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Injury Information Systems in Mexico, progress and challenges

Injury Information Systems in Mexico, progress and challenges . Dr Rafael Lozano Dra Martha Hijar. ICE on Injury Statistics Meeting Cuernavaca, Mexico 1-2 June, 2005. Health Information System in Mexico Changes in the Injuries Information System

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Injury Information Systems in Mexico, progress and challenges

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  1. Injury Information Systems in Mexico, progress and challenges Dr Rafael Lozano Dra Martha Hijar ICE on Injury Statistics Meeting Cuernavaca, Mexico 1-2 June, 2005

  2. Health Information System in Mexico Changes in the Injuries Information System Impacts from changes on the injury data and statistics Conclusions Outline

  3. Population Million 106.4 Mexico 2005 Males 52.9 85 + Females 53.5 80 a 84 % with social security 45.1 75 a 79 Males Females 70 a 74 % without social security 54.9 65 a 69 % Urban Areas 74.7 60 a 64 % Rural Areas 25.3 55 a 59 50 a 54 45 a 49 40 a 44 35 a 39 30 a 34 25 a 29 20 a 24 15 a 19 10 a 14 5 a 9 0-4 7.0 6.0 5.0 4.0 3.0 2.0 1.0 0.0 1.0 2.0 3.0 4.0 5.0 6.0 7.0 States 32 Counties 2.4 thousand Localities 199 thousand MEXICO 2005

  4. Utilization ( 2000) ambulatory care hospitalization 31% 42% 38% 33% 31% 25% Organization of the Mexican Health System SOCIAL SECURITY MOH PRIVATE SYSTEM Employers (private insurance) Consumers (fee for service) Federal government (General taxes) Employers (labor taxes) Employees (labor taxes) Federal government (General taxes) Cuotas de recuperación FINANCIAL Federal, state and prepayment Seguro Popular Others PEMEX IMSS IMSS Oportunidades Secretaría de Salud Private innsurance Prepayment ISSSTE ORGANIZATION Public Hospitals Public clinics Public Hospitals Public clinics Private Hospitals Private clinics Private doctors PROVISION Formal labor sector Beneficiary Retired Margin Popula- tion Rural areas Informal workers Self-employers Non-insured population High income /low income Consumers

  5. Mexico Health Information System INEGI, CONAPO Private sector Institutions Routine records Social Insurance (IMSS ISSSTE PEMEX SDN SM) MOH (32 SHS, NIH, FH) S e r v i c e s R i s k Surveys O p i n i o n D a m a g e s R e s o u r c e s E x p e n d i t u r e P o p u l a t i o n Census Sources Information areas

  6. HEALTH INFRASTRUCTURE In-patient Hospitals beds SSA 454 32,207 IMSS-Op 69 2,181 IMSS 262 29,039 ISSSTE 105 6,778 PEMEX 23 958 SEDENA 42 4,174 SECMAR 32 788 State 23 1,148 University 5 473 Private 829 7,629 Total 1,844 85,375

  7. What is meant by Health Information Systems? An integrated effort to collect, process, report and use health information and knowledge to influence policy- making, programme action, and research DATA Analysis ÎNFORMATION Understanding Assessment KNOWLEDGE Application ACTION

  8. MAIN CHALLENGE How do we generate the data we need to attribute outcomes to particular programmes or policies?

  9. Information Is not only Information Technology

  10. Vision Cybernetic Integration Programa Programa Programa Programa Programa Programa Programa Programa hardware software Informatics dataware humanware Systemic approach of four components • Equipment • Communication • Programming • Information • Organization Cybernetic Infrastructure

  11. Health Information System in Mexico Changes in the Injuries Information System Impacts from changes on the injury data and statistics Challenges Outline

  12. In 2002 Format of injuries attended in the emergency rooms* Format of hospital discharges (SAEH)* In 2003 Format of death certificate** In 2004 Process of capturing death certificates** *only health facilities of MOH ** SEED (coverage of …. injury deaths) Changes in the HIS related with injuries

  13. Complex process to produce data Different interest of participants Institutions & States Few incentives to support the introduction of new formats (hand filled) Culture of information Failures on the processand problems to solve • Completeness • Quality of data • Missclasification • Coding • Relative importance • Poor use of data

  14. Health Information System in Mexico Changes in the Injuries Information System Impacts from changes on the injury data and statistics Challenges Outline

