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From Provincial to National: The Development of Thailand Injury Surveillance Chamaiparn Santikarn, MD., MPH. Non-communicable Diseases Bureau, Ministry of Public Health Siriwan Santijiarakul, MSc. Epidemiology Bureau, Ministry of Public Health, Thailand Introduction

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from provincial to national the development of thailand injury surveillance
From Provincial to National: The Development of Thailand Injury Surveillance

Chamaiparn Santikarn, MD., MPH.

Non-communicable Diseases Bureau, Ministry of Public Health

Siriwan Santijiarakul, MSc.

Epidemiology Bureau, Ministry of Public Health, Thailand

introduction
Introduction
  • 1995, Thailand Provincial Injury Surveillance started in 5 large sentinel hospitals
  • Population under surveillance - all injury cases presenting at the emergency rooms (occurred within 7 days)
introduction3
Introduction
  • System objectives: Establish a database for assessing acute care and referral services; and facilitate injury prevention at provincial and national levels
data flow and responsible unit
Data flow and responsible unit

E.R.

Nurse

Medical Record Department

Medical Statistics Technicians

Diskette to

Epidemiology Division

Report distributed within hospital and province

6 mnth.

4-6 mnth.

Local action

National action

introduction5
Introduction
  • Emphasized on local utilization for action than centralizing the data
  • Local information users - physicians, nurses and policymakers
  • PC software specifically developed for local processing
introduction6
Introduction
  • Menu of 35 ready-made tabulations
  • TRISS methodology was used to estimate survival probability
  • Screening tool to identify trauma cases with unexpected outcome for trauma audit
  • Quality of acute care services monitored
introduction7
Introduction
  • System expanded to 22 large hospitals
  • In 2001, national coordinating unit proposed reducedreporting criteria, included only severe injuries (deaths, observed and /or admitted)
objectives
Objectives
  • Gain better representativeness of important injury events in each province
  • Better data quality
  • Decrease resource need

7 มีนาคม 2557

Dr. Chamaiparn Santikarn

methods
Methods
  • To assure the sentinel hospitals

Epidemiology Division used the available data

    • Identify workload decrease under the new criteria
    • Information changes due to the new criteria
slide10

A.D. 2001

22 reporting sentinel sites

15 study sites

7 Other sites

methods11
Methods
  • In December 2000
    • Workshop for Establishing the National Injury Surveillance
    • Analysis results presented
results
Results

With the new reporting criteria

  • The number of records to be reported decreased

from 197,140 to 63,607

  • 68 % decrease
  • Total workload would

be decreased by 58 %

fig 1 distribution of maximum ais of trauma cases

previous vs.. new criteria, 15 sentinel hospitals, 1998

Fig. 1 Distribution of maximum AIS of trauma cases

No. of records

1

2

3

4

5

6

Max. AIS

Source : 15 sentinel hospitals, provincial injury surveillance, Thailand.

fig 2 distribution of maximum ais of trauma cases

previous vs.. new criteria, 13 non -Bangkokhospitals

Fig. 2 Distribution of maximum AIS of trauma cases

No. of records

1

2

3

4

5

6

Max. AIS

Source : sentinel hospitals, provincial injury surveillance, Thailand 1998.

fig 3 distribution of maximum ais of trauma cases

previous vs.. new criteria, Bangkok,1998

Fig. 3 Distribution of maximum AIS of trauma cases

No. of records

1

2

3

4

5

6

Max. AIS

Source : sentinel hospitals in Bangkok , provincial injury surveillance, Thailand .

results16
Results
  • 5 leading cause of injuries in each sentinel site
    • Minor change 2nd - 3rd rank
    • Tendency towards external causes with more severe outcome
slide17

Five leading cause of injuries, previous criteria vs. new criteria

previous criteria

new criteria

cases

%

cases

%

Transp. Acc 93,020 47.2 Transp. Acc 36,922 58.0

Acc. Inan. Frce 36,092 18.3 Acc. Falls * 7,987 12.6

Acc. Falls 25,597 13.0 Acc. Inan. Frce* 7,314 11.5

Assaults 16,106 8.2 Assaults 4,727 7.4

Self-harm 13,520 6.9 Self-harm 2,619 4.1

Others 12,085 6.5 Others 4,038 6.3

Total 197,140 100.0 Total 63,607 100.0

results18
Results
  • The experts and authorities supported the new criteria
  • Local concerns/worries
    • Data for administration within the hospital
    • Epidemics detection of some minor injuries but potential health service burden in the provincial level
results19
Results
  • The new criteria became

minimum data collection standard for national injury surveillance

  • Hospitals could still use previous criteria to meet with internal need and provincial utilization
results20
Results
  • Simple computer technique needed to manage electronic file before sending in the data
results under new criteria
Results (under new criteria)
  • The system could continue in spite of severe manpower crisis in central coordinating unit (2002-2003)
  • Could report RTI victims risk behaviors monthly the Deputy Prime Minister to monitor the fight against RTI ( 2004 )
slide22

2005 A.D.

  • 28 sentinel hospitals in network
  • Other 12 provincial hospitals operate this surveillance model for local use
  • National project to promote child MC helmet - a response to surveillance report
  • 14 sentinel hospitals broaden roles to health promoting hospital for road safety
discussions
Discussions
  • To much workload is common for agency collecting or managing surveillance data
  • Negative impact on data quality and timeliness
  • Capacity of computer hardware usually wasted in developing countries
discussions25
Discussions
  • Report of Surveillance Evaluation in Sentinel provinces (2001)
    • Administration within the hospital use only total number of the ER cases
    • Epidemics detection of minor injury

not done, nor investigated

discussions26
Discussions
  • Report of Surveillance Evaluation in Sentinel provinces (2001)
    • Severe injury data – used for monitoring referral and intra-hospital trauma care
    • All hospitals evaluated – still used the previous criteria !?!
lesson learned
Lesson learned
  • More difficult to live with less data after having it !
recommendations
Recommendations
  • Future establishment of national injury surveillance system in developing countries
    • Focus on severe injuries only
    • Aims for quality of acute care as well as prevention
    • Sentinel surveillance work !
    • Sentinel hospitals are great partnership
conclusion
Conclusion
  • This reporting criteria of Thailand National injury Surveillance suitable for developing countries
      • resources are scarce
      • acute care still needs improvement
      • injury prevention just begun
acknowledgment
Acknowledgment
  • International Collaborative Effort on Injury Statistics
  • LA Fingerhut, MA
  • U.S. CDC's NCHS, NIH's NICHD
  • 28 sentinel hospitals
  • Surveillance evaluating

team

results31
Results
  • Investment for the first year (not including salary)
      • 3.8 million baht
      • approximately 10,000US $ (according to the exchange rate

at present )

results32
Results
  • Distribution of trauma cases by

severity

    • maximum AIS scale in each patient
    • 161,916 cases - current criteria
    • 47,900 cases - new criteria
slide33

Fig. 4 Distribution of age of trauma cases

current vs. new criteria, 15 sentinel hospitals, 1998

No. of records

Age [year]

<1

5-9

15-19

25-29

35-39

45-49

55-59

slide34

Fig. 5 Distribution of age of trauma cases

compared between current v.s. new criteria, 15 sentinel hospitals, 1998

Percentage

5-9

25-29

45-49

>1

15-19

35-39

55-59

% of decreased of new criteria cases

Age [year]

results data quality a d 2001
ResultsData quality A.D. 2001

New national report criteria

  • Report coverage
    • Observed & admitted 86%
    • Dead cases 77%
  • Completeness and reliability 89%
  • Timeliness in data entering

within 30 days 46%