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Information Sources of a Health Information System on Traffic Injuries

Isabel Ricart i de Mesones
Diplomada en Enfermería, Especialidad en Enfermería Pediátrica, Técnico Medio en Salud Pública, Agencia de Salud Pública, Barcelona, España

Mailing Adress: Agencia de Salud Pública. Pl Lesseps, 1 -08023- Barcelona, España

Manuscript received by 5.02.04
Manuscrito accepted by
5.04.2004 

Index de Enfermería [Index Enferm] 2005; 48-49: 54-58 (original version in Spanish, printed issue)

 

 

 

 

 

 

 

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Ricart I de Mesones I. Information Sources of a Health Information System on Traffic Injuries. Index de Enfermería [Index Enferm] (digital edition) 2005; 48-49. In </index-enfermeria/48-49revista/48-49e54-58.php> Consulted

 

 

 

Abstract

Description of a system of sanitary information on injured persons of traffic. The aims(lenses) are: to know the characteristics of the group capable of getting hurt for traffic accident; to know the dimension of the problem; to know the needs of sanitary resources; to spread the results in conference to developing preventive campaigns. Description of the used measurements and of the most important indicators. Description and limitations of the sources(fountains) of information suitable(adapted) for a SISLET and of the phases of execution of the system.

 

 

 

 

 

 

 

Introduction

     In order to rationalize any health system, the aims, strategies and health responsibilities should be defined. To improve the Health Information Systems (HIS) and their use and to encourage health workers to use them are two ways to achieve this purpose. According to the WHO1, a Health Information System is a structure for the collection, process, analysis and transmission of the information needed to organize and make health services work. In any HIS, the information collected reflects the reality and it is the result of the data processing that we need for a defined purpose2.
     The aim of this article is the description of a system of health information on road traffic injuries in order to make it easy for the people responsible for collecting the information, to assume the importance of their work in the information process. The information presented in this article can be used for any other information system by adapting it to different aims.
     The hypothetical information system presented here is about Traffic Injuries (SISLET)
3. The information of a SISLET comes from different sources. The design of this system is based on some premises: the geographical unit, the information needs and the people to whom it is addressed, the database that should be created, the information needed, the sources we should consult, the most effective backups, the statistical analysis methods and the process of the information since it is collected until it is made public. It is also necessary to take into account the evaluation of the system in order to check its operational capacity4-9.

Characteristics of a SISLET. Information systems have evolved because of the increase of activity and the complexity of the assistance and registration processes and the universalization of the new technologies. A SISLET is an information system that processes information on people injured in road accidents in a routine manner and by using different sources that the system unifies and relates to get as much information as possible about every injured person. It is a dynamic system that can be modified according to information requirements.
     The basic character of a SISLET should be defined attending to the following characteristics
5:
     -Efficacy:  Degree of benefits obtained in ideal conditions.
     -Effectiveness: Degree of beneficial effects when compared to the expected results, in normal conditions.
     -Efficiency: Effects or results reached in relation to the effort made in terms of money, time and resources.
     -Reliability: Degree of precision and stability or consistency in the similarity of the results in repeated measures.
     -Validity: Degree of similarity between the results and the reality of the phenomenon we are studying
10.
     -Confidentiality: The Law about Personal Character Data Protection (LOPD) does not allow people different from the researches to treat personal data, so that they should be treated cautiously. Those violating this law shall be punished.
     -Usefulness: The usefulness of a SISLET depends on whether right decisions can be made or not taking the results as a starting point. If some mistakes are made during the process, the estimation of the magnitude of the problem can be wrong and it will have a later effect on the preventive interventions designed afterwards, either exaggerating them (useless increase on the health cost) or minimizing them (interventions that do not reach the minimum required to be effective).

Aims of a SISLET

     Once the priorities are established according to the health policy, the aims should be pointed out, because establishing them beforehand makes it easy to evaluate the results. The aims of a SISLET are to monitorize the population in order to know the characteristics of the group capable of getting hurt in road accidents (risk population), to be aware of the dimension of the problem, the influencing factors, the needs of health resources, the evaluation of the available resources and their output and to spread the results in order to develop preventive campaigns.