  15. Format used in emergency rooms SIS-SS-17-P

  16. > 1h 1-2h 3+ % Falls 49.5 16.5 34.0 29.9 Venomous animals 53.6 16.4 29.9 20.5 Sharp Objects 57.5 17.7 24.8 14.8 Falls Blunt Object 53.4 17.8 28.8 9.8 Venenous animals Sharp Objects MVA 61.4 21.0 17.5 9.0 Blunt Object Figths 38.9 18.8 42.4 3.2 MVA Hand and foot 52.2 17.1 30.7 2.3 Others Fires 48.2 13.8 38.0 2.2 Figths Female Hands and feets Poisonings 44.3 20.1 35.5 1.5 Male Fires fire arms 47.6 21.6 30.8 0.6 Poisonings Others 51.3 17.0 31.8 6.2 fire arms Total 52.7 17.3 30.0 431,521 0.0 5.0 10.0 15.0 20.0 25.0 30.0 35.0 Injuries at emergency rooms, México 2003

  17. 40.0 25.0 35.0 30.0 20.0 25.0 15.0 20.0 15.0 10.0 10.0 5.0 5.0 0.0 0.0 0-4 5 A 14 15 A 24 25 A 44 45 A 64 65+ Lunes Martes Miercoles Jueves Viernes Sabado Domingo Males Females 0-14 15-44 45+ Injuries from road traffic accidents registered in emergency services of the MOH, 2003

  18. Total Non Insured Insured Private Total 5,579.8 1,920.4 2,433.0 1,226.3 Communicable, Maternal and Nutrition 44.9 57.2 34.8 45.5 Non Communicable 43.4 32.1 52.2 43.4 Injuries 7.2 7.6 7.0 6.9 Institution 100.0 36.4 42.5 21.1 Hospital Discharges, Mexico 2003

  19. Injury-related hospital discharges in MOH, 2002-2004 % 4.7–8.2 8.3–9.9 9.10–13.6

  20. Hospitalization format (SAEH) SIS-SS-14-P

  21. Injury-related hospital discharges with both registries (external cause & nature of the injury by state, MOH hospitals, 2002-2004 % 62.5–89.0 89.1–92.7 92.8–97.5

  22. Distribution of type of injury by external cause in 35 to 64 year old males, MOH, 2002-2004 Fuente: SAEH, 2002-2004

  23. Average length of stay 8.0 20.0 7.0 16.0 6.0 12.0 5.0 8.0 4.0 4.0 3.0 0.0 2.0 0 1 5 0 1 5 10 15 20 25 30 35 40 45 50 55 60 65 70 75 80 85 Hospital discharges due to road traffic accidents 2002-2004 Case fatality at hospital per 100 dis 10 15 20 25 30 35 40 45 50 55 60 65 70 75 80 85 Male ped Female ped Male crash Female crashes

  24. Death registries Under registration  † † † † † funeral parlor cemetery Number of certificate † † † † † † † Health Services Dead No. certificate Death Certificates Informs Relative   Death certificate  Death certificates  • Medical facilities (public and private) • Private physicians • Coroners Wrong diagnosis MOH Civil Registry DELAY INEGI inconsistencies Registration Publications Bad registration bad codification Health services SEED

  25. UNDERTEMINATE INTENT, 2003 Veracruz Tabasco Michoacán Distrito Federal Quintana Roo Morelos Tlaxcala Cercified by doctor Coroner Baja California Hidalgo Oaxaca Jalisco Tamaulipas 1989 97.2 59.9 Puebla Yucatán 1990 97.5 61.7 Campeche Nayarit Colima 1991 97.7 65.1 Querétaro Sinaloa 1992 97.3 66.5 Chiapas Guanajuato 1993 97.7 68.1 San Luis Potosí México Baja California Sur 1994 98.3 75.6 Guerrero Zacatecas 1995 98.4 77.9 Chihuahua Nuevo León Coahuila 1996 98.7 79.1 Sonora Durango 1997 99.0 81.8 Aguascalientes 1998 98.9 81.8 0 2 4 6 8 10 1999 99.1 83.1 2000 99.3 83.3 2001 99.0 84.4 RATE X 100,000 POP 2002 98.8 83.9 2003 98.7 84.2 2004 98.5 86.1 Quality of injuries death registries Who Certifies?

