Ohio’s Trauma Registry REHAB Data Collection Glenn, RN Chief – Trauma, Information & Medical Section Ohio Department of Public Safety Division of Emergency Medical Services Trauma center Acute Care Hospital Scene

Ohio’s Trauma Registry Authorized by ORC –Senate Bill 98, in 1992 –Trauma Registry –EMS Incidence Reporting

Ohio’s Trauma Registry WHY? –Lack of data is a primary factor in inadequate emergency planning –Healthcare needs to be evidence based –Education/curriculum development –Research is severely hindered by incomplete data –Injury Prevention needs to be data-driven –Outcome measures in healthcare are a high priority

Current Registry Requirements Trauma related deaths Identification of trauma patients Monitoring of trauma patient care data Determination of uncompensated care Other data specified by the EMS Board

Ohio Trauma Registry EMS Board has adopted rules that; –Establish an Advisory Committee –Assure confidentiality of submitted data –Assure no individual provider can be identified –Create risk adjusted reports to allow for differences in severity –Prevent use of data in civil lawsuit –Recognizes regional trauma registries –Ohio Administrative Code

Trauma Registry Advisory Committee Appointed by EMS Board, as a subcommittee of the state trauma committee to oversee the operation of the OTR 18 Members –2 Surgeons,2 ED physicians, –2 Nurses, 2 Trauma Registrars –2 Hospital Representatives2 Health Information Professionals –1 EMS Provider 1 Rehabilitation Representative –1 County Coroner1 PM& R Physician –1 Regional Trauma Registry Representative –1 Consumer, not affiliated with an EMS provider

Who Reports to the Registry? Required to Report –✔ Hospitals –✔ County Coroners –✘ Inpatient Rehabilitation Facilities –Ambulatory Surgical Facilities –Nursing Facilities –County Homes/County Nursing Homes –Other State and Public Agencies

When is Data Submitted? All data is due 90 days following the end of each quarter –1st quarter 2004 dataDUE June 29, 2004 –2nd quarter 2004 data DUE September 28, 2004 –3rd quarter 2004 data DUE December 29, 2004 –4th quarter 2004 data DUE March 31, 2005 EMS Board policy for extension to deadline –On the EMS Website

What Data is Submitted? Inclusion/exclusion criteria are found in the OTR REAHAB data dictionary Data Dictionary is on-line – –Hard copies available from Division of EMS

ICD-9-CM Diagnosis Codes on discharge from acute care hospital ICD-9-CM Diagnosis Codes ICD-9-CM Diagnoses Descriptions – Fractures – Fractures, dislocations/sprains, intracranial injury, internal injury of thorax, abdomen and pelvis, open wounds, injury to blood vessels 911.0, 911.1, 912.0, Abrasions/friction burns to trunk, shoulder and upper arm 916.0, 916.1, 919.0, Abrasions / friction burns hip, thigh, leg, ankle, other or multiple sites 920 – Contusions and crush injury – Burns, injury to nerves and spinal cord, traumatic complications and unspecified injury Smoke inhalation – Frostbite, hypothermia and external effects of cold 994.0, 994.1, 994.7, Asphyxiation, strangulation, drowning, and electrocution – Child maltreatment and abuse ***OR*** ICD-9-CM Diagnoses AND WITH ANY OF THE FOLLOWING External Cause Codes (E-Codes)E-CODE Anoxic Brain Injury E800 – E848.8 E878 – E905.0 E906.0 – E928.8 E950.0 – E Uncal herniation 348.5, Cerebral Edema 348.8Pneumocephalus Subconjunctival hemorrhage Traumatic ARDS 784.7Epistaxis

