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Day 2 | CME- Trauma Symposium | The kentucky trauma registry in the era costich

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he kentucky trauma registry in the era costich

he kentucky trauma registry in the era costich

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  • 1. Kentucky’s Trauma System: A Work in Progress Julia F. Costich, JD, PhD & Svetla S. Slavova, PhD Kentucky Injury Prevention & Research Center Depts. of Health Services Management & Biostatistics Univ. of Kentucky College of Public Health
  • 2. Topics Covered • Trauma system participating facilities • Trauma registry characterization • Trauma registry data • Trauma system strategic planning • Trauma system evaluation structure
  • 3. Participating facilities/ACS Verified • Level I: Univ. of Kentucky & Univ. of Louisville • Level I Pediatrics: Kosair Children’s Hospital & Ky Children’s Hospital • Level II: None o Pikeville & Owensboro in process • Level III: Ephraim McDowell, Taylor Regional Medical Center, Frankfort Regional Medical Center o Hazard Appalachian Regional Hospital in process
  • 4. Participating facilities/State-verified • Fort Logan Hospital: Level IV • James B. Haggin Memorial Hospital: Level IV • Livingston County Hospital: Level IV • Marcum and Wallace Hospital: Level IV
  • 5. Level IV status under development • Crittenden County Hospital • Harrison Memorial Hospital • Medical Center at Franklin • Medical Center at Scottsville • Methodist Union Hospital • Parkway Regional Medical Center • Russell County Hospital • St. Joseph Berea • Trigg County Hospital • Possibly 7 more
  • 6. ®v ®v ®v ®v ®v ®v ®v ®v ®v ®v ®v ®v ®v ®v ®v ®v®v ®v Crittenden Co. Eph. McDowell U of L Trigg Co. St. Joseph Berea Livingston Co. l Fort Logan UK Spring View Pikeville Med. Ctr. Owensboro Med Ctr Harrison Memorial UK Children's. Taylor Regional. Kosair Children's l Frankfort Regional. Marcum & Wallace James B. Haggin. ®v KY Trauma Centers All Trauma Facilities in Current Reports
  • 7. Trauma Registry vs. Hospital Discharge Data • Trauma Registry o 902 KAR 28:040: regulatory authorization and structure o Cases that meet ACSCOT case definition o Verified or applicant facilities o Extensive clinical information o ED and inpatient information in same dataset • Hospital Discharge and Outpatient/ED Data o 900 KAR 7:030: regulatory authorization and structure o All non-federal facilities o Limited clinical information o Injury analysis includes all injury-related ICD codes, not just ACSCOT o Inpatient and ED information in different datasets
  • 8. Table 1: Reporting Site Totals, 2012 Univ. of Louisville Hospital 2964 30% Univ. of Kentucky Hospital 2875 29% Kosair Children's Hospital 864 9% Pikeville Medical Center 650 6% Owensboro Medical Center 633 6% Kentucky Children's Hospital 442 4% Frankfort Regional Medical Center 312 3% Eph. McDowell Regional Med Ctr 299 3% Taylor Regional Medical Center 228 2% Haggin Memorial Hospital 147 1% Eph. McDowell Ft. Logan 142 1% Harrison Memorial Hospital 139 1% All others 349 3% Total 10044 (ED: 2006)
  • 9. Table 2: Primary Body Part Injured Brain 2285 24% Lower extremity 2001 21% Torso 1836 19% Upper extremity 1386 15% Other head/face/neck 874 9% Vertebral column 753 8% Spinal cord 106 1% System-wide/late effects 17 0% Other & unspecified 213 2%
  • 10. Primary Body Part Injured Brain 24% Vertebral column 1% Lower extremity 21% Torso 20% Other & unspecified 2% Other head/face/neck 8% System-wide/late effects 15% Spinal cord 0.2% Upper extremity 9%
  • 11. Table 3: Major Findings by Location & Cause Other Fire- Cut/ Location MVC transp arm Falls Fire Pierce Struck Other Total Street & highway 39% 3084 452 85 71 10 25 41 30 3798 Home 38% 21 111 256 2184 273 266 232 362 3705 Farm 2% 13 40 1 55 4 7 17 53 190 Industrial site 3% 11 15 3 127 19 19 46 67 307 Recreational site 6% 34 269 3 167 4 4 56 25 562 Public building 4% 1 24 21 226 5 24 45 27 373 Residential institution 2% 0 0 0 155 3 7 24 17 206 Other 1% 3 15 3 48 2 4 16 22 113 Unspec/missing 5% 25 69 46 170 23 44 81 76 534 Total 3192 995 418 3203 343 400 558 679 9788
  • 12. Major Findings by Location Street & highway 39% Public building 4% Home 38% Farm 2% Industrial site 3% Recreational site 6% Residential institution 2% Other 1% Unspecified/ missing 5%
  • 13. Table 4: Pre-Hospital Information Zip code of the injury is not available for about 30% of the trauma registry records
  • 14. Table 5: Inpatient & ED Discharge Destinations ED Discharge Destinations Same hospital 231 11.7% Another hospital 950 48.2% Home 626 31.7% Other institution 31 1.6% Died 135 6.8% Inpatient Discharge Destinations Home 5606 69.7% LTC/ICF/Rehab 1517 18.9% Home health/hospice 550 6.8% Died 311 3.9% Other hospital 54 0.7%
  • 15. Table 6: Primary Method of Payment Auto insurance 1972 19.6% Commercial insurance 1874 18.7% "Self-pay" 1873 18.6% Medicare 1768 17.6% Medicaid 1304 13.0% Workers compensation 269 2.7% Other 123 1.2% Missing 861 8.6%
