Introduction to Data Presentation Billings Area 2011: Injury Data Introduction

Transcription

1 Utilize the Participants Summary Presentation (see template) to illustrate value of data. Inform students that next 2 days will focus on Injury Data, with three major blocks of instruction: 1. Review and morbidity/mortality coding ( Injury Data Introduction ) 2. Data Collection ( Data Collection ; Data Collection Planning ; Data Collection Lab ) 3. Basic Injury Epidemiology & Statistics ( Data Analysis ; WISQARS ) 1

2 Session goal & Objectives: ( By the end of the session, participants will be able to ) Describe the uses of data including understanding an injury problem, guiding injury prevention programming, and uses in evaluation Define the term injury as used in data collection we will introduce a systematic method of classifying injury, the ICD Define the types of data. We ll include a review of some data terms we used in Introduction to IP, as well as a few new terms List general sources of data 2

3 Open Floor Discussion (ask the questions to the students; engage them to provide personal experiences; consider using flip chart to facilitate discussion) Two Types of Data: Qualitative data: used to understand people s opinions/attitudes/beliefs; collected through interviews, surveys, focus groups; gives insight on development of your program/messages/materials. Quantitative data: raw numbers/counts; used indentify injury patterns. Collected through surveillance, observations, risk assessments; gives insight on setting program priorities and evaluating impact of your program. Use of Data in IP: Understand trends/patterns/risk factors/causes of injury in a population Set priorities for prevention Guide/persuade decision makers re: public health policy (i.e., community survey data re: passing a seat belt law) Develop program messages & materials (design of float coats in AK; safety message for a targeted group) Justify needs/build your case for funding (i.e., grants) Evaluate your program What are some common sources of injury data? Local IHS Severe Injury Surveillance System (SISS) Resource and Patient Management System (RPMS) Medical Records & Death Certificates EMS & Police Observations (i.e., seat belt surveys, home safety assessments) Questionnaires/Surveys/Focus Groups/Key Informant Interviews 3

4 Two Types of Data: Qualitative data: used to understand people s opinions/attitudes/beliefs; collected through interviews, surveys, focus groups; gives insight on development of your program/messages/materials. Quantitative data: raw numbers/counts; used indentify injury patterns. Collected through surveillance, observations, risk assessments; gives insight on setting program priorities and evaluating impact of your program. Use of Data in IP: Understand trends/patterns/risk factors/causes of injury in a population Set priorities for prevention Guide/persuade decision makers re: public health policy (i.e., community survey data re: passing a seat belt law) Develop program messages & materials (design of float coats in AK; safety message for a targeted group) Justify needs/build your case for funding (i.e., grants) Evaluate your program What are some common sources of injury data? Local IHS Severe Injury Surveillance System (SISS) Resource and Patient Management System (RPMS) Medical Records & Death Certificates EMS & Police Observations (i.e., seat belt surveys, home safety assessments) Questionnaires/Surveys/Focus Groups/Key Informant Interviews 4

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7 Agents of Injury: (Remember from Level 1, the epi triangle, with host, agent, and environment?) Injuries, for the most part, result from short-term exposure to large concentrations of energy: Mechanical: crushing injury in wringer washer, energy transferred during M/V crash Thermal: heat injuries fire, hot water scalding Chemical: battery acid spill, poisoning Electrical: lightening Radiation: sunburn, overexposure to x-ray Absence of oxygen: drowning, suffocation, smoke inhalation, carbon monoxide Absence of heat: hypothermia, frostbite Excess heat: heat stroke (hyperthermia) Two Main Injury Categories: (An agents of injury isn t a very specific way to categorize injuries for data collection and analysis) Unintentional: Drowning, Fall, Fire/Burn, MVC, Poisoning, Other Intentional: Suicide, Self-Harm, Assault (child abuse, elder abuse, domestic violence, etc) Note to Instructor: Transition from two main categories of injury to ICD-9 Consider statement similar to: In the medical field, injuries are classified with a standardized coding system call the International Classification of Disease 7

8 Agents of Injury: (Remember from Level 1, the epi triangle, with host, agent, and environment?) Injuries, for the most part, result from short-term exposure to large concentrations of energy: Mechanical: crushing injury in wringer washer, energy transferred during M/V crash Thermal: heat injuries fire, hot water scalding Chemical: battery acid spill, poisoning Electrical: lightening Radiation: sunburn, overexposure to x-ray Absence of oxygen: drowning, suffocation, smoke inhalation, carbon monoxide Absence of heat: hypothermia, frostbite Excess heat: heat stroke (hyperthermia 8

