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

10 Leading Causes of Death, United States Ten Leading Causes of Death, United States Age Groups Rank< All Ages 1 Congenital Anomalies 5,623 Unintentional Injury 1,641 Unintentional Injury 1,176 Unintentional Injury 1,542 Unintentional Injury 15,412 Unintentional Injury 12,569 Unintentional Injury 16,710 Malignant Neoplasms 49,637 Malignant Neoplasms 93,391 Heart Disease 576,301 Heart Disease 696,947 2 Short Gestation 4,637 Congenital Anomalies 530 Malignant Neoplasms 537 Malignant Neoplasms 535 Homicide 5,219 Suicide 5,046 Malignant Neoplasms 16,085 Heart Disease 37,570 Heart Disease 64,234 Malignant Neoplasms 391,001 Malignant Neoplasms 557,271 3 SIDS 2,295 Homicide 423 Congenital Anomalies 199 Suicide 260 Suicide 4,010 Homicide 4,489 Heart Disease 13,688 Unintentional Injury 14,675 Chronic Low. Respiratory Disease 11,280 Cerebro- vascular 143,293 Cerebro- vascular 162,672 4 Maternal Pregnancy Comp. 1,708 Malignant Neoplasms 402 Homicide 140 Congenital Anomalies 218 Malignant Neoplasms 1,730 Malignant Neoplasms 3,872 Suicide 6,851 Liver Disease 7,216 Diabetes Mellitus 10,022 Chronic Low. Respiratory Disease 108,313 Chronic Low. Respiratory Disease 124,816 5 Placenta Cord Membranes 1,028 Heart Disease 165 Heart Disease 92 Homicide 216 Heart Disease 1,022 Heart Disease 3,165 HIV 5,707 Suicide 6,308 Cerebro- vascular 9,897 Influenza & Pneumonia 58,826 Unintentional Injury 106,742 6 Unintentional Injury 946 Influenza & Pneumonia 110 Benign Neoplasms 44 Heart Disease 163 Congenital Anomalies 492 HIV 1,839 Homicide 3,239 Cerebro- vascular 6,055 Unintentional Injury 8,345 Alzheimer's Disease 58,289 Diabetes Mellitus 73,249 7 Respiratory Distress 943 Septicemia 79 Septicemia 42 Chronic Low. Respiratory Disease 95 Chronic Low. Respiratory Disease 192 Diabetes Mellitus 642 Liver Disease 3,154 Diabetes Mellitus 5,496 Liver Disease 6,097 Diabetes Mellitus 54,715 Influenza & Pneumonia 65,681 8 Bacterial Sepsis 749 Chronic Low. Respiratory Disease 65 Chronic Low. Respiratory Disease 41 Cerebro- vascular 58 HIV 178 Cerebro- vascular 567 Cerebro- vascular 2,425 HIV 4,474 Suicide 3,618 Nephritis 34,316 Alzheimer's Disease 58,866 9 Circulatory System Disease 667 Perinatal Period 65 Influenza & Pneumonia 38 Influenza & Pneumonia 53 Cerebro- vascular 171 Congenital Anomalies 475 Diabetes Mellitus 2,164 Chronic Low. Respiratory Disease 3,475 Nephritis 3,455 Unintentional Injury 33,641 Nephritis 40, Intrauterine Hypoxia 583 Benign Neoplasms 60 Cerebro- vascular 33 Septicemia 53 Diabetes Mellitus 171 Liver Disease 374 Chronic Low. Respiratory Disease 1,008 Viral Hepatitis 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 FUNCTIONESSENTIAL SERVICE 1992 CORE COMPONENT SUBCOMPONENTS AssessmentMonitor heath Diagnose and investigate EvaluationNeeds assessment Data collection Research Policy DevelopmentInform, educate, and empower Mobilize partnerships Public information and education Injury prevention Trauma system committee Develop policiesLegislation Regulations Trauma system planning and operations Regulations and rules AssuranceEnforce lawsState Lead Agency Ensure links to or provision of care Prehospital careCommunications Triage and transport, medical direction, and treatment protocols Definitive careFacility designation, interfacility transfer, and rehabilitation Ensure competent workforce Human resourcesWorkforce resources and educational preparation 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 IndicatorScoring 101.1There 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 101.1There 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.

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 101.1There 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.

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? [Name] [Role]