Measurements of a SISLET. The measurements of any information system are those of the frequencies used in epidemiology, such as the number of cases, the reasons, the prevalence or the rates. Some of them are explained in the following section.

Indicators. The indicators are the measurements used in order to know the frequency and the characteristics of the road accidents and their victims. They shed some light on the magnitude of the problem and they allow us to make predictions. The most important indicators in a register of people injured in road accidents are the following:
     - Mortality indicators: The mortality measures the number of deaths in a specific population and time. The indicators are either absolute numbers or rates and they show the evolution in time of a specific fact.
     - Morbidity indicators: The morbidity measures the number of people that fall ill (in this hypothetical case, the number of people that get injured) in a specific population and time. The indicators appear in terms of prevalence or incidence.
     - Prevalence: It represents the number of people that, in relation to the total population, suffer an injury in a specific moment. It considers the probability that a person sustains injuries in a specific moment.
     - Incidence: It considers the number of new cases that appear in a specific period and the swiftness in which they happen. It represents the probability and the speed in which the individuals of a population will get injured during a specific period of time
11.

Characteristics of the sources of information of a SISLET. The information of a SISLET comes from different sources but not all of them identify the same groups of population and they are not equally accessible. The figure 1 is a pyramid that presents the kind of people injured according to different sources. They appear in decreasing order.
     -The injured people that do not turn to the health service are only represented in the health population survey.
     - The injured people treated in Primary health centres can be found in the same Primary registers and in the health population survey.
     -Those who turn to Emergency services appear in the Emergency services, 061 (medical emergencies), fire brigade and police registers.
     -Those admitted to hospital appear on the hospital discharge register.
     -Injured people who die can be found in the Emergency services, 061, fire brigade, hospital discharge, police, Forensic Institute and Mortality registers.
     -Finally, those with any kind of handicap because of the injuries can be represented in any injured group, except in the one of the injured who die.
     These are some premises related to the information sources that a SIS should consider as a starting point:
     -It is useful but not essential to get personal details from all the information sources so as to contrast the registers. If there is no identifying data, registers can be related at random according to the number of variables repeated in every register in the different information sources: date of birth, date of the accident, date of death, etc. It has to be taken into account that the same injured person can appear in different registers.
     -The information provided should be limited to a geographic zone, time of the study and the causes of the injuries, according to the aims.
     -The information sources are only valid when contrasting them
12-13.

