Ohio’s Trauma RegistryOhio’s Trauma Registry

REHAB Data REHAB Data CollectionCollection

Glenn, RNGlenn, RN

Chief – Trauma, Information & Chief – Trauma, Information & Medical SectionMedical Section

Ohio Department of Public SafetyOhio Department of Public Safety

Division of Emergency Medical Division of Emergency Medical ServicesServices

Trauma center

Acute Care Hospital

Scene

Ohio’s Trauma RegistryOhio’s Trauma Registry

Authorized by ORC 4765.06Authorized by ORC 4765.06– Senate Bill 98, in 1992Senate Bill 98, in 1992– Trauma RegistryTrauma Registry– EMS Incidence Reporting EMS Incidence Reporting

Ohio’s Trauma RegistryOhio’s Trauma RegistryWHY?WHY?– Lack of data is a primary factor in inadequate Lack of data is a primary factor in inadequate

emergency planningemergency planning– Healthcare needs to be evidence based Healthcare needs to be evidence based – Education/curriculum development Education/curriculum development – Research is severely hindered by incomplete dataResearch is severely hindered by incomplete data– Injury Prevention needs to be data-drivenInjury Prevention needs to be data-driven– Outcome measures in healthcare are a high priorityOutcome measures in healthcare are a high priority

Current Registry RequirementsCurrent Registry RequirementsTrauma related deathsTrauma related deaths

Identification of trauma patientsIdentification of trauma patients

Monitoring of trauma patient care dataMonitoring of trauma patient care data

Determination of uncompensated care Determination of uncompensated care

Other data specified by the EMS BoardOther data specified by the EMS Board

Ohio Trauma RegistryOhio Trauma RegistryEMS Board has adopted rules that;EMS Board has adopted rules that;– Establish an Advisory CommitteeEstablish an Advisory Committee– Assure confidentiality of submitted dataAssure confidentiality of submitted data– Assure no individual provider can be identifiedAssure no individual provider can be identified– Create risk adjusted reports to allow for differences in Create risk adjusted reports to allow for differences in

severityseverity– Prevent use of data in civil lawsuitPrevent use of data in civil lawsuit– Recognizes regional trauma registriesRecognizes regional trauma registries

– Ohio Administrative Code 4765-4Ohio Administrative Code 4765-4

Trauma Registry Advisory CommitteeTrauma Registry Advisory Committee

Appointed by EMS Board, as a subcommittee of the state Appointed by EMS Board, as a subcommittee of the state trauma committee to oversee the operation of the OTR trauma committee to oversee the operation of the OTR 18 Members 18 Members – 2 Surgeons,2 Surgeons, 2 ED physicians, 2 ED physicians, – 2 Nurses, 2 Nurses, 2 Trauma Registrars2 Trauma Registrars– 2 Hospital Representatives2 Hospital Representatives 2 Health Information Professionals2 Health Information Professionals– 1 EMS Provider 1 EMS Provider 1 Rehabilitation Representative1 Rehabilitation Representative – 1 County Coroner1 County Coroner 1 PM& R Physician1 PM& R Physician– 1 Regional Trauma Registry Representative1 Regional Trauma Registry Representative– 1 Consumer, not affiliated with an EMS provider1 Consumer, not affiliated with an EMS provider

Who Reports to the Registry?Who Reports to the Registry?Required to ReportRequired to Report– ✔ ✔ HospitalsHospitals– ✔✔ County CoronersCounty Coroners– ✘✘ Inpatient Rehabilitation FacilitiesInpatient Rehabilitation Facilities– Ambulatory Surgical FacilitiesAmbulatory Surgical Facilities– Nursing FacilitiesNursing Facilities– County Homes/County Nursing HomesCounty Homes/County Nursing Homes– Other State and Public AgenciesOther State and Public Agencies

When is Data Submitted?When is Data Submitted?

All data is due 90 days following the end of All data is due 90 days following the end of each quartereach quarter– 1st quarter 2004 data1st quarter 2004 data DUE June 29, 2004DUE June 29, 2004– 2nd quarter 2004 data 2nd quarter 2004 data DUE September 28, 2004DUE September 28, 2004– 3rd quarter 2004 data 3rd quarter 2004 data DUE December 29, 2004DUE December 29, 2004– 4th quarter 2004 data 4th quarter 2004 data DUE March 31, 2005DUE March 31, 2005

EMS Board policy for extension to deadlineEMS Board policy for extension to deadline– On the EMS Website On the EMS Website

http://ems.ohio.gov/ohio_trauma_registry.htmhttp://ems.ohio.gov/ohio_trauma_registry.htm

What Data is Submitted?What Data is Submitted?

