Improving Information Systems for Injury Monitoring to Support Prevention at the Local Level. Opportunities and obstacles

Abstract

Tapaturmien ehkäisytyötä kunnissa tekevien tietotarpeet ovat monipuoliset. Usein kunnissa toimivilta puuttuvat aivan keskeiset tapaturmatiedot. Paikalliset toimijat kaipaavat tietoa tapaturmissa syntyneiden vammojen yleisyydestä ja muutoksista tapaturmatilanteessa, mutta erityisesti tietoa paikoista, tilanteista ja olosuhteista, jossa tapaturmat ovat heidän kunnassaan sattuneet. Vaikka yli 40 valtakunnalliseen tietojärjestelmään tallentuu tapaturmatietoa, ei olemassa oleva tieto saavuta kunnan ammattilaisia tai tietosisällöt eivät vastaa paikallisia tietotarpeita.

Paikallisten toimijoiden kaipaamaa tietoa on mahdollista kerätä ensiapuvastaanotolla. Tiedonkeruun onnistuminen ensiavussa edellyttää kuitenkin nykyistä huomattavasti käyttäjäystävällisempiä terveydenhuollon tietojärjestelmiä. Osaava tapaturma-alan asiantuntija tarvitaan tukemaan tapaturmatiedon keruuta ja tiedon hyödyntämistä. Terveydenhuolto-organisaation ja kunnan tuki tällaiselle työlle on välttämätön. Myös valtakunnallisissa tietojärjestelmissä olemassa oleva tapaturmatieto tulee saada kuntatoimijoiden käyttöön kehittämällä tiedonjakelujärjestelmiä. Ministeriöiden ohjaus on voimakkaasti painottunut tiedon laadun parantamiseen. Painopisteen tulisi siirtyä tiedon hyödyntämiseen.

Vuonna 2010 Suomessa kuoli tapaturmaisesti 2 856 henkilöä ja tapaturmissa syntyneiden vammojen hoidosta kertyi 1,2 miljoonaa hoitopäivää. Terveyden edistäminen, sairauksien ja tapaturmien ehkäiseminen ovat terveydenhuoltolainsäädännön mukaan kunnan tehtävä. Hyvä tietopohja on välttämätön, joskaan ei riittävä ehto laadukkaalle tapaturmien ehkäisytyölle.

Tutkimusaineisto kerättiin osallistumalla tapaturmien ehkäisyhankkeisiin kunnissa, havainnoimalla ja haastattelemalla. Analyysi olemassa olevista, tapaturmatietoa sisältävistä seurantajärjestelmistä perustui kirjallisiin tietolähteisiin ja asiantuntijahaastatteluihin. Valtakunnallisia pyrkimyksiä kehittää paikallista tapaturmaseurantaa tutkittiin analysoimalla ministeriöiden tapaturma- ja tilastoalan tavoite- ja toimenpideohjelmia.

An alignment among injury prevention researchers exists that injury prevention at the local level is one level in which injury prevention ought to be implemented. To strengthen injury prevention activities in local communities is also one target area in the national health and safety policies. Local level injury data can provide a powerful stimulus for action and guidance on prevention.

This study was undertaken to gain knowledge about local injury monitoring and the possibilities to enhance it. Four independent, but interrelated studies were conducted. The individual aims of each study are 1) to increase understanding of local practitioners viewpoints on injury monitoring, 2) to increase knowledge on factors associated with the process of developing emergency department (ED) based injury data collection in the Finnish context, 3) to increase knowledge of the possibilities that national data sources have to enhance local injury monitoring and 4) to assess the potential of national health and safety recommendations for enhancing injury monitoring for local prevention.

The research uses a variety of qualitative data. Focus group interviews were the main data collection method in the study on local viewpoints on injury monitoring. Altogether 48 employees attended six group interviews. Data for the study of initiating injury registration in EDs comprise key informant interviews, project participation, researcher s own notes and minutes of the meetings. In total 10 people were interviewed, of which three were employees in primary health care, four in specialised medical care and one from each of the project management, the IT-company and the municipal administration. Data, for the third study on the potential of national data sources, include scientific articles, grey literature, expert interviews and other forms of personal communications with experts who work in the national data collecting organisations. Reports from committees, working groups, and commissioned studies and memorandums from the relevant ministries form data for the fourth study to assess the potential of national recommendations on local injury monitoring.

