State Of Wisconsin Trauma Registry Presented by:

Purpose for Trauma Data Collection A well designed trauma registry assists health care providers, policymakers and community organizations in establishing a coordinated approach to trauma care and injury prevention. Trauma registries are scalable and can provide important information at the local, State and national levels. The following are some uses for trauma system data: Evaluate and improve the timeliness, appropriateness and quality of patient care; Provide a mechanism for comparing patient outcomes across service areas, provider groups, etc.; Identify excessively hazardous environments (e.g., specific auto intersections); Prioritize and evaluate public health interventions relating to injury prevention; Identify injury trends by geographic location, hospital length of stay, etc.; Provide data for clinical benchmarking, process improvement, and patient safety; and Provide the capability to monitor trauma system trends. Southeast RTAC

Overall Structure of a Trauma Registry A trauma registry is a system of timely data collection that aids in the evaluation of trauma care for a set of injured patients who meet specific criteria for inclusion. In addition to hospital-based trauma data, it also includes patient information from other health care providers including prehospital care and rehabilitation if utilized. An effective trauma registry requires that a system be in place that supports data collection, submission, abstraction and verification of the completeness and accuracy of the data. Finally, the trauma registry provides a mechanism for overall patient care and system evaluation. Southeast RTAC

Basic Elements of a Trauma Registry A trauma registry uses both computer software packages and hardware for the collection, verification, storing and analysis of data. The trauma registry will outline a set of inclusion criteria that characterize the patient population to be captured in the data abstraction process. Systematically defined data elements are gleaned from existing patient records and added to the registry. Other components include qualified personnel for effective management of the system and data sources/processes that allow for the tracking of the trauma patient from entrance into the health care system through rehabilitation or death. Southeast RTAC

Definition of a Trauma Patient A trauma patient may be defined in a wide variety of ways based upon each state or hospital registry. Patients are identified using inclusion criteria (specific rules allowing a patient to be included in the data collection system) or exclusion criteria (specific rules disallowing a patient to be included in the data collection system) to initiate the data collection. Many trauma registries have developed more specific inclusion or exclusion criteria that are used to define the trauma patient captured in a registry. Southeast RTAC

Inclusion Criteria Inclusion criteria are a set of conditions that must be met in order to participate in a clinical trial. In other words - the standards used to determine whether a person may be allowed to participate in a clinical trial. The most important criteria used to determine appropriateness for clinical trial participation include age, sex, the type and stage of a disease, treatment history, and other medical conditions. Southeast RTAC

INCLUSION CRITERIA Level I, II, III, and IV trauma care facilities will submit data from their trauma registries for all patients meeting the following criteria: ICD-9 discharge diagnosis 800.00 – 959.9 Excluding 905-909 (late effects of injury) Excluding 910-924 (blisters, contusions, abrasions, insect bites) Excluding 930-939 (foreign bodies) Excluding drowning, unless consequence of MVC Excluding strangulation/asphyxiation Excluding poisoning or drug overdose Excluding falls from same level resulting in isolated closed distal extremity fracture or isolated hip fracture AND admitted to the Facility or transferred to another facility for trauma care OR DOA transported to the Facility Injury-related death in the ED or after Facility admission Facility-specified trauma response has been activated Southeast RTAC

ICD-9-CM Coding System The Basic Steps to ICD-9-CM Coding To ensure that an appropriate code has been chosen to describe the diagnosis of a particular patient, the following steps should be followed: 1. Look for all main terms that may appear in the diagnostic statement describing the patient's condition. 2. Locate the main terms taken from the diagnostic statement in the Alphabetic Index of the ICD-9-CM manual. 3. Look for any modifying words of the main term. 4. Review the modifying words listed under the main term in the ICD-9-CM manual. 5. Be aware of any notes or cross-references. 6. Choose a tentative code from those found in the Alphabetic Index. 7. Verify the tentative code's accuracy in the Tabular List. Carry the codes to their highest level of specificity (fourth or fifth digits) if they are available. 8. Look for any instructional notes that may be near the selected code. 9. Then assign the code selected from the Tabular List as the appropriate code for the patient's condition. Southeast RTAC

