setting injury priorities smartrisk learning series march 29, 2007 dr. sande harlos, moh

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SETTING INJURY SETTING INJURY PRIORITIES PRIORITIES SMARTