Model Trauma System Planning and Evaluation Use of the Public Health Approach [Name] [Role]

Model Trauma System Planning and Evaluation

Use of the Public Health Approach

[Name][Role]

Trauma Care Within a Public Health Framework

A Brief Overview

Why a Public Health Approach?

Section 1:

Benefits of a Public Health Approach

• Gives credibility to trauma as a public health problem

• Reasonable, methodical approach recommended by the IOM

• Grounds trauma in a theoretical base• Incorporates trauma under a public health approach• Allows trauma to be more competitive for funding

Benefits of a Public Health Approach

• Improves dialogue between trauma, public health and policy makers

• Assures consistency in federal programs and documents such as the Trauma Vision and EMS Agenda for the Future

• Begins looking at outcomes along with structure and process

• Enhances integration of trauma systems into public health, disaster planning and terrorism response

Trauma as a Public Health Problem

Section 2:

The Burden of Injury

• Injury is the leading cause of death in the U.S. for ages 1-44.

• Injury (unintentional, suicide, homicide) is the 4th leading cause of death overall.

10 Leading Causes of Death, United States

Ten Leading Causes of Death, United States Age Groups

Rank <1 1-4 5-9 10-14 15-24 25-34 35-44 45-54 55-64 65+ All Ages

1CongenitalAnomalies

5,623 UnintentionalInjury 1,641

UnintentionalInjury 1,176





MalignantNeoplasms

49,637

MalignantNeoplasms

93,391

HeartDisease 576,301

HeartDisease 696,947

2Short

Gestation 4,637

CongenitalAnomalies

530

MalignantNeoplasms

537

MalignantNeoplasms

535 Homicide 5,219 Suicide 5,046

MalignantNeoplasms

16,085

HeartDisease 37,570

HeartDisease 64,234

MalignantNeoplasms

391,001

MalignantNeoplasms

557,271

3 SIDS 2,295

Homicide 423 CongenitalAnomalies

199 Suicide 260 Suicide 4,010 Homicide 4,489

HeartDisease 13,688


Chronic Low.Respiratory

Disease 11,280

Cerebro-vascular 143,293

Cerebro-vascular 162,672

4Maternal

PregnancyComp. 1,708

MalignantNeoplasms

402 Homicide 140

CongenitalAnomalies

218

MalignantNeoplasms

1,730

MalignantNeoplasms

3,872 Suicide 6,851

LiverDisease

7,216

DiabetesMellitus 10,022


Disease 108,313


Disease 124,816

5Placenta

CordMembranes

1,028

HeartDisease

165

HeartDisease

92 Homicide 216

HeartDisease

1,022

HeartDisease

3,165

HIV 5,707

Suicide 6,308 Cerebro-vascular

9,897

Influenza& Pneumonia


6 UnintentionalInjury 946


110

BenignNeoplasms

44

HeartDisease

163

CongenitalAnomalies

492

HIV 1,839

Homicide 3,239 Cerebro-vascular


Alzheimer'sDisease 58,289


7Respiratory

Distress 943

Septicemia 79

Septicemia 42


Disease 95


Disease 192

DiabetesMellitus

642

LiverDisease

3,154

DiabetesMellitus

5,496

LiverDisease

6,097



65,681

8BacterialSepsis

749


Disease 65


Disease 41

Cerebro-vascular

58

HIV 178

Cerebro-vascular

567

Cerebro-vascular

2,425

HIV 4,474

Suicide 3,618 Nephritis

34,316

Alzheimer'sDisease 58,866

9Circulatory

SystemDisease

667

PerinatalPeriod

65


38


53

Cerebro-vascular

171

CongenitalAnomalies

475

DiabetesMellitus

2,164


Disease 3,475

Nephritis 3,455


Nephritis 40,974

10Intrauterine

Hypoxia 583

BenignNeoplasms

60

Cerebro-vascular

33

Septicemia 53

DiabetesMellitus

171

LiverDisease

374


Disease 1,008

ViralHepatitis

2,331

Septicemia 3,360

Septicemia 26,670

Septicemia 33,865

At-Risk Groups by Injury Type

• All injury causes• Males

• Unintentional injury• Young males• Rural residents

• Homicide• Urban young males of color• Rural residents

• Falls• Children• Elderly

Economic Cost of Injury

• $157.6 billion annually

• $44.8 billion direct health care

• $64.9 billion lost wages

Societal

• More years of productive life lost than cardiac, cancer and stroke combined

• Disabling conditions with long-term care and lost productivity costs

Personal Cost of Injury

• Second trauma– Family– Friends– Peers – Community as a whole

Trauma Systems Within a

Public Health Framework

Section 3:

Mission of Public Health

Assuring conditions in which people can be healthy

Mission of the Trauma System

Prevent injuries while ensuring that the right patient gets to the right hospital in the right amount of time

Public Health Defined

The science and art of preventing disease, prolonging life and promoting health and efficiency through organized community efforts (Winslow)

Trauma System Defined

An organized, inclusive approach to facilitating and coordinating a multidisciplinary system response to preventing injuries and providing care to the injured

Public Health Goals

• Prevent epidemics and spread of disease

• Protect against environmental hazards

• Prevent Injuries

• Promote and encourage healthy behaviors

• Respond to disasters and assist communities in recovery

• Assure the quality and accessibility of Health Services

Trauma System Goals

• Decrease the incidence and severity of trauma

• Ensure optimal, equitable and accessible care for all persons sustaining trauma

• Prevent unnecessary deaths and disabilities from trauma

• Contain costs while enhancing efficiency

• Implement quality and performance improvement of trauma care through out the system

• Ensure certain designated facilities have appropriate resources to meet the needs of the injured

Public Health Framework

• Three core functions– Assessment– Policy development– Assurance

• 10 essential services

How Does a Public Health System Accomplish its Goals?