  26. Selección del Informante QUIEN CERTIFICÓ LA DEFUNCIÓN Parentesco Persona aut. SSA Nacional M..tratante Otro médico M..Legista Otro No esp % % % % % % % Línea directa 75.2 74.0 78.1 68.8 75.7 69.0 66.1 Línea indirecta 16.9 18.4 16.7 14.7 17.6 17.2 14.0 Sin parentesco 2.0 1.9 1.7 3.0 2.6 6.9 1.5 No especificado 5.9 5.7 3.6 13.4 4.1 6.8 18.4 EDAD DEL FALLECIDO Nacional <1 año <5 años 60 a 69 70 a 79 80 y más % % % % % % Línea directa 75.2 79.8 79.7 80.5 76.2 65.3 Línea indirecta 16.9 12.8 13.2 12.1 16.5 26.5 Sin parentesco 2.0 0.5 0.6 1.8 1.9 2.5 No especificado 5.9 6.9 6.5 5.6 5.4 5.6 CAUSAS DE MUERTE SELECCIONADAS Nacional Maternas Diabetes Mal definidas Accidentes Homicidios Suicidios % % % % % % % Línea directa 75.2 81.8 73.1 57.6 66.3 63.5 66.7 Línea indirecta 16.9 10.6 13.2 25.6 15.6 10.8 12.7 Sin parentesco 2.0 1.2 0.1 3.8 3.6 4.2 7.2 No especificado 5.9 6.4 13.6 13.0 14.5 21.5 13.4 Línea directa (padres, hijos, hermanos, cónyuge ocompañero)) Línea indirecta ( abuelo, nieto, tío, primo y otro parentesco) FUENTE: Base de datos de las defunciones del Sistema Estadístico Epidemiológico de las Defunciones (SEED), 2004

  27. Codificación TB 95.5 89.0 82.4 Acci-dentes 67.8 79.8 53.8 Peri-natal 94.5 83.1 74.0 Mal Def 89.8 80.0 67.3 Concepto Causas codificadas resp. a causas a codificar Causas correctas resp. a causas codificadas Causa básica correcta* Total 93.6 93.1 75.7 *Se exigió calidad con la mayor especificidad (4 caracteres) 14% de las causas mal definidas correspondían a otros capítulos y 6.8% de ellas eran por causas externas Problemas de codificación en Diabetes mellitus, Causas externas, Desnutrición y trastornos metabólicos y Malformaciones congénitas (Reglas CIE-10)

  28. Transport Accidents in Mexico City, 2000 No. % Total 1118 100.0 - Car Accident 234 20.9 - Crash 67 6.0 - fall from vehicle 3 0.3 - pedestrian injured 596 53.3 - Other 86 7.7 Adequately described 132 11.8 Source: Death certificates analysis V09.9 pedestrian injured in unspecified transport accident 2,149

  29. SECRETARÍA DE SALUD CERTIFICADO DE DEFUNCIÓN Institución residencial 1 1 2 Calle o carretera (vía pública) 4 Sí No Sí No Granja (rancho o parcela) 2 2 1 1 7 1 4 3 2 8 5 Número de la cédula profesional Modelo 2004 FOLIO 0 4 0 0 0 0 0 0 0 ANTES DE LLENAR EL CERTIFICADO, ES NECESARIO QUE LEA LAS INSTRUCCIONES EN EL REVERSO 23. SI LA MUERTE FUE ACCIDENTAL O VIOLENTA, ESPECIFIQUE 23.4 Violencia familiar 23.3 Lugar donde ocurrió la lesión 23.1 Fue un presunto 23.2 ¿Ocurrió en el desempeño de su trabajo? Escuela u oficina pública 2 Vivienda particular 0 Accidente Homicidio Área comercial o de servicios Áreas deportivas 5 3 Se ignora Suicidio 3 9 Área industrial (taller, fábrica u obra) 6 Se ignora 9 Se ignora 8 Otro Se ignora 9 9 23.5 La defunción fue registrada en el Ministerio Público con el acta número 23.6 Describa brevemente la situación, circunstancia o motivos en que se produjo la lesión MUERTES ACCIDENTALES Y VIOLENTAS 23.7. En caso de accidente de vehículo de motor, anote el domicilio donde ocurrió la lesión 23.7.1 Calle y Localidad o Colonia 23.7.2 Municipio o Delegación 23.7.3 Entidad Federativa DEL INF 24. DATOS DEL INFORMANTE 24.2 Parentesco con el fallecido(a) 24.1 Nombre 25. CERTIFICADA POR 26. SI EL CERTIFICANTE ES MÉDICO Persona autorizada por la Secretaría de Salud Médico tratante Médico legista Otro médico Autoridad civil Otro DEL CERTIFICANTE 27. DATOS DEL CERTIFICANTE 27.1 Nombre y Firma 28. FECHA DE CERTIFICACIÓN 27.2 Domicilio y Teléfono Día Mes Año

