Understanding Injury: What are the Indicators?

1. Understanding Injury: What are the Indicators? Ian Pike, PhD Canadian Injury Indicators Team Director. BC Injury Research and Prevention Unit Asst. Professor, Pediatrics, UBC Alison Macpherson, PhD Canadian Injury Indicators Team Asst. Professor, Kinesiology and Health Science, York University

2. Purpose of this Presentation • To provide a brief introduction to Injury Indicators and some of the work of the Canadian Injury Indicators Team

3. Injury Indicator Definition (Pencheon, 2008) • Indicators are succinct summary measures that describe as much about a system as possible • Injury indicators provide a clear signal and help us understandwhat is happening; they allow us to compare the injury situation between groups and places, and over time • Indicators are more than measures and signals; they must also drive decision and action (i.e. they inform policy, practice and research)

4. Car Dashboard has several indicators that are measures that tell you your speed, how much gas you have, engine temp., what gear you are in, engine revs., etc. Indicators are like a Dashboard

5. Why Indicators? • Ready reference - easily understood • Clear signal – in this case, they signal what is happening in regards to child and youth injuries • Prompts action – gives an idea of what to do Inuksuit are indicators - different forms have different purposes: e.g. to show directions to travelers, to warn of impending danger, to mark a place of respect, or to act as helpers in the hunting of caribou

6. There are hundreds of indicators…Which ones are most useful?

7. Child and Youth Injury Indicators: Work to Date Burden of Injury among Canadian children & youth National Child and Youth Health Coalition Initiative • The Canadian Injury Indicators Team: • Injury Indicators for Canadian Children and Youth • Injury Indicators for Canadian First Nations and Inuit Children and Youth • Injury Policy Indicators and their Associated Risk Factors and Outcomes • CIHR Team in Child and Youth Injury Prevention (LOI stage) Previous Research Canadian Injury Indicators Development Team: Child & Youth

8. Canadian Injury Indicators Team

9. Methods • Phase 1 – Defining Criteria and Establishing Domains • Phase 2 – Literature Review • Phase 3 – Selection of existing indicators and creation of new ones: Expert panel meeting • Phase 4 – Modified-Delphi Process • Phase 5 – Specification of Indicators • Phase 6 – Modified-Delphi II - Broader input through survey

10. Criteria (Rigby, et al., 2003) • Evidence-based, underpinned by research • Significant burden to society, the family and the individual • Representative of significant population groups • Data availability • Topic amenable to effective action • Understandable to broad audience • Regularity and repeatability to enable trend analysis

11. 34 Injury Indicators • Outcome Indicators • e.g. mortality, PYLL, hospitalization • Risk Indicators • e.g. child restraints, young drivers, drunk driving, rural, residential swim pools • Policy Indicators • e.g. GDL, bicycle helmets, playground CSA standards, window guards, hot water tank

12. Indicator Definition Definition of Relevant Terms Justification for this Indicator Operational Definition of a Case Method of Calculation Numerator Denominator Data sources, availability and quality/years represented Units of measurement Guide for Use Scope of Indicator Specification of Data Needed Limitations How to Use this Indicator Definition & Specification of Indicators

13. 19 Bicycle Helmet Legislation

14. Injury Indicators for Children and Youth

15. Rating of Overall Indicators

16. Rating of Motor Vehicle Indicators

17. Rating of Violence Indicators

18. Rating of Policy Indicators

19. Results • From the initial list of 51 indicators, a refined list of 34 indicators was established • Indicators were grouped into Policy Indicators, Risk Factor Indicators, and Outcome indicators • In general, indicators related to motor vehicle crashes and overall injury indicators ranked the highest • Indicators related to violence and trauma care ranked lower for usefulness and much lower in their ability to prompt action

20. Related Projects: Policy Indicators (CIHR) GOALS: • A greater understanding of the elements related to successful injury prevention policies and their interaction with injury risk factors and outcomes • Improved injury-related policies across Canada • Reduced injury among Canadian children and youth

21. Related Projects: Injury Indicators for First Nations and Inuit children and youth • Health Canada’s First Nations and Inuit Health Branch supported a parallel development of indicators • Mirrored same process as original project • 33 indicators defined and specified in the following domains: - Indicators that will be measured across all injury areas - Animal Bites - Hypothermia/Frostbite - Violent/Inflicted Injury - Burns and Falls - Drowning - Suicide - Motorized Vehicle Collisions

22. Project Goal • To use an evidence-informed approach to develop a list of injury indicators for First Nations and Inuit children and youth • Final list of indicators must be useful in prompting action to prevent injuries among First Nations and Inuit children and youth

23. Methods • Phase 1 – Literature search • Phase 2 – Advisory Group brainstormed list of indicators • Phase 3 – Refinement of indicators using a modified Delphi process: we asked groups to give feedback and to rank indicators based on criteria • Phase 4 – Indicator specifications written • Phase 5 – Feedback on specifications • Future – Planning for validation and implementation of indicators

24. Injury Indicators for First Nations and Inuit Children and Youth

25. Injury Indicators for First Nations and Inuit Children and Youth (continued)

26. What Now? • Continue work on policy indicators project • Publish two plain-language summaries of injury indicators 1)First Nations and Inuit children and youth indicators and 2)Mainstream Canadian children and youth indicators • Work toward validation of the indicators • Work toward making a ‘dashboard’ of indicator data available through a child and youth injury web portal • Prepare future grant proposals to support community level injury prevention surveillance

27. For more information, please contact: Alison Macpherson at York University alison3@yorku.ca Ian Pike at BC Injury Research and Prevention Unit (BCIRPU) ipike@cw.bc.ca Shannon Piedt at BC Injury Research and Prevention Unit (BCIRPU) spiedt@cw.bc.ca

28. Thank you Acknowledgements Funding: First Nations and Inuit Health Branch Centre for Community Child Health Research Child and Family Research Institute Child Health BC University of British Columbia