Dataset Information

All Wales Injury Surveillance System revised: development of a population-based system to evaluate single-level and multilevel interventions.

ABSTRACT:

Background

Injury surveillance has been established since the 1990s, but is still largely based upon single-source data from sentinel sites. The growth of electronic health records and developments in privacy protecting linkage technologies provide an opportunity for more sophisticated surveillance systems.

Objective

To describe the evolution of an injury surveillance system to support the evaluation of interventions, both simple and complex in terms of organisation.

Methods

The paper describes the evolution of the system from one that relied upon data only from emergency departments to one that include multisource data and are now embedded in a total population privacy protecting data linkage system. Injury incidence estimates are compared by source and data linkage used to aid understanding of data quality issues. Examples of applications, challenges and solutions are described.

Results

The age profile and estimated incidence of injuries recorded in general practice, emergency departments and hospital admissions differ considerably. Data linkage has enabled the evaluation of complex interventions and measurement of longer-term impact of a wide range of exposures.

Conclusions

Embedding injury surveillance within privacy protecting data linkage environment can transform the utility of a traditional single-source surveillance system to a multisource system. It also facilitates greater involvement in the evaluation of simple and complex healthcare and non-healthcare interventions and contributes to the growing evidence basis underlying the science of injury prevention and control.

SUBMITTER: Lyons RA

PROVIDER: S-EPMC4853534 | biostudies-literature | 2016 Apr

REPOSITORIES: biostudies-literature

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Publications

All Wales Injury Surveillance System revised: development of a population-based system to evaluate single-level and multilevel interventions.

Lyons Ronan A RA Turner Samantha S Lyons Jane J Walters Angharad A Snooks Helen A HA Greenacre Judith J Humphreys Ciaran C Jones Sarah J SJ

Injury prevention : journal of the International Society for Child and Adolescent Injury Prevention 20151209

<h4>Background</h4>Injury surveillance has been established since the 1990s, but is still largely based upon single-source data from sentinel sites. The growth of electronic health records and developments in privacy protecting linkage technologies provide an opportunity for more sophisticated surveillance systems.<h4>Objective</h4>To describe the evolution of an injury surveillance system to support the evaluation of interventions, both simple and complex in terms of organisation.<h4>Methods</h ...[more]

PMID: 26658339

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Project description:BackgroundThe unrelated mean effects (UME) model has been proposed for evaluating the consistency assumption globally in the network of interventions. However, the UME model does not accommodate multiarm trials properly and omits comparisons between nonbaseline interventions in the multiarm trials not investigated in 2-arm trials.MethodsWe proposed a refinement of the UME model that tackles the limitations mentioned above. We also accompanied the scatterplots on the posterior mean deviance contributions of the trial arms under the network meta-analysis (NMA) and UME models with Bland-Altman plots to detect outlying trials contributing to poor model fit. We applied the refined and original UME models to 2 networks with multiarm trials.ResultsThe original UME model omitted more than 20% of the observed comparisons in both networks. The thorough inspection of the individual data points' deviance contribution using complementary plots in conjunction with the measures of model fit and the estimated between-trial variance indicated that the refined and original UME models revealed possible inconsistency in both examples.ConclusionsThe refined UME model allows proper accommodation of the multiarm trials and visualization of all observed evidence in complex networks of interventions. Furthermore, considering several complementary plots to investigate deviance helps draw informed conclusions on the possibility of global inconsistency in the network.HighlightsWe have refined the unrelated mean effects (UME) model to incorporate multiarm trials properly and to estimate all observed comparisons in complex networks of interventions.Forest plots with posterior summaries of all observed comparisons under the network meta-analysis and refined UME model can uncover the consequences of potential inconsistency in the network.Using complementary plots to investigate the individual data points' deviance contribution in conjunction with model fit measures and estimated heterogeneity aid in detecting possible inconsistency.