Adult Impairment Group Code on Admission to Rehabilitation Facility Brain Dysfunction Orthopedic Disorders 02.1 Non-traumatic injury * Status Post Bilateral Hip Fractures * must be associated with an acceptable E-code Status Post Femure (shaft) Fracture 08.3 Status Post Pelvic Fracture Traumatic, open injury 08.4 Status Post Major Multiple Fractures Traumatic, closed injury Spinal Cord Dysfunction, Traumatic Paraplegia, unspecified Amputation of Limb Paraplegia, incomplete 05.1 Unilateral Upper Limb above the elbow (AE) Paraplegia, complete 05.2 Unilateral Upper Limb below the elbow (BE) Quadriplegia, Unspecified 05.3 Unilateral Lower Limb above the knee (AK) Quadriplegia, Incomplete C Unilateral Lower Limb below the knee (BK) Quadriplegia, Incomplete C Bilateral Lower Limb above the knee (AK/AK) Quadriplegia, Complete C Bilateral Lower Limb above/below the knee (AK/AK) Quadriplegia, Complete C Bilateral Lower Limb below the knee (BK/BK) Other Traumatic Spinal Cord Dysfunction 05.9 Other amputation

Pediatric Impairment Group Code on Admission to Rehabilitation Facility Brain Dysfunction Burns Traumatic, open injury 7.11Burns Traumatic, closed injury Hypoxemic Ischemic Encephalopathy Major Multiple Trauma 6.1 Brain + Spinal Cord Injury Traumatic Spinal Cord Dysfunction 6.2 Brain + Multiple Fracture/Amputation Paraplegia, unspecified 6.3 Spinal Cord + Multiple Fracture/amputation Paraplegia, incomplete 6.4 Other multiple trauma Incomplete Paraplegia T Incomplete Paraplegia T10-L Incomplete Paraplegia L3-4 Orthopedic Disorders Incomplete Paraplegia L5-S1 Orthopedic Conditions Incomplete Paraplegia Sacral Status Post Hip Fracture Paraplegia, complete Status Post Femure (shaft) Fracture

How is Data Submitted? All data is submitted electronically to the EMS web site Direct entry of individual record data - or - - or - Upload of file with multiple records –3 rd party software users

REHAB Registry Trauma Rehabilitation Reporting –All In-patient rehabilitation facilities –Web based entry/submission process –36 Data fields, all are required –Data collection scheduled to begin January 1, 2005

Upload File Upload File function is needed for users that utilize a 3 rd party software to collect data

Download Records Facilities can pull back all the data that they submit. In an Excel file, this allows for graphs and reports to be generated

EMSIRS EMS Incident Reporting System EMS agencies required to report –Transporting agency reports data –Web based entry/submission system –90 fields, 52 are required, 38 are option/local use only –Data collection began January 1, 2002 –Over 1 million records in the system to date –EMS agencies MUST participate in order to be eligible for the EMS/Trauma grant program 5.2 million dollars awarded by the EMS Board annually

Ohio Trauma Registry TRAUMA ALL hospitals required to report –Transporting agency reports data –Web based entry/submission system –52 fields, all are required –Data collection began January 1, 1999 –Over 100,000 records in the system to date –Hospitals MUST participate in order to be eligible for the EMS/Trauma grant program, or to participate in DEMS funded programs

OTR Special Projects Data Validation Study –Validate 12 data points ICD-9-CM diagnosis and external cause codes ED vital signs and Glasgow Coma Scale scores DOB, Gender, Zip code –1000 records –28 Hospitals 15 Non trauma centers, 18 trauma centers)

OTR Special Projects Probabilistic Linkage –Links records in separate data bases that do not have a Unique Identifier

OTR Special Projects Probabilistic Linkage Does Work! –Used by the CDC and National Highway Traffic Safety Administration –Critical fields from a record in each database are evaluated for the “probability” that they are the same incident/patient –We’ll use probabilistic linkage to link OTR to EMSIRS Ohio Crash Records REHAB Data base When complete, Ohio’s Trauma Registry will be the most comprehensive in the county!

Ohio’s Trauma Registry The Goal Provide Data for Development of Public PolicyDevelopment of Public Policy Healthcare educationHealthcare education Injury PreventionInjury Prevention ResearchResearch