Inclusion/exclusion criteria are found in Inclusion/exclusion criteria are found in the OTR REAHAB data dictionarythe OTR REAHAB data dictionary

Data Dictionary is on-lineData Dictionary is on-line– http://ems.ohio.gov/ohio_trauma_registry.htmhttp://ems.ohio.gov/ohio_trauma_registry.htm– Hard copies available from Division of EMSHard copies available from Division of EMS

ICD-9-CM Diagnosis Codes on discharge from acute care hospitalICD-9-CM Diagnosis Codes on discharge from acute care hospital

ICD-9-CM Diagnosis CodesICD-9-CM Diagnosis Codes ICD-9-CM Diagnoses DescriptionsICD-9-CM Diagnoses Descriptions

800.00 – 819.1 800.00 – 819.1 FracturesFractures

821.00 – 904.9821.00 – 904.9 Fractures, dislocations/sprains, intracranial injury, internal injury of thorax, abdomen and Fractures, dislocations/sprains, intracranial injury, internal injury of thorax, abdomen and pelvis, open wounds, injury to blood vesselspelvis, open wounds, injury to blood vessels

911.0, 911.1, 912.0, 912.1911.0, 911.1, 912.0, 912.1 Abrasions/friction burns to trunk, shoulder and upper armAbrasions/friction burns to trunk, shoulder and upper arm

916.0, 916.1, 919.0, 919.1916.0, 916.1, 919.0, 919.1 Abrasions / friction burns hip, thigh, leg, ankle, other or multiple sitesAbrasions / friction burns hip, thigh, leg, ankle, other or multiple sites

920 – 929.9920 – 929.9 Contusions and crush injuryContusions and crush injury

940.0 – 959.9940.0 – 959.9 Burns, injury to nerves and spinal cord, traumatic complications and unspecified injuryBurns, injury to nerves and spinal cord, traumatic complications and unspecified injury

987.9987.9 Smoke inhalationSmoke inhalation

991.0 – 991.6991.0 – 991.6 Frostbite, hypothermia and external effects of coldFrostbite, hypothermia and external effects of cold

994.0, 994.1, 994.7, 994.8994.0, 994.1, 994.7, 994.8 Asphyxiation, strangulation, drowning, and electrocutionAsphyxiation, strangulation, drowning, and electrocution

995.50 – 995.59995.50 – 995.59 Child maltreatment and abuseChild maltreatment and abuse

***OR******OR***

ICD-9-CM Diagnoses ICD-9-CM Diagnoses AND WITHAND WITHANY OF THE FOLLOWINGANY OF THE FOLLOWING

External Cause CodesExternal Cause Codes(E-Codes)(E-Codes)

E-CODEE-CODE

348.1348.1 Anoxic Brain InjuryAnoxic Brain Injury E800 – E848.8E800 – E848.8E878 – E905.0E878 – E905.0E906.0 – E928.8E906.0 – E928.8E950.0 – E998.9E950.0 – E998.9

348.4348.4 Uncal herniationUncal herniation

348.5,348.5, Cerebral EdemaCerebral Edema

348.8348.8 PneumocephalusPneumocephalus

372.72372.72 Subconjunctival hemorrhageSubconjunctival hemorrhage

518.5518.5 Traumatic ARDSTraumatic ARDS

784.7784.7 EpistaxisEpistaxis

Adult Impairment Group Code on Admission to Rehabilitation FacilityAdult Impairment Group Code on Admission to Rehabilitation Facility

Brain DysfunctionBrain Dysfunction Orthopedic DisordersOrthopedic Disorders

02.102.1 Non-traumatic injury *Non-traumatic injury * 08.1208.12 Status Post Bilateral Hip FracturesStatus Post Bilateral Hip Fractures

* must be associated with an acceptable E-code.* must be associated with an acceptable E-code. 08.208.2 Status Post Femure (shaft) FractureStatus Post Femure (shaft) Fracture