  • 16. Table 7: Age-Related Information Primary Intentional Age group Number % Cause % % Missing 19 0.2% <1yr 170 1.7% Falls 41.8% 25.9% 1-4yr 418 4.2% Falls 39.7% 5.5% 5-14yr 912 9.1% Falls 35.4% 1.2% 15-24 1453 14.5% MVC 46.5% 13.9% 25-34 1324 13.2% MVC 44.0% 17.5% 35-44 1217 12.1% MVC 38.9% 14.3% 45-54 1311 13.1% MVC 36.2% 10.6% 55-64 1101 11.0% Falls 39.2% 6.2% 65-74 844 8.4% Falls 50.2% 3.3% 75-84 785 7.8% Falls 68.8% 2.3% 85+ 490 4.9% Falls 81.2% 0.4% Total 10044
  • 17. Other Data Drug or Alcohol Involvement N= % Alcohol 776 7.7% Rx drug 777 7.7% Illegal drug 264 2.6% 1817 18.1% Patient Sex N= % Female 3834 38.2% Male 6209 61.8% Total 10043 Race & Ethnicity N= % White 9009 89.7% African-American 767 7.6% Other/missing 268 0.8% Hispanic/Latino 191 1.9% Length of Stay N= % 1-7 days 6714 66.8% 8-30 days 98 1.0% > 30 days 1262 12.6% Missing 1970 19.6%
  • 18. Mission Right Patient, Right Care, Right Time Trauma Advisory Council Retreat Vision Provide a comprehensive, coordinated accessible trauma care system, striving for optimal prevention, management and mitigation of injury in the Commonwealth of Kentucky.
  • 19. Values • Inclusivity (starting with EMS, first responders through all levels of care) • Accessibility • Cost-efficiency • Evidence-based care • High quality • Timeliness • Performance improvement • Collaboration • Consistency (standardization) • Professionalism • Reliability • Equitability • Appropriate funding
  • 20. Strengths of current system • Leadership • Trauma Advisory Council • Existing trauma centers and future potential • Statute and regulations • Funding from outside sources • State Trauma Registry • Air ambulance availability • Modular educational programs • Telemedicine and tele- health availability • CDM (registry data management vendor) • RTTDC (rural training) • Statewide registrar meeting • Inclusiveness • KHA support • State Public Health support
  • 21. Weaknesses of current system • Funding • Public perception • Perception of injury • Perception of trauma centers • Geographic distribution • Law without funding • Inadequate regional support & coordination • MD buy-in • EMS systems & turnover in some areas • EMS reluctant to transport to trauma center • Shortage of burn beds and burn training • Rural EMS agencies poorly funded • Database doesn’t capture non- verified centers/lack of statewide participation • TAC has no executive power • Education deficit (clinical trauma knowledge) • Challenging geography • Lack of specialists in rural facilities
  • 22. Strategic Initiatives 1. Achieve state general funding using TAC, trauma centers, EMS, KHA and the legislation. 2. Educate legislators, public and providers about the value and relevance of the trauma system. 3. Enhance EMS engagement in the system, and enhance EMS relevance as defined by role, purpose and identity. 4. Support hospital initiatives to achieve trauma reimbursement. 5. Use state trauma data to provide a dashboard for legislature and public, enhanced by personal stories.
  • 23. What would a well-developed trauma system look like? (based on Amer. Coll. of Surgeons guidelines) Key Elements: System Assessment Policy Development System Assurance
  • 24. System Assessment Category Standard Injury Epidemiology Thorough description of injury epidemiology Trauma Management Information System Established trauma MIS Resource Assessment Assessment completed and updated Emergency Preparedness Assessment Assessment completed including coordination Cost/Benefit and Societal Investment Assesses and monitors values to constituents
  • 25. Policy Development Category Standard Category Standard Statutory Authority/ Administrative Rules Statutory Authority & Administrative rules System Performance Data Data used to evaluate performance and develop policy System Leadership Process used to establish, maintain, improve system Performance Reports and Reviews System leaders review system performance reports Statewide Trauma System, Plan Comprehensive written system plan Inform/Educate Partnerships Lead agency informs and educates State, fosters collaboration Financial & Infrastructure related resources Sufficient resources exist, financial and infrastructure Public Health Emergency Preparedness Links Trauma, public health and emergency preparedness are linked
  • 26. System Assurance Category Standard Category Standard Trauma MIS & Outcomes Trauma MIS used to assess & assure system performance Integration of Trauma Plan Trauma plan integrated with mass casualty plan EMS System Support System supported by EMS, trauma, EMS, public health integrated Outreach and Prevention Trauma system demonstrates prevention & outreach activities Role for all Acute Care Facilities All acute care facilities integrated into network that meets standards; optimal care for all injured patients Continuous Trauma Care Improvement Each hospital must improve care as measured by outcomes Analytic Monitoring Tools Agency uses tools to monitor performance Rehabilitation Availability Adequate rehab facilities integrated into system
  • 27. Contact Information Kentucky Injury Prevention & Research Center 333 Waller Ave. Lexington, KY 40504 859-257-4954 www.mc.uky.edu/kiprc