9 Two Main Injury Categories: (An agents of injury isn t a very specific way to categorize injuries for data collection and analysis) Unintentional: Drowning, Fall, Fire/Burn, MVC, Poisoning, Other Intentional: Suicide, Self-Harm, Assault (child abuse, elder abuse, domestic violence, etc) 9

10 Note to Instructor: There are several very good online resources for ICD-9 (some are include on a PPT slide at the end of this presentation) The World Health Organization (WHO) is a very good resource: and includes a good history lesson at The American Academy of Professional Coders (AAPC) is another good resource: Go to the resources tab for ICD-10 and ICD-9 info. Of particular interest is the code translator. The purpose of this presentation is not to make students expert, certified coders; instead we re providing a general overview for students to have a good understanding of how injury is classified, how to query an existing database with ICD codes, and how to conduct a simple analysis of such a database. International Classification of Disease (general history & description): History of ICD dates back to the 1850s (again, see WHO website for more on history) Since 1948, World Health Organization (oversees the ICD ICD is the international standard diagnostic classification system for all general epidemiological, many health management purposes and clinical use (including billing). ICD includes codes for diagnosis of disease and injury; and cause of injury codes Codes are updated annually; so it s important to understand that new codes will influence multi-year analysis (example: Fall from skateboard introduced in year 3 of a 5 year dataset if you didn t know that was a new code, you would misinterpret that skateboard fall injuries didn t start until yr3). Since 1999 the United States has utilized two ICD versions: ICD-9: Used to code non-fatal (i.e., doctor s office visits and hospitalizations) ICD-10: Used to code deaths The two versions don t directly correlate. One reason is that ICD-10 expands to 141,000 codes compared to ICD-9 s 17,000 10

11 ICD diagnosis codes for illness and nature of injury (some old timers might refer to them as N-Codes) Note to Instructor: Describe differences between ICD-9 and ICD-10 diagnosis codes (as they related to injury prevention) A good resource on ICD-10 overview is provided by the AAPC at ICD-9 (Diagnosis Codes) Used exclusively in the US for coding diagnosis of non-fatal illness & injury (most other countries use ICD- 10 for both morbidity & mortality coding) Diagnosis codes are required for medical billing. Medical personnel may generically refer to diagnosis codes as ICD9 codes; although you will learn that ICD9 includes more than just diagnosis codes. Injuries are numeric codes in the range of the ICD-9 Updated at least annually The Dept of Health & Human Services has indicated on Oct. 1, 2013 the ICD-9 will be phased out for coding of medical bills (Medicare reimbursement) and replaced with ICD-10. ICD-10 (Diagnosis Codes) Used exclusively in the US for coding diagnosis of fatal illness & injury (most other countries use ICD-10 for both morbidity & mortality coding) Basically, this is the cause of death on a death certificate Injuries are alphanumeric codes in the range S00-T98 of the ICD-10 S are codes to a specific body part T are codes to multiple body parts; burns; poisoning 11

12 Note to Instructor: Slide is intended to illustrate coding differences between ICD-9 and ICD-10 A big difference is ICD-9 code categories focus on the nature of injury (i.e., fracture or burn); while ICD-10 categories focus more on the injured body part The example ICD-9 code illustrates the specificity of the coding where 800 refers to fx vault of skull; the 4 th digit (.0) refers to no intercranial injury; and the 5 th digit (.x5) refers to mild loss of consciousness (LOC) defined by ICD-9 as less than 1 hr. After brief overview, refer to ICD-9 and ICD-10 handouts for full listing of injury diagnosis groups. 12

13 Note to Instructor: Describe differences between ICD-9 and ICD-10 external cause of injury codes (as they related to injury prevention) A good resource on ICD-10 overview is provided by the AAPC at ICD-9 (External Cause of Injury Codes) Used exclusively in the US for coding external cause of injury (most other countries use ICD-10 for both morbidity & mortality coding) Unlike diagnosis codes; are not required for medical billing. Referred to as E-Codes due to naming format (numeric preceded by E ) Same numeric range as diagnosis codes There are separate, supplemental E-codes to identify the place of injury (home, school, etc) although under-utilized Also, updated at least annually Also planned to be phased out on Oct. 1, 2013 the ICD-9 and replaced with ICD-10. Per 2004 study ( only 26 states require E- coding for hospital discharges; enforcement varies, resulting in only about 40% of those states having hospital discharge E-code rates at above 90%. IHS does a great job E-coding for hospital discharges when the d/c is from one of our facilities. E-code rates are low for ambulatory (incl. emerg. Dept.) and for cases involving CHS. For example, a 2005 study in the Reno District (PHX Area) looked at E-code rates in 7 IHS & tribal clinics over a 4 year period ( ) and found 0-97% (51% average) of injury cases had E-codes. What can be done to improve E- code rates? Reno District staff shared results with clinic administrators and discussed the important public health application of E-codes. A few clinics decided to implement policies to require E-coding. ICD-10 (External Cause of Injury Codes) for the most part, same discussion/explanation as ICD-10 Diagnosis Codes Used exclusively in the US for coding external cause of death on death certificates (most other countries use ICD-10 for both morbidity & mortality coding) Injuries are alphanumeric codes in the range V01-Y98 Like ICD-9, allows for coding for place; but also allows for code for activity (what person was doing prior to death; i.e, physical activity, working) 13

