Injury Data Introduction Intermediate Injury Prevention August 23

Injury Data Introduction Intermediate Injury Prevention August 23 -26, 2011 – Billings, MT

Injury Data Introduction v Session Goal: • Review injury data concepts fr: Intro to IP Course • Understand classification system for injury morbidity & mortality v Session Objectives: • Describe the uses of data • Define types of data • Identify common sources of injury data • Describe classification system for injury coding • Interpret listings of injury morbidity/mortality codes

In Review… v. What are the two types of data? (hint: words v. numbers) v. How are data used in IP? v. What are the sources of injury data?

Two Types of Data Qualitative Data v Interviews v Surveys v Focus groups v Gives insight on development of your program/messages/ materials Quantitative Data v Raw numbers v Counts v Identify injury patterns v Surveillance v Observations v Risk assessments

Use of Data in Injury Prevention v Understand trends patterns v Risk factors v Causes of injury in a population v Set priorities for prevention v Guide/persuade decision makers v Develop a program messaging & materials (design of float coats in AK; safety message for a targeted group) v Justify needs/build your case for funding (i. e. , grants) v Evaluate your program

Common sources of injury data? v Local IHS severe injury surveillance system v Resources and patient management system v Medical records & death certificates v EMS & police v Questionnaires v Surveys v Focus groups v Key information interviews v Observations (seat belt surveys, home safety assessments)

In Review… v. What are the agents of injury? (hint: Injury results from the transfer of energy) v. What are the two main categories of injury? (hint: MVC and Domestic Violence are examples)

Agents of Injury v Mechanical: crushing injury in wringer washer, energy transferred during MV crash v Thermal: heat injuries – fire, hot water scalding v Chemical: battery acid spills, poisoning v Electrical: lightening v Radiation: sunburn, overexposure to x-ray v Absence of oxygen: drowning, suffocation, smoke inhalation, Carbon monoxide v Absence of heat: hypothermia, frostbite v Excess heat: heat stroke (hyperthermia)

Two Main Categories of Injury Unintentional v Drowning v Fall v Fire v Burn v MVC v Poisoning Intentional v Suicide v Self-Harm v Assault v Child Abuse v Elder Abuse v Domestic Violence

International Classification of Disease v Diagnosis Codes v Cause of Injury Codes v ICD-9 (Non-fatal) v ICD-10 (Deaths)

Diagnosis Codes ICD-9 v Morbidity v Required for Billing v Numeric v 800 -999 v Updated > annually v Phase out: 2013 ICD-10 v Mortality v Alphanumeric v S 00 -T 98 v Updated every Oct. v Oct. 1, 2013 Morbidity

Diagnosis Codes - Examples ICD-9 Fractures Open Wound Crushing Burns Poisoning ICD-10 800 -829 870 -897 925 -929 940 -949 960 -979 Injury to… Head Neck Knee/Lower Leg Mult. Body Parts Burns & Corrosn Frostbite Poisoning S 00 -S 09 S 10 -S 19 S 80 -S 89 T 00 -T 07 T 20 -T 32 T 33 -T 35 T 36 -T 50 fx vault of skull; closed; 800. 02 no intercranial injury less than 1 hr LOC See Reference Handout

External Cause of Injury Codes ICD-9 v v v v v Morbidity Not required for billing Numeric preceded by “E” E 800 -E 999 Allows for code for Place Updated > annually Phase out: 2013 State laws/coding rates vary IHS hospital d/c rates: high IHS ED & CHS rates: low ICD-10 v v v v Mortality Required for death certif Alphanumeric V 01 -Y 98 Allows for code for Place Allows for code for Activity Updated every Oct. 1, 2013 Morbidity

Diagnosis Codes - Examples ICD-9 MV Traffic Accidents Falls Suicide/Self-Inflicted Homicide (Assault) ICD-10 E 810 -E 819 E 880 -E 888 E 950 -E 959 E 960 -E 969 Transport Accidents Falls Intentional Self-Harm Assault V 01 -V 99 W 00 -W 19 X 60 -X 84 X 85 -Y 09 See Reference Handout

Anatomy of an E-Code E XXX. Y Injury Category Specificity

Anatomy of an E-Code E 813. 2 MVC; collision w/other vehicle Injured person was a motorcyclist

Analysis of E-Codes MVC E 800 -E 825 Fall E 880 -E 888 Fire E 890 -E 899 Suicide Assault E 950 -E 959 E 960 -E 969 E 810. 0 E 819. 1 E 813. 1 E 814. 7 E 816. 0 E 819. 0 E 880. 1 E 884. 0 E 884. 1 E 885. 2 E 890. 1 E 890. 3 E 950. 1 E 955. 0 E 966. 0 MVC invol. pedestrian Fall; playground equip.

E-Code Example: Falls (E 880 -E 888) Fall from: …escalator …sidewalk curb …building/structure …well …playground …chair …bed …commode …skateboard …snowboard …ladder …scaffolding …diving …storm drain/manhole …cliff …wheelchair …other furniture …roller skates …skis …other/unspecified

Analysis of E-Codes Falls E 800 -E 888 E 880. 1 E 880. 9 E 884. 2 E 884. 6 E 888 E 888 E 888 Fall from sidewalk curb Fall from stairs Fall from chair Fall from commode Unspecified Fall

E-Codes Limitations v Records Not Always E-coded v Miscoding & Inconsistent Coding v Poor Chart Info = Nonspecific E-Code v Don’t Always Provide Desired Specificity v Must Stay Apprised of Updates

Injury Fatality Hospitalization E Coded on Death Certificate by Coroner E Coded at Hospital County Health Department State Government WISQARS Data System (Web- Based) National Center for Health Statistics

External Cause of Injury Coding References v American Academy of Professional Coders http: //www. aapc. com/ v World Health Organization http: //www. who. int/classifications/icd/en/ v CDC National Center for Health Statistics http: //www. cdc. gov/nchs/icd. htm v CDC article on improving E-coding http: //www. cdc. gov/mmwr/preview/mmwrhtml/rr 5701 a 1. htm

E-Code Exercise Searchable ICD-9 code: http: //icd 9 cm. chrisendres. com/index. php