Data and Surveillance
Why are Data and Surveillance Important?
Surveillance systems and data are crucial to helping us understand who is affected by child injury, who is at greatest risk, the factors that increase or reduce risk, the cost of providing care, and how injury affects a child’s health, education, quality of life, and well-being. We use data to estimate the magnitude of specific injury problems, characterize trends over time, detect epidemics or emerging issues, suggest appropriate prevention activities, evaluate existing programs and initiatives, suggest hypotheses for further research, identify knowledge gaps, and to point us toward innovative policies, practices, and prevention strategies.
The ultimate goal of injury surveillance is to improve child health. People and organizations who could help prevent child injury include legislators, government officials, public safety agencies, health care providers and health care systems, employers, the business community, community-based organizations, schools, journalists, and media groups. Surveillance helps provide an empirical basis for child injury prevention efforts, monitors progress in reducing injury, and enables a focus on the most compelling problems. Working together to collect data the community needs, making the data readily accessible, and translating the data into products and messages form the basis of effective program development.
Data and Surveillance Goals and Actions
Goal: Improve existing data collection systems.
Several challenges exist for current surveillance activities in child injury prevention. Many hospital-based systems allow for collecting external causes of injury or E-codes, which are critical in moving beyond the physical diagnosis (e.g., broken leg) to understanding how the injury occurred (e.g., child struck by a vehicle); however, E-code data are often either missing or incomplete.
Criteria for including hospitals, individuals, and data elements into specific systems are often inconsistent, resulting in difficulties in comparing and combining different data systems. Many data systems are not population-based or do not represent specific areas of interest (such as states, counties, and local communities). This limits the data’s usefulness in understanding the child injury issue among specific populations.
- Improve data quality (completeness and validity), with a focus on using E-codes to better understand the circumstances surrounding injuries.
- Evaluate and improve key data systems to represent the breadth and diversity of the U.S. population.
- Standardize data collection and reporting key data systems such as child death reviews. Child death reviews can be most effective if they utilized standard data collection methods and when they are used to inform decision making about interventions.
- Enhance collaboration among key agencies and organizations that collect data. Better collaboration on data systems can create a more comprehensive understanding of child injuries to inform program and policy decisions.
Goal: Upgrade and enhance systems to address gaps in data.
Data collected in existing systems can be enhanced by improving the methods used to obtain, aggregate, and expand the information collected. New tools to measure the economic costs and comparative effectiveness of child injury prevention, treatment, and rehabilitation can provide data that can inform policy and resource allocation. Data on how injured children fare over time is critical to planning and delivering services. Understanding the circumstances and details of child injury events would help us identify key contributors to injury and promising prevention strategies. In-depth investigations tell the story behind the statistics and are more compelling to lay audiences than numbers alone. Additionally, linking different databases together avoids duplication and fills data gaps of individual data systems. Innovative approaches include linking electronic health records to preventive behaviors or using in-vehicle systems that record risk factors associated with near-crash events.
- Use stakeholders to identify specific deficiencies and gaps in data.
- Add additional injury questions or modules into existing national and state surveillance systems.
- Collect better data on true economic costs and long-term disability.
- Collect more information about circumstances (e.g., activity at the time of injury, use of protective equipment) through approaches such as case studies and qualitative methods.
- Assess data needs for states, local communities, and underrepresented populations, and develop strategies to address such needs.
- Improve links among injury databases through sharing information, improving and sharing linking algorithms and approaches, and supporting the development of new technologies.
Goal: Improve access to data.
Data must reach people in a position to prevent child injury; however, this does not always happen. The time between when the data are collected and released can be months to years and are often maintained as complex computer files that require code books and specific computer programs to decipher.
Several examples exist of highly functional, user-friendly, interactive database systems for child injury, that allow users without programming skills to easily access and query data based on individual needs. These include WISQARS, the Youth Risk Behavior Surveillance System, and the motor vehicle Fatality Analysis Reporting System. These systems can serve as models for data sources that are not currently interactive, such as the National Health Interview Survey, National Health Care Surveys, poison control center data, and state-specific data systems, such as traumatic brain injury surveillance and emergency care.
- Use stakeholder input to understand data access barriers.
- Assess and address barriers for timeliness of data release/availability.
- Develop online access systems for key databases; systems should include enhanced functionality to query, analyze, and display data.
- Encourage sharing designs, protocols, procedures, software, and programs for data access systems.
- Develop and maintain a central, Web-based clearinghouse for key population-based databases.
Injury Risk Factors and Field Investigations
Field based investigations of young worker deaths and a follow-back survey of adolescents treated in emergency departments for work related injuries identified issues with worker training, supervision and compliance with child labor laws that were not identified in population-based surveillance alone.
-National Institute for Occupational Safety and Health
Goal: Improve analysis, interpretation, and dissemination of surveillance data.
Public health surveillance not only involves systematic data collection, it also involves analyzing, interpreting, and disseminating data to drive public health priorities and action. Findings from surveillance data can be used to estimate the magnitude of specific injury problems, characterize trends over time, detect epidemics or emerging issues, recommend appropriate prevention activities, evaluate existing programs and initiative, and suggest hypotheses for further research.
Managing high quality child injury data and surveillance systems requires persons who are trained in public health surveillance, injury control, and state of the art methods to manage, analyze, and disseminate data. Unique aspects of injury surveillance and epidemiology often require customized training and education. This may include advanced graduate training and continuing education opportunities for existing public health professionals on unique data sources such as trauma registries and occupational injury databases, external-cause-of-injury coding, and injury severity and disability measures.
- Build capacity by training local public health practitioners and agencies to conduct analysis and interpret results. This can be done by federal agencies, state or local health departments, or nongovernmental organizations with an expertise in this area.
- Develop plans for regular analysis and reports of key surveillance data.
- Tailor data reports for specific audiences and develop dissemination strategies for key decision makers.
- Support the use of local data, such as data from local hospital systems, to evaluate local prevention efforts.
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