08.308.3 Status Post Pelvic FractureStatus Post Pelvic Fracture

02.2102.21 Traumatic, open injuryTraumatic, open injury 08.408.4 Status Post Major Multiple FracturesStatus Post Major Multiple Fractures

02.2202.22 Traumatic, closed injuryTraumatic, closed injury

Spinal Cord Dysfunction, TraumaticSpinal Cord Dysfunction, Traumatic

004.210004.210 Paraplegia, unspecifiedParaplegia, unspecified Amputation of LimbAmputation of Limb

04.21104.211 Paraplegia, incompleteParaplegia, incomplete 05.105.1 Unilateral Upper Limb above the elbow (AE)Unilateral Upper Limb above the elbow (AE)

04.21204.212 Paraplegia, completeParaplegia, complete 05.205.2 Unilateral Upper Limb below the elbow (BE)Unilateral Upper Limb below the elbow (BE)

04.22004.220 Quadriplegia, UnspecifiedQuadriplegia, Unspecified 05.305.3 Unilateral Lower Limb above the knee (AK)Unilateral Lower Limb above the knee (AK)

04.221104.2211 Quadriplegia, Incomplete C1-4Quadriplegia, Incomplete C1-4 05.405.4 Unilateral Lower Limb below the knee (BK)Unilateral Lower Limb below the knee (BK)

04.221204.2212 Quadriplegia, Incomplete C5-8Quadriplegia, Incomplete C5-8 05.505.5 Bilateral Lower Limb above the knee (AK/AK)Bilateral Lower Limb above the knee (AK/AK)

04.222104.2221 Quadriplegia, Complete C1-4Quadriplegia, Complete C1-4 05.605.6 Bilateral Lower Limb above/below the knee (AK/AK)Bilateral Lower Limb above/below the knee (AK/AK)

04.222204.2222 Quadriplegia, Complete C5-8Quadriplegia, Complete C5-8 05.705.7 Bilateral Lower Limb below the knee (BK/BK)Bilateral Lower Limb below the knee (BK/BK)

04.23004.230 Other Traumatic Spinal Cord Other Traumatic Spinal Cord DysfunctionDysfunction

05.905.9 Other amputationOther amputation

Pediatric Impairment Group Code on Admission to Rehabilitation FacilityPediatric Impairment Group Code on Admission to Rehabilitation Facility

Brain DysfunctionBrain Dysfunction BurnsBurns

01.22101.221 Traumatic, open injuryTraumatic, open injury 7.117.11 BurnsBurns

01.22201.222 Traumatic, closed injuryTraumatic, closed injury

1.2111.211 Hypoxemic Ischemic EncephalopathyHypoxemic Ischemic Encephalopathy Major Multiple TraumaMajor Multiple Trauma

6.16.1 Brain + Spinal Cord InjuryBrain + Spinal Cord Injury

Traumatic Spinal Cord Dysfunction Traumatic Spinal Cord Dysfunction 6.26.2 Brain + Multiple Fracture/AmputationBrain + Multiple Fracture/Amputation

004.210004.210 Paraplegia, unspecifiedParaplegia, unspecified 6.36.3 Spinal Cord + Multiple Fracture/amputationSpinal Cord + Multiple Fracture/amputation

04.211004.2110 Paraplegia, incompleteParaplegia, incomplete 6.46.4 Other multiple traumaOther multiple trauma

04.211104.2111 Incomplete Paraplegia T1-9Incomplete Paraplegia T1-9

04.211204.2112 Incomplete Paraplegia T10-L2Incomplete Paraplegia T10-L2

04.211304.2113 Incomplete Paraplegia L3-4Incomplete Paraplegia L3-4 Orthopedic DisordersOrthopedic Disorders

04.211404.2114 Incomplete Paraplegia L5-S1Incomplete Paraplegia L5-S1 Orthopedic ConditionsOrthopedic Conditions

04.211504.2115 Incomplete Paraplegia SacralIncomplete Paraplegia Sacral 05.1105.11 Status Post Hip FractureStatus Post Hip Fracture

04.212004.2120 Paraplegia, completeParaplegia, complete 05.1205.12 Status Post Femure (shaft) FractureStatus Post Femure (shaft) Fracture