  30. MVA and quality of the information for GIS, Mexico 2004 13,830 Deaths due to MVA With data Without data 65.5% 34.5% 13.7% Unspecified (ambulance, hospital, etc.) 65.9% highway  60.3% with correct location 20.4% street / corner  33.5 % number and street 49.4 % useful 50.6% useless

  31. Lesiones accidentales e intencionales dentro de las principales causas de muerte, 2003 Orden 0 a 4 años de edad 5 a 14 años de edad 15 a 29 años de edad Asfixia y trauma al nacimiento Accidentes de vehículo de motor 1 Leucemia 8.6 13.3 26.1 (transito) Infecciones respiratorias agudas bajas Accidentes de vehículo de motor Agresiones (homicidios) 2 7.5 12.8 7.8 (transito) Peatón lesionado en accidente de vehículo de motor Malformaciones congénitas del corazón Lesiones autoinfligidas intencionalmente (suicidios) 3 7.1 6.5 7.7 Enfermedades infecciosas Ahogamiento y sumersión 4 4.8 VIH/SIDA 4.0 5.0 intestinales accidentales Peatón lesionado en accidente de vehic. de motor Bajo peso al nacimiento y Agresiones (homicidios) 5 3.3 3.9 3.3 prematurez Desnutrición calórico protéica Infecciones respiratorias agudas bajas Ahogamiento y sumersión 2.6 6 3.1 2.6 accidentales Ahogamiento y sumersión Nefritis y nefrosis 7 2.7 0.9 3.2 accidentales Leucemia Anencefalia y malformaciones Malformaciones congénitas del corazón 8 2.3 2.6 0.7 similares Nefritis y nefrosis Desnutrición calórico protéica Cirrosis y otras enfermedades 9 2.1 2.1 0.7 Leucemia crónicas del hígado Peatón lesionado en accidente vehiculo de motor Lesiones autoinfligidas 10 2.1 1.7 intencionalmente (suicidios) 0.7 Diabetes mellitus Enfermedades infecciosas Accidentes de vehículo de motor 11 1.8 1.5 intestinales 0.7 (transito) Epilepsia

  32. Lesiones accidentales e intencionales dentro de las principales causas de muerte, 2003 Orden 30 a 44 años de edad 45 a 59 años de edad Total Cirrosis y otras enfermedades 1 17.9 11.5 12.6 crónicas del hígado Diabetes mellitus Diabetes mellitus Cirrosis y otras enfermedades Enfermedades isquémicas del 2 Agresiones (homicidios) 13.1 7.6 10.8 crónicas del hígado corazón Enfermedad cerebrovascular Diabetes mellitus Enfermedades isquémicas del 3 9.2 5.9 5.7 corazón Accidentes de vehículo de motor Cirrosis y otras enfermedades 4 4.3 5.8 5.7 (transito) Enfermedad cerebrovascular crónicas del hígado Enfermedad pulmonar 5 Agresiones (homicidios) 2.3 5.5 3.8 VIH/SIDA obstructiva crónica Enfermedades isquémicas del Infecciones respiratorias agudas 6 corazón 2.2 4.6 2.9 Nefritis y nefrosis bajas Lesiones autoinfligidas 7 2.0 intencionalmente (suicidios) 2.7 2.4 Tumor maligno de la mama Enfermedades hipertensivas Accidentes de vehículo de motor 8 2.0 Uso de alcohol 2.5 2.2 (transito) Nefritis y nefrosis Peatón lesionado en accidente Tumor maligno del cuello del 9 1.9 2.5 2.2 de vehículo de motor útero Asfixia y trauma al nacimiento 10 1.9 2.4 2.1 Enfermedad cerebrovascular Uso de alcohol Agresiones (homicidios) Accidentes de vehículo de motor 11 1.7 2.1 2.0 Nefritis y nefrosis Enfermedades hipertensivas (transito)

  33. The results due to changes in the health information system can be seen in the medium term. It is difficult to expect “good data” (consistent, valid, timely, complete) in the short run if there is no change in the incentives to physicians and health personnel Because they are complex in nature, injuries require more detailed registration than other health damages. Coroners are a very complicate group to incorporate Conclusions I

  34. Permanent training in codification The information on injuries produced by the MOH is seldomly used The research community should be more involve in the improvements of the routine injuries registration Conclusions II

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