Local injury prevention practitioners have multitudinous data needs that change and extend rapidly as the local injury prevention programmes develop. Instead of investments in creating sustainable monitoring, short-term data collections on narrowly defined injury topics are common in local communities. Two different aims seem to justify injury monitoring and data requests. The first justification is to conduct evidence based injury prevention: to have data for planning and evaluation, to get feedback of one s own work and to conduct obligatory safety promotion work with an adequate knowledge of the injury situation. The second aim is that local practitioners propose to use injury information as a practical tool, to convince decision makers of the importance of injury prevention and to obtain sufficient resources to conduct injury prevention activities, to inform local actors and the general public, and also to educate staff on injury risks while they are collecting data. Barriers among local practitioners to conducting injury monitoring and surveillance work seem to include: limited knowledge and capacities related to available injury data sources, the data contents and whether or not the data can be accessed and to the lack of organisational readiness and resources to work with surveillance data.

A successful initiation of data collection on injuries in EDs is challenging and sensitive to several contextual factors. Existing work practices to introduce new work tasks, the alignment of injury registration with daily work routines and an intra-organisational communication culture that encourages negotiating of ambiguous cases all support the initiation of injury registration. In addition, the interviewees identified the thorough injury specific knowledge and injury research experience of the project leader strongly supporting the initiation and implementation processes. In the context of the primary health care organisation, an excessive number of injury patients, some of which had minor injuries and the busy pace of work seemed to decrease the willingness to adopt injury registration. The success and acceptability of new systems such as injury registration among the ED personnel is critically dependent on the software application that is used. It has to support the actual work process in a smooth way. Support from the municipality that intends to use the information and an alignment between the injury data collection with health and medical care organisation s other preventive goals such as prevention of alcohol-related harm seemed to support the acceptance of the injury registration.

National data sources could provide incidence and trend information on injuries for local purposes. Such information is requested by managers in the local organisations. Contrastingly, commonly requested data on injury circumstances are regularly collected for occupational, traffic and fire-related injuries only. In general, data gaps would remain even if all data collected into national information systems were used. Injuries commonly treated in ambulatory care, such as sports injuries, injuries to pedestrians or unprotected road users are currently not well represented in the national data. The assessment of the national data sources also raised concerns about data quality. Data accuracy on injury specific variables is to a large extent unknown. However, national data sources in Finland rate well on timeliness.

National data sources seem to serve local audiences poorly. Information from 22 identified national information systems that collect injury data including information on the municipalities largely remain unused at the local level. The national data collecting organisations have each developed data dissemination practices for their own audiences and, as yet, local injury prevention practitioners working with a more comprehensive, all injuries - all ages - all situations -approach have not been sufficiently recognised as a data user group.

Since the end of 1980s more than 100 policy recommendations to improve injury monitoring have been made. Over 50% of these recommendations target improvements in the information systems data collection processes, data contents in general or improving the data contents by the joint-use of data from other statistical information systems or changes in the specificity or accuracy of the data. Improvement of data dissemination has received less attention with 18% of recommendations targeting information system s characteristics such as data accessibility. 15% of the recommendations specifically target changes to enhance local injury monitoring. However, many of these recommendations would require organisational changes in the local organisations work practices. These changes are not readily achievable.

A deeper understanding of local injury prevention practitioners data needs, and the possibilities to do actual injury monitoring related work tasks can support efforts to promote the development of information systems for local monitoring. There is a need for investments in Finland to enhance data collection in EDs with injury expertise. In addition, improving data dissemination practices from national data sources could significantly improve injury monitoring at the local level. Local practitioners need to be integrally involved in these processes. These developments could be supported by national recommendations.