How is Data Submitted?How is Data Submitted?All data is submitted electronically to All data is submitted electronically to the EMS web sitethe EMS web sitehttp://ems.ohio.gov/ohio_trauma_registry.htmhttp://ems.ohio.gov/ohio_trauma_registry.htm

Direct entry of individual record dataDirect entry of individual record data - or -- or -

Upload of file with multiple recordsUpload of file with multiple records– 33rdrd party software users party software users

REHAB RegistryREHAB Registry

Trauma Rehabilitation ReportingTrauma Rehabilitation Reporting – All In-patient rehabilitation facilitiesAll In-patient rehabilitation facilities– Web based entry/submission processWeb based entry/submission process– 36 Data fields, all are required36 Data fields, all are required– Data collection scheduled to begin January 1, 2005Data collection scheduled to begin January 1, 2005

Upload File

Upload File function is needed for users that utilize a 3rd party software to collect data

Download Records

Facilities can pull back all the data that they submit . In an Excel file, this allows for graphs and reports to be generated

EMSIRSEMSIRSEMS Incident Reporting SystemEMS Incident Reporting System

EMS agencies required to reportEMS agencies required to report– Transporting agency reports dataTransporting agency reports data– Web based entry/submission systemWeb based entry/submission system– 90 fields, 52 are required, 38 are option/local use only90 fields, 52 are required, 38 are option/local use only– Data collection began January 1, 2002Data collection began January 1, 2002– Over 1 million records in the system to dateOver 1 million records in the system to date– EMS agencies MUST participate in order to be eligible for EMS agencies MUST participate in order to be eligible for

the EMS/Trauma grant programthe EMS/Trauma grant program5.2 million dollars awarded by the EMS Board annually5.2 million dollars awarded by the EMS Board annually

Ohio Trauma RegistryOhio Trauma RegistryTRAUMATRAUMA

ALL hospitals required to reportALL hospitals required to report– Transporting agency reports dataTransporting agency reports data– Web based entry/submission systemWeb based entry/submission system– 52 fields, all are required52 fields, all are required– Data collection began January 1, 1999Data collection began January 1, 1999– Over 100,000 records in the system to dateOver 100,000 records in the system to date– Hospitals MUST participate in order to be eligible for the Hospitals MUST participate in order to be eligible for the

EMS/Trauma grant program, or to participate in DEMS EMS/Trauma grant program, or to participate in DEMS funded programsfunded programs

OTR Special ProjectsOTR Special Projects

Data Validation StudyData Validation Study – Validate 12 data pointsValidate 12 data points

ICD-9-CM diagnosis and external cause codesICD-9-CM diagnosis and external cause codes

ED vital signs and Glasgow Coma Scale scoresED vital signs and Glasgow Coma Scale scores

DOB, Gender, Zip code DOB, Gender, Zip code

– 1000 records1000 records– 28 Hospitals 15 Non trauma centers, 18 trauma 28 Hospitals 15 Non trauma centers, 18 trauma

centers)centers)

OTR Special ProjectsOTR Special Projects

Probabilistic LinkageProbabilistic Linkage – Links records in separate data bases that do not Links records in separate data bases that do not

have a Unique Identifierhave a Unique Identifier

OTR Special ProjectsOTR Special Projects

Probabilistic Linkage Does Work!Probabilistic Linkage Does Work!– Used by the CDC and National Highway Traffic Safety Used by the CDC and National Highway Traffic Safety

AdministrationAdministration

– Critical fields from a record in each database are evaluated Critical fields from a record in each database are evaluated for the “probability” that they are the same incident/patientfor the “probability” that they are the same incident/patient

– We’ll use probabilistic linkage to link OTR to We’ll use probabilistic linkage to link OTR to EMSIRSEMSIRSOhio Crash RecordsOhio Crash RecordsREHAB Data baseREHAB Data base

When complete, Ohio’s Trauma Registry will be the most When complete, Ohio’s Trauma Registry will be the most comprehensive in the county!comprehensive in the county!

Ohio’s Trauma RegistryOhio’s Trauma Registry

The GoalThe GoalProvide Data forProvide Data for

•Development of Public PolicyDevelopment of Public Policy•Healthcare educationHealthcare education

•Injury PreventionInjury Prevention•ResearchResearch