14 Note to Instructor: Slide is intended to illustrate coding differences between ICD-9 and ICD-10 A big is that ICD-10 provides many more coding options, thus allowing for the ability to be much more descriptive and specific for research purposes. For example, ICD-10 provides 20 codes for Falls; while ICD-9 provides only 9 codes for Falls (see Reference Handouts) Again, emphasize ICD-9 and ICD-10 datasets shouldn t be merged for analysis due to the significant differences in coding and additional codes in ICD

15 Note to Instructor: Because we ll later be querying an ICD-10 dataset (WISQARS), the following slides and exercise are intended to provide students a better understanding of ICD-9s E-codes. An E-code is a 4 (sometimes just 3) digit number preceded by the letter E. The first 3 digits indicate the type of injury group. The fourth digit, which follows the decimal point, provides additional descriptive information or specificity of the injury event. 15

16 Example E-code The number 813 indicated the injury involved a motor vehicle traffic accident involving collision with another vehicle. The.2 indicates the injured person was a motorcyclist. 16

17 E-Codes allow ability to identify injury trends This slide illustrates a listing of E-codes you might receive from query of a hospital discharge database One easy, low tech method of trying using E-codes to determine injury trends and identify potential intervention strategies is to print the E-code listing from the database. Draw lines to separate the groupings. It is apparent that the 2 leading injury types for this community are MVCs and Falls. But can we identify any further patterns or trends in injury with E-codes. Yes, when you look up each code within the groupings you will note that there appears to be: (a) a possible MVC-pedestrian problem per the frequency of E814.7; and (b) a possible playgroundequipment related fall problem per E In summary, when injuries are E-coded you can determine trends in the general type of injury (E-code range, E880-E888), as well as trends of specific types of injury (E-code, 884.0). 17

18 E-coding allows the ability to describe specific causes and contributing factors associated with an injury event. For example, there are individual codes that allow for the coding of fall injuries associated with review slide. 18

19 You might query a dataset and find the following listing of fall E-codes A simple analysis method is to list them in order, draw a line to separate same codes And you might be able to identify some trends Beware Unfortunately, we often find that vague or unspecific E-codes are used resulting in Other/Unspecified as the leading type of fall. 19

20 While ICD-9 codes are very important and useful, there are some limitations associated with E-codes that you should be aware of: Not always E-coded especially contract care facilities. Miscoding/Inconsistent coding human error and interpretation problems. For example, fall from vehicle might be coded as: E818 Other noncollision motor vehicle traffic accident; fall from MV while in motion or E884.9 Other fall from one level to another; from stationary vehicle, tree, embankment, haystack. Insufficient info fell and fractured hip. Not always desired specificity E918 caught accidentally in or between objects. Must look at narrative in SC found these were wringer washer related. Stay appraised of updates pre-1997 no domestic violence code, reflected only weapon (E966; knife). In 1997 new E-code E967.3 adult abuse by spouse or partner. If unaware of update might be misled of DV epidemic beginning in

21 Diagram illustrates how injuries are typically assigned ICD-9 or ICD-10 External Cause of Injury codes Important Note: Coding requires Certification! 21

22 A few ICD-9, ICD-10, and E-coding references Note: A quick internet search will also result in several vendors for code books, as well as, several online listings of codes. 22

23 Online ICD-9 code lookup tool is at: But have students use hardcopy to get a feel for the codes and how they are structured. E-code Exercise: (allow approx 30 minutes) Use hardcopy of ICD-9 and the ICD-9 E-code listing (pg 2 of handout: ICD 9 Summary of Codes ) Students learn how to E-code a typical injury description that might be found in a medical record. Students also learn potential for miscoding and importance of complete injury descriptions. Students may work individually or in pairs. Have half the class start with case description #1 and the other half start with #10 (to ensure all are coded if time starts running out). Using answer key, review answers and comments (provide copy of answer key to students after discussion). Extra Credit E-Code Analysis Exercise: (for those that finish the E-code Exercise early) Continue use of hardcopy of ICD-9 and the ICD-9 E-code listing (pg 2 of handout: ICD 9 Summary of Codes ) Students identify main injury categories and conduct simple counts to answer the exercise questions. Provide answer sheet for anyone that wants one. 23