Exclusion criteria Exclusion criteria are the standards used to determine whether a person may or may not be allowed to participate in a clinical trial. The most important criteria used to determine appropriateness for clinical trial participation include age, sex, the type and stage of a disease, treatment history, and other medical conditions. Southeast RTAC

Types of Trauma Data Collected ED/admission assessment/treatment hospital assessment/treatment disposition and diagnosis (including injury severity scores) patient outcome Even more important than the details of the data collected is the necessity that a uniform system of data definitions be established for each data element. This ensures that information collected across a variety of trauma patients in different hospitals is comparable. General categories for basic information collected in most trauma registries include: patient demographics injury location injury date and time cause of injury safety equipment used out-of-hospital assessment/treatment Southeast RTAC

Incomplete Collection of Trauma Cases Costs, data availability, and human error often limit the “accuracy” and/or “completeness” of all data captured. Substantial research describes problems with injury severity scoring associated with hand-coded data, or mapped ICD-9-CM codes using software packages. New linkage technologies (such as probabilistic linkage) can be used to incorporate cases or data that are captured in another independent database, and work to minimize these data limiting issues. For example, trauma registries should be periodically “linked” to state death records to identify trauma deaths occurring before hospital admission and trauma-related deaths occurring shortly after hospital discharge. Southeast RTAC

Costs Associated with Registry Development and Maintenance Costs are greatly reduced by limiting the amount of redundant data entry that is associated with trauma registry abstraction. Hospitals should assess existing computerized patient records to determine what patient data could be “merged” with registry records to defray data entry costs. Southeast RTAC

Participation in a Trauma Registry Ideally all acute care health facilities that receive injured patients would participate in a trauma registry. In addition, information regarding the pre-hospital care of patients and care that is offered after hospitalization should be included in the trauma registry. Limiting registries to information available in hospital records purposefully excludes injured patients who do not receive in-patient care and greatly inhibits that “richness” of the resulting data for those included in the registry. Southeast RTAC

How will I report my data? 1. Level III/IV trauma care facilities will create records for the patients they keep. 2. Level I/II facilities will enter all the data on the patients transferred from the Level III/ IV trauma care facilities. Level III/IV trauma care facilities will not need to enter any data on the patients they transfer to a Level I or II. There are two options for entering data for Level III / IV trauma care facilities. a. The facilities can enter the data themselves or rely on the receiving facility to enter the data. b. All facilities must enter their own data on patients they keep at their facilities or patients that are transferred across state lines. 3. There will be created for Level III/IV's a "bin" in which a record will be created on the patient transferred. This will allow Level III/IV's to have access to the data on the patient they transferred from the point of injury up to the point of transfer to the Level I/II. Level III/IV's will then have data for their hospital performance improvement requirements. 4. The Level III/IV facility can enter a complete trauma record on all patients, if desired. Southeast RTAC

Frequently asked questions How is my data used? The Bureau of Local Health Support and EMS (Bureau of LHS & EMS) will create aggregate standard and ad hoc reports within the abilities of the web-based system for anyone requesting the data, such as hospitals, RTACs, and the legislature. *Currently there is an Ad Hoc committee that is working on issues regarding the registry. Is my data private and secure? All data sent to the State Trauma Registry is kept confidential. Aggregate reports are designed to ensure that no single individual, hospital, or EMS provider can be identified. Access to the data is controlled by using several methods: Access authorization must be requested and approved. Individuals are assigned roles based on what data they need to use and how they use the data. Individuals have personal login-ids and passwords. Individuals are required to change their passwords regularly. Southeast RTAC