Project description:ObjectivesThe study aimed to assess if specialised healthcare service interventions in Wales benefit the population equitably in work commissioned by the Welsh Health Specialised Services Committee (WHSSC).ApproachThe study utilised anonymised individual-level, population-scale, routinely collected electronic health record (EHR) data held in the Secure Anonymised Information Linkage (SAIL) Databank to identify patients resident in Wales receiving specialist cardiac interventions. Measurement was undertaken of associated patient outcomes 2-years before and after the intervention (minus a 6-month clearance period on either side) by measuring events in primary care, hospital attendance, outpatient and emergency department. The analysis controlled for comorbidity (Charlson) and deprivation (Welsh Index of Multiple Deprivation), stratified by admission type (elective or emergency) and membership of top 5% post-intervention costs. Costs were estimated by multiplying events by mean person cost estimates.ResultsWe identified 5,999 percutaneous coronary interventions (PCI) and 1,640 coronary artery bypass graft (CABG) between 2014-06-01 to 2020-02-29. The ratio of emergency to elective interventions was 2.85 for PCI and 1.04 for CABG. In multivariate analysis significant associations were identified for comorbidity (OR = 1.52, CI = (1.01-2.27)), deprivation (OR = 1.34, CI = (1.03-1.76)) and rurality (OR = 0.81, CI = (0.70-0.95)) for PCI interventions, and comorbidity (OR = 1.47, CI = (1.10-1.98)) for CABG. Higher costs post-intervention were associated with increased comorbidity for PCI and CABG in the top 5% cost groups, but for PCI this was not seen outside the top 5%. For PCI, moderate cost increase was associated with increased deprivation, but the picture was more mixed following CABG interventions. For both interventions, lower costs post intervention were seen in rural locations.ConclusionWe identified and compared health outcomes for selected specialist cardiac interventions amongst patients resident in Wales, with these methods and analyses, providing a template for comparing other cardiac interventions.

Project description:BackgroundPrevious research aimed at improving injury surveillance standards has focused mainly on issues of data quality rather than upon the implementation of surveillance systems. There are numerous settings where injury surveillance is not mandatory and having a better understanding of the barriers to conducting injury surveillance would lead to improved implementation strategies. One such setting is community sport, where a lack of available epidemiological data has impaired efforts to reduce injury. This study aimed to i) evaluate use of an injury surveillance system following delivery of an implementation strategy; and ii) investigate factors influencing the implementation of the system in community sports clubs.MethodsA total of 78 clubs were targeted for implementation of an online injury surveillance system (approximately 4000 athletes) in five community Australian football leagues concurrently enrolled in a pragmatic trial of an injury prevention program called FootyFirst. System implementation was evaluated quantitatively, using the RE-AIM framework, and qualitatively, via semi-structured interviews with targeted-users.ResultsAcross the 78 clubs, there was 69% reach, 44% adoption, 23% implementation and 9% maintenance. Reach and adoption were highest in those leagues receiving concurrent support for the delivery of FootyFirst. Targeted-users identified several barriers and facilitators to implementation including personal (e.g. belief in the importance of injury surveillance), socio-contextual (e.g. understaffing and athlete underreporting) and systems factors (e.g. the time taken to upload injury data into the online system).ConclusionsThe injury surveillance system was implemented and maintained by a small proportion of clubs. Outcomes were best in those leagues receiving concurrent support for the delivery of FootyFirst, suggesting that engagement with personnel at all levels can enhance uptake of surveillance systems. Interview findings suggest that increased uptake could also be achieved by educating club personnel on the importance of recording injuries, developing clearer injury surveillance guidelines, increasing club staffing and better remunerating those who conduct surveillance, as well as offering flexible surveillance systems in a range of accessible formats. By increasing the usage of surveillance systems, data will better represent the target population and increase our understanding of the injury problem, and how to prevent it, in specific settings.

Dataset Information

All Wales Injury Surveillance System revised: development of a population-based system to evaluate single-level and multilevel interventions.

Background

Objective

Methods

Results

Conclusions

Publications

All Wales Injury Surveillance System revised: development of a population-based system to evaluate single-level and multilevel interventions.

Similar Datasets

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