Information sources. The different information sources being used for our information system are analysed:
Figure 1. People injured in road accidents identified by different sources of infomation     1. Mortality register. It considers the deaths caused by road traffic injuries. It takes information from the Statistical Death Reports (BED), where the cause of the death is established by the codes of the International Classification of Diseases (ICD). There is information about the number of deaths, the date and the cause. It is useful because it is exhaustive and valid when talking about the cause of the death. It is connected to the city register. It also presents some limitations: it does not offer the circumstances in which the accident took place and it does not say anything about the time between the accident and death and about the place where it happened. It just codifies the main cause of death.
7,14-19
     2. Discharge register. It offers the number of admissions to hospital because of road traffic injuries. It specifies the kind, location and seriousness of the injuries, the dates of admission and discharge, and what happens with the patient afterwards (transfer, recovery, death). Usefulness: it is a very important health source to evaluate the impact of the road traffic injuries on the health of the population. It describes the use of health services (hospitalization). Limitations: it does not consider the injured who do not need to be admitted to hospital, those who are transferred out of the geographic area considered in the study or the deaths happening just after the accident. It does not consider the circumstances or the place where the accident takes place.
20-25
     3. Register of the Emergency services. It takes into account the emergency medical care provided by the emergency services to those injured in road accidents. It gives a report on the injured people who turn to Emergency services and on the diagnosis and the seriousness of the injuries. It offers information about the kind of user (driver, passenger or pedestrian), about what happens with the patient (discharge, admission, transfer, death.) and about the kind of vehicle (private car, motorcycle, lorry, bus, bicycle), no matter whether we talk about the vehicle used by the victim or the vehicle which has caused the injuries (in order to specify, we will refer to "the position with regard to the vehicle"). Usefulness: it gives information about the injuries and about the use of health services. Limitations: the death of those admitted to hospital and the deaths "in situ" are not considered. It does not give any information about the circumstances or the place where the accident took place. There may be some differences in the thoroughness between the registers of different hospitals. The injured people who receive any kind of treatment are the only ones who appear.
     4. Forensic Institute. It considers the autopsies performed on road accident victims. Every road accident involves a judicial process where the autopsy is required, so that this source gives information about all road traffic deaths occurred in the city, whatever the place of the accident, the address of the dead person or the time between the crash and death. It gives a report on the microscopy and macroscopic injuries and the cause of death. It includes all deaths by accident in the city. Usefulness: it is highly exhaustive and reliable. Limitations: the circumstances and the place where the accident occurred are not always considered.
26
     5. Anatomical forensic clinic register. It gives a report on medical tests which belong to people still alive that in this case concentrates on health damages because of road accidents. It gives information about the non mortal victims of road accidents who require judicial intervention, medical surveillance and subsequent monitoring. It also considers disabilities (any limitation or loss in the faculty to carry out an activity inside the normal limits) and after-effects (permanent disability). When disabilities are not permanent, it gives information about the time needed for the recovery. Some expert tests to check the ability of the patient are carried out. They include assessment of the injuries, mental tests (disability statements, disability and after-effects, evaluating the work ability in the context of law, wrong medical praxis reports). Usefulness: it is possible to determine the development of disabilities and their after-effects. It also describes the injuries and it mentions the hospital where the treatment was given as well as the number of days of the injuries. All this information makes it possible to carry out economic studies on road traffic injuries. Limitations: there is no information about the circumstances in which the road accident took place. People sustaining minor injuries and the place where the accident happened are not taken into account.
Table 1 Kind of information provided by the different sources     6. Health survey. It considers the answers to questions about health and healthy habits. The samples were chosen according to each survey (women, young people, injured people, people chosen at random, etc.). When well designed, it can be used to estimate the population prevalence of road traffic injuries. On the one hand, it is the only instrument that lets us know about the health felt and perceived by the patient. Besides, it is the most effective method to get information about the socioeconomic characteristics and the lifestyle of the patient. On the other hand, it makes it possible to get information about the disabilities of the population. Furthermore, it would be also possible to learn about the consequences of health problems caused by road traffic injuries as well as the physical and emotional effects they have on the patients and their families that are not offered by the mortality and morbidity rates. Usefulness: it considers injured people treated or not by the health system. It gives information about the disabilities and the use of services. Limitations: the validity of the retrospective information is questionable because of biased memory and because of the subjectivity in the answers. In general health surveys there are usually just a few questions about road traffic injuries.
27-28
     7. The fire brigade. Their register takes into account injured people in serious accidents in which their help is required. They also consider accidents in which people remain trapped in vehicles that have lost their shape or those in which vehicles may set on fire because of fuel leak or those already burnt. They give information about the kind and seriousness of the injuries, health interventions carried out, prognosis, place where the patient was transferred and immediate deaths. Usefulness: quality technical health reports with a good description of the injuries because the sanitary staff is highly qualified. It gives information about the characteristics of the road, the vehicle, the hospital in which the patient is admitted, the assistance provided "in situ" and during the journey to hospital. Limitations: the register only considers deaths and serious injuries. People sustaining minor injuries and later deaths are not considered.
     8. 061-Medical emergencies. This register considers every person injured in a road accident who requires assistance "in situ" or who needs to be transferred to hospital. They provide assistance to every injured person whatever the seriousness of their injuries, which determines the kind of professional who comes to help (driver, nurse, doctor). It offers information about the injuries, the prognosis, medical assistance, place of the accident, kind of user and the hospital where the patient was admitted. Usefulness: the information is taken in the place of the accident. It takes into account immediate deaths, injured people who required their assistance, the seriousness of the injuries and the hospital where the patient was admitted. Limitations: it is exclusively about sanitary information because its aim is the stabilization of the patient so as to transfer him quickly and in an adequate manner. People sustaining minor injuries that do not require their assistance are not considered in the registers. Later deaths are not considered either.
     9. Police register. It offers information about all road accidents in which police take part. It also explains the circumstances, the mechanism and the place of the accident, the number, kind and model of the vehicles involved, time and date, luminosity and kind of light, state of the road, weather conditions, number, position and condition of the injured people, place to which they were transferred, material damage. Usefulness: it gives detailed information that does not exist in other registers such as the detailed mechanism and the circumstances in which the accident took place. Limitations: it does not offer any information on the injuries. The prognosis is not reliable for us because it is not issued by a health worker. It includes death just for a period of 24 hours after the accident.
     10. Primary care. This is the register of the patients injured in road accidents who do not require judicial intervention, but who require medical surveillance. The GP evaluates the injuries and signs the medical certificate. This register gives information about the injuries, the prognosis, the development of the patient, the after-effects, the disabilities and the dates of the beginning and end of the sick leave. Usefulness: the fact that it considers the whole process makes it possible to know about the time passed until the patient is discharged from hospital and about the disabilities which become chronic. Limitations: there is not a common register unifying the different primary care centres. Injured people who do not need primary care services are not considered. Immediate or later death in hospital is not considered. It does not say anything about the circumstances in which the accident happened and the position of the injured person.
29

