1. Australian Injury Indicators James Harrison Malinda Steenkamp Research Centre for Injury Studies, Flinders University of South Australia Incorporating the AIHW National Injury Surveillance Unit

2. Research Centre for Injury Studies, May 2002 2 Background Injury - National Health Priority Area 34 Australian Injury Indicators NISU report on injury indicators –Update data source developments –Provide technical review and specification of indicators –Identify actions and processes for further improvements

3. Research Centre for Injury Studies, May 2002 3 Australian Injury Indicators 12 - deaths data –Death rate (DR) for injury in total population –DRRatio injury status of Indigenous + non-Indigenous populations 11 - morbidity data –Hospital separation rate (HSR) for falls - persons 65+ yrs –HSR for near drowning - children 0-4 yrs Rest - other data sources/not defined –% domestic pools with appropriate barriers/fencing –Access of injury patients to optimal care

4. Research Centre for Injury Studies, May 2002 4 Useful and valid injury indicators? Purposes and topics Specifications Data sources (not discussed) Data quality (not discussed)

5. Research Centre for Injury Studies, May 2002 5 Purpose Process - Purpose(s) of indicators? Why specified purpose? –To guide development and evaluation –Information requirements Current set - no specific purpose –Ambiguity in specification e.g. indicators based on hospital data measuring — population incidence of serious injury? — burden of injury on acute health care services? — something else?

6. Research Centre for Injury Studies, May 2002 6 Australian Injury Indicators Injury indicators based on national data –12 based on deaths data (e.g. Death rate for injury in total population) –11 based on morbidity data (e.g. Hospital separation rate for falls - persons 65+ yrs) Rest - other data sources/not defined (Total number of Australian injury indicators=34)

7. Research Centre for Injury Studies, May 2002 7 Purpose(s) of injury indicators Indicators based on national data: –To measure, and monitor change in, the population incidence of serious injury in Australia (recommended) Remaining indicators: –Purpose not clear (not discussed further)

8. Research Centre for Injury Studies, May 2002 8 Technical specifications (1) Translates purpose and topic - set of definitions and instructions Specification: –Definition of a measure –Documenting definitions and instructions Criteria ( after Injury ICE, Cryer, Langley, et al): –Define ito anatomical/physiological damage –Included cases should be all/well-defined sample –Case ascertainment independent

9. Research Centre for Injury Studies, May 2002 9 Technical specifications (2) Defined ito anatomical/physiological damage? –NO, based on external cause codes (e.g. Falls in 65+ - ICD-9 E880-E888) –Reflects data situation at time of definition –Change in situation - deaths and hospital data  Redefine ‘injury’ ito ICD-10(-AM) S00-T89 –Includes ‘Medical injury’ (T80-T88) –Excludes ‘Sequelae’ (T90-98)

10. Research Centre for Injury Studies, May 2002 10 Technical specifications (3) Included cases all/well defined sample? –National deaths data collection All supposed to be included No formal evaluations –National Hospital Morbidity Data Base Nearly all cases - small number excluded No formal evaluations Private hospital coverage - 94.4% Not ‘all injuries’ - % of various types not incl.? (changes in admission policies, etc.)

11. Research Centre for Injury Studies, May 2002 11 Technical specifications (4) Ascertainment independent? –National deaths data collection In general - probably YES, some queries —Age-related variation in querying External cause –National Hospital Morbidity Data Base Only some injuries result in admission Some admitted cases - more than one record Some injury occur in hospital Deaths in hospital data

12. Research Centre for Injury Studies, May 2002 12 Draft Framework (1)

13. Research Centre for Injury Studies, May 2002 13 Draft Framework (2)

14. Research Centre for Injury Studies, May 2002 14 Two models of specification Minimal change model Better specification based on more comprehensive criteria - replicate explicit and implicit specifications that underlie indicators as originally specified Technically revised model Recommended revisions - now feasible will improve national data for purpose of monitoring population incidence of serious injury

15. Research Centre for Injury Studies, May 2002 15 Technically revised model Specification - set of technical criteria Restriction of cases with anatomical/physiological damage Omitting ‘same day’ cases from hospital data Specifying mortality indicators ito date of death Re-specification of all indicators ito ICD-10 codes

16. Research Centre for Injury Studies, May 2002 16 Main points Part of national process, for review and testing Most indicators refer to injury occurrence Purpose: Measure and monitor change in population incidence of serious injury in Australia Specific products: –Better technical specification of current indicators based on more comprehensive criteria (Minimal change model) –Recommendations for improvements re monitoring population incidence of injury (Technically revised model)

17. Research Centre for Injury Studies, May 2002 17 Further development Indicators of injury incidence –Implement Technically revised model after discussion and testing –Ensure enough system stability to enable monitoring –Implement incremental technical refinement –Develop indicators of severe injury incidence –Review indicator specification periodically –Undertake quality assurance –Propose changes to data sources where necessary Remaining indicators –Assess and specify purpose(s) –Revise, develop, introduce relevant new ones –Develop new data sources where possible