1. 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

2. Ohio’s Trauma Registry Authorized by ORC 4765.06 –Senate Bill 98, in 1992 –Trauma Registry –EMS Incidence Reporting

3. 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

4. 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

5. 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 4765-4

6. 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

7. 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

8. 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 http://ems.ohio.gov/ohio_trauma_registry.htm

9. What Data is Submitted? Inclusion/exclusion criteria are found in the OTR REAHAB data dictionary Data Dictionary is on-line –http://ems.ohio.gov/ohio_trauma_registry.htm http://ems.ohio.gov/ohio_trauma_registry.htm –Hard copies available from Division of EMS

10. ICD-9-CM Diagnosis Codes on discharge from acute care hospital ICD-9-CM Diagnosis Codes ICD-9-CM Diagnoses Descriptions 800.00 – 819.1 Fractures 821.00 – 904.9 Fractures, dislocations/sprains, intracranial injury, internal injury of thorax, abdomen and pelvis, open wounds, injury to blood vessels 911.0, 911.1, 912.0, 912.1 Abrasions/friction burns to trunk, shoulder and upper arm 916.0, 916.1, 919.0, 919.1 Abrasions / friction burns hip, thigh, leg, ankle, other or multiple sites 920 – 929.9 Contusions and crush injury 940.0 – 959.9 Burns, injury to nerves and spinal cord, traumatic complications and unspecified injury 987.9 Smoke inhalation 991.0 – 991.6 Frostbite, hypothermia and external effects of cold 994.0, 994.1, 994.7, 994.8 Asphyxiation, strangulation, drowning, and electrocution 995.50 – 995.59 Child maltreatment and abuse ***OR*** ICD-9-CM Diagnoses AND WITH ANY OF THE FOLLOWING External Cause Codes (E-Codes)E-CODE 348.1 Anoxic Brain Injury E800 – E848.8 E878 – E905.0 E906.0 – E928.8 E950.0 – E998.9 348.4 Uncal herniation 348.5, Cerebral Edema 348.8Pneumocephalus 372.72 Subconjunctival hemorrhage 518.5 Traumatic ARDS 784.7Epistaxis

11. Adult Impairment Group Code on Admission to Rehabilitation Facility Brain Dysfunction Orthopedic Disorders 02.1 Non-traumatic injury * 08.12 Status Post Bilateral Hip Fractures * must be associated with an acceptable E-code. 08.2 Status Post Femure (shaft) Fracture 08.3 Status Post Pelvic Fracture 02.21 Traumatic, open injury 08.4 Status Post Major Multiple Fractures 02.22 Traumatic, closed injury Spinal Cord Dysfunction, Traumatic 004.210 Paraplegia, unspecified Amputation of Limb 04.211 Paraplegia, incomplete 05.1 Unilateral Upper Limb above the elbow (AE) 04.212 Paraplegia, complete 05.2 Unilateral Upper Limb below the elbow (BE) 04.220 Quadriplegia, Unspecified 05.3 Unilateral Lower Limb above the knee (AK) 04.2211 Quadriplegia, Incomplete C1-4 05.4 Unilateral Lower Limb below the knee (BK) 04.2212 Quadriplegia, Incomplete C5-8 05.5 Bilateral Lower Limb above the knee (AK/AK) 04.2221 Quadriplegia, Complete C1-4 05.6 Bilateral Lower Limb above/below the knee (AK/AK) 04.2222 Quadriplegia, Complete C5-8 05.7 Bilateral Lower Limb below the knee (BK/BK) 04.230 Other Traumatic Spinal Cord Dysfunction 05.9 Other amputation

12. Pediatric Impairment Group Code on Admission to Rehabilitation Facility Brain Dysfunction Burns 01.221 Traumatic, open injury 7.11Burns 01.222 Traumatic, closed injury 1.211 Hypoxemic Ischemic Encephalopathy Major Multiple Trauma 6.1 Brain + Spinal Cord Injury Traumatic Spinal Cord Dysfunction 6.2 Brain + Multiple Fracture/Amputation 004.210 Paraplegia, unspecified 6.3 Spinal Cord + Multiple Fracture/amputation 04.2110 Paraplegia, incomplete 6.4 Other multiple trauma 04.2111 Incomplete Paraplegia T1-9 04.2112 Incomplete Paraplegia T10-L2 04.2113 Incomplete Paraplegia L3-4 Orthopedic Disorders 04.2114 Incomplete Paraplegia L5-S1 Orthopedic Conditions 04.2115 Incomplete Paraplegia Sacral 05.11 Status Post Hip Fracture 04.2120 Paraplegia, complete 05.12 Status Post Femure (shaft) Fracture

13. How is Data Submitted? All data is submitted electronically to the EMS web site http://ems.ohio.gov/ohio_trauma_registry.htm Direct entry of individual record data - or - - or - Upload of file with multiple records –3 rd party software users

14. 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

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

24. 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

25. 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

27. 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

29. 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)

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

31. 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!

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