Phases of a SISLET

Theoretical process:
     - Spotting the problem: the fact that people injured in road accidents are on the increase may cause alarm among the population and make it necessary to define the problem.
     - Defining the aims: to know and to describe the magnitude and factors of the problem and the characteristics of the group capable of getting injured.
     - Selecting the useful information: to specify the information and the period of time we are going to consider them.

Instrumental process:
     - Analysis of the information sources available. Sources of information which are unreliable, incomplete, biased or difficult to gain access to are dismissed.
     - Collecting information: the methodology and the instruments used through this process should be systematized and unified for all the centres. The methodology should be systematic and exhaustive. It is important for people taking part in this process to be trained before and to know about the usefulness of the register.
     - Data storage: creating database and input of information. It should be done by the staff of the different centres or by the centre coordinating a SISLET.
     - Quality check of the database: the aim is to work towards the unification of criteria between the sources of information, to spot mistakes and to determine the validity and reliability of the information sources.
     - Analysis of the information: it is the most gratifying stage of the whole circuit because it is at this point that we have the indicators we were looking for since the beginning.
30
     - Spreading the results: all the groups taking part in this process should have access to the results, either the people who dealt with the information or public health administrative staff.
31
     - Evaluation of the SISLET: it would be done according to the aims achieved and considering whether the cost higher or lower than planned.

Limitations of the information sources

     - Sometimes, different sources of information mean different results. If it is not clear, the methodology would be examined because different methods may lead to different results, such as the mortality rate and the final date to consider death, that may include or exclude certain deaths.
     - There can be different criteria and instruments such as differences in computer systems that make it difficult the connection between different data. People who design the information sources do not always consider some aspects that can be negative for the researcher. That is because the sources of information are usually designed attending to specific needs that do not always coincide which those of an information service.
     - There may be too much information, some of it is not useful for the SISLET and it makes it difficult to optimize the work.
     - There may be inadequate files catalogued and organized.
     - There may be questionable information and statements in terms of validity and reliability.
32-33
     - The source should be related to its context in order to understand and solve the limitations by contrasting it with information form different sources. This way, limitations should be detected.
     - Some limitations will not remain under the control of a SISLET and we should make an effort in order to avoid the variability of the results by implementing scientific methods when dealing with the sources.
     Finally, the final usefulness of a SISLET may be questioned if it does not have any effect on preventive interventions.
     The system developed by the Public Health Agency of Barcelona (ASPB) since 1993 is an example of an Information System on Traffic Injured. The sources of this system are Medical Emergencies, Road Accident Reports by Barcelona Policeman, deaths reported by the Anatomical Forensic Institute of Barcelona, the Mortality Register and the Health Surveys of Catalonia. The aim of this project is to monitor the magnitude and the characteristics of the people injured in road accidents in the city of Barcelona. Seven public hospitals of the city are currently participating in it. Documents on this issue are available on the ASPB webpage: https://www.aspb.es/quefem/.

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