How Might a Trauma System Accomplish its Goals?

Benefits of Linking Public Health and the Trauma System

Benefits to the Trauma System:

• Access to a well-established and accepted conceptual model for health care system assessment, planning, intervention, and evaluation.

• Potential communications infrastructure (notification systems)• Access to all-hazards information• Population-based data• Resources for disaster preparedness• Opportunity to integrate the trauma system into other community

health efforts to promote overall health• A more precise identification of populations at risk and a targeting

of specific issues based on these data• Framework for injury prevention strategies

Benefits to the Public Health System:

• Access to a well-established health system infrastructure• Health system response that differentiates facilities by

level of resource availability• Existing protocols and guidelines for the care process• Access to patient outcome data • Existing performance improvement process• Additional resources for injury prevention efforts• Resources to provide all-hazards care• Recognition that injury continues to be a public health

problem despite significant efforts at trauma system development

Benefits of Linking Public Health and the Trauma System

Public Health Core Functions Trauma System Components

CORE FUNCTION ESSENTIAL SERVICE

1992 CORE COMPONENT

SUBCOMPONENTS

Assessment Monitor heath

Diagnose and investigate

Evaluation Needs assessment

Data collection

Research

Policy Development Inform, educate, and empower

Mobilize partnerships

Public information and education

Injury prevention

Trauma system committee

Develop policies Legislation

Regulations

Trauma system planning and operations

Regulations and rules

Assurance Enforce laws State Lead Agency

Ensure links to or provision of care

Prehospital care Communications

Triage and transport, medical direction, and

treatment protocols

Definitive care Facility designation, interfacility transfer, and

rehabilitation

Ensure competent workforce

Human resources Workforce resources and educational preparation

Evaluation Evaluation Data collection Research

Interdisciplinary Review Committee

Assessing and Improving Trauma Systems Within a Public Health Framework

Section 4:

Trauma System Assessment within a Public Health Framework

• Benchmarks (24)

• Indicators (113)

• Scoring (Sequence of 5 for each Indicator)

Benchmarks

• Global overarching goals, expectations, or outcomes.

• In the trauma system, identifies a broad system attribute.

Benchmark

101. There is a thorough description of the epidemiology of injury in the system jurisdiction using both population-based data and clinical databases.Essential Service: Monitor Health

Indicator Scoring

101.1 There is a thorough description of the epidemiology of injury mortality in the system jurisdiction using population-based data

0. Don’t know

1. There is no detailed analysis of injury mortality.

2. Death certificate data have been used to describe the statewide incidence of trauma deaths aggregating all etiologies, but no E-code reporting is available.

3. Death certificate data, by E-code, are reported on a statewide basis, but are not reported by sub-State jurisdiction.

4. Death certificate data, by E-code, are reported on a statewide and on a sub-State jurisdiction. These data are compared to national benchmarks, if available.

5. Death certificate data, by E-code, are used as part of the overall assessment of trauma care in a State or sub-State, including statewide rural and urban preventable mortality studies.

Indicators

• Tasks or outputs that characterize the benchmark.

• Identify actions or capacities within the benchmark

Benchmark

101. There is a thorough description of the epidemiology of injury in the system jurisdiction using both population-based data and clinical databases.

Essential Service: Monitor Health

Indicator Scoring

101.1 There is a thorough description of the epidemiology of injury mortality in the system jurisdiction using population-based data.

0. Don’t know






Scoring

• Breaks down indicator into completion steps

• Provides an assessment of current status and marks progress over time to reach a certain milestone

Benchmark

101. There is a thorough description of the epidemiology of injury in the system jurisdiction using both population-based data and clinical databases.

Essential Service: Monitor Health

Indicator Scoring

101.1 There is a thorough description of the epidemiology of injury mortality in the system jurisdiction using population-based data

0. Don’t know






Uses of the Tool

• Self assessment• Establish baseline data• Achieve consensus process• Target specific activities

– Allocation of resources

• Self-Reassessment– Progress monitoring – Performance Improvement– Balanced Scorecard

Variances in Scores by Stakeholders

• May Indicate Systems Challenges– Communications challenges– Compartmentalization challenges– Differences of opinion

Conclusion

• Public Health and Trauma System are intrinsically linked

• Both focus on risk reduction• Injuries continue to be a leading cause of

death in the US• The strategies to reduce the burden of

injury are found in the framework that is public health

QUESTIONS?

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Model Trauma System Planning and Evaluation Use of the Public Health Approach [Name] [Role]

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