Legal Justification: As a public health authority for Wisconsin's Trauma Care System under s. 146.56, Wisconsin Statutes and with the support of DHFS, DPH has created the Statewide Trauma Care Registry. DHFS serves as the lead agency for the development, implementation and evaluation of the state trauma care system. Chapter HFS 118, section 118.09 of the "Trauma Care" Administrative Rule states, "All hospitals, ambulance service providers and first responder services shall submit to the department data determined by the department to be required for the department's operation of the state trauma registry.“ "The department shall use injury data collected under s. 146.56 (2), Stats., for confidential review relating to performance improvement in the trauma care system. The department may use the confidential injury data for no other purpose. *Please note the word department refers to the Department of Health and Family Services. Southeast RTAC

Wisconsin Legislature Subchapter III- Trauma Care Improvement HFS 118 Wisconsin Legislature Subchapter III- Trauma Care Improvement HFS 118.09 Trauma Registry HFS 118.09(1) Purpose The purpose of the trauma registry is to collect and analyze trauma system data to evaluate the delivery of adult and pediatric trauma care, develop injury prevention strategies for all ages, and provide resources for research and education. Southeast RTAC

HFS 118.09 Trauma Registry HFS 118.09(2) Department coordination of data collected by trauma care facilities, ambulance service providers and first responder services. The department shall do all of the following: Develop and publish a data submission manual that specifies all of the following: 1. Data elements and definitions 2. Definitions of what constitutes a reportable trauma case. 3. Method of submitting data to the department. 4. Timetables for data submission. 5. Electronic record format. 6. Protections for individual record confidentiality. Southeast RTAC

HFS 118.09 Trauma Registry HFS 118.09(2) b) Notify trauma care facilities, ambulance service providers and first responder services of the required registry data sets and update the facilities and providers, as necessary, when the registry data set changes. c) Specify both the process and timelines for hospital and ambulance service provider submission of data to the department. Southeast RTAC

HFS 118.09 Trauma Registry HFS 118.09(3) Submission of data All hospitals, ambulance service providers and first responder services should submit to the department on a quarterly basis trauma data determined by the department to be required for the department’s operation of the state trauma registry. The department shall prescribe all of the following: Southeast RTAC

HFS 118.09(3) Submission of data HFS 118.09 Trauma Registry HFS 118.09(3) Submission of data The department shall prescribe all of the following: a) Standard application and report forms to be used by all applicants and trauma care facilities. b) The form and content of records to be kept and the information to be reported to the department. Southeast RTAC

HFS 118.09 Trauma Registry HFS 118.09(4) Registry Use a) The department and the RTACs shall use the trauma registry data to identify and evaluate patient care and to prepare a standard quarterly and annual reports and other reports and analyses as requested by the RTACs. Southeast RTAC

HFS 118.09 Trauma Registry HFS 118.09(4) Registry Use b) The department shall use the injury data collected under s.146.56(2), Stats., for confidential review relating to performance improvement in the trauma care system. The department may use the confidential injury data for no other purpose. Southeast RTAC

For Additional Information Marianne Peck State Trauma Coordinator Department of Health and Family Services peckme@dhfs.state.wi.us Debi Peters Project Manager Bureau of Environmental Health Division of Public Health Peterdl@dhfs.state.wi.us Southeast RTAC

References www.hrsa.gov/trauma/registries.htm found on worldwide web April 9, 2007 http://en.wikipedia.org/wiki/Main_Page Information on inclusion and exclusion criteria found on worldwide web on April 10, 2007 http://nxt.legis.state.wi.us Chapter HFS 118 Trauma Registry information found on worldwide web on April 10, 2007 www.usc.edu/health/uscp/compliance/tm8.htm compliance manual found on worldwide web on April 12, 2007 Wisconsin Trauma Registry Inclusion Criteria and Data Element Dictionary Level I, II, III & IV Trauma Care Facilities, Revised June 2006 Wisconsin’s Trauma Care Registry Frequently-asked Questions/Information document. Southeast RTAC