionableIs made with accountability and follow‐up
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EMSC Grant
Helping CDR teams make better injury prevention recommendations
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EMSC GrantWe worked with
5 Washington State CDR teams
19 non‐intervention control teams
Washington State Department of Health
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EMSC GrantWe provided
team training
technical assistance – collaborative process improvement
access to web based expert resources
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Process Improvement Strategies
broaden CDR team membership
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Process Improvement Strategies
broaden CDR team membership
create a Prevention Action Team
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Process Improvement Strategies
group discussions by death mechanism
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Process Improvement Strategies
group your discussions by death mechanism
invite content experts to specific meetings
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Process Improvement Strategies
monitor missing data & identify likely sources
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Process Improvement Strategies
keep meeting minutes & “action items”
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Process Improvement Strategies
keep meeting minutes & “action items”
… the work isn’t done when the report gets sent to the State!
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Process Improvement Strategies
use a template to compose your prevention recommendations
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Process Improvement Strategies
identify & refer to best practice resources
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Decision Support Tool
Web‐based: (http://depts.washington.edu/cdreview)
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Decision Support Tool
Review of prevention strategies for death due to: drowningyouth suicidemotor vehicle occupant injuryfirearmschild abuse
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Decision Support Tool
Selection of intervention based on rating, population or strategy
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Decision Support Tool
Replication resources for intervention identified as “recommended” or “promising”
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OutcomesQuality of Recommendations
0
10
20
30
40
50
Comparison‐Baseline
Comparison ‐Follow‐Up
Intervention ‐Baseline
Intervention ‐Follow‐Up
% possible score
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Next Steps
Move decision support site to multistate CDR database
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Next Steps
Add & update topics
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Next Steps
Share what we have learned
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Lessons Learned
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Lessons Learned
Successful teamsmake prevention a priority
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Lessons Learned
CDR teams can improve the quality of their prevention recommendations
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Lessons Learned
It is crucial to value the recommendation process
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Thank you!
• National Center for Child Death Review • Washington State Department of Health• Child Death Review Teams from
– Benton‐Franklin Counties– Kitsap County– Seattle‐King County– Spokane County– Tacoma‐Pierce County
• Steve Wirtz, PhD• Seattle Children’s Hospital
Supported by EMS‐C Targeted Issue Grant 1 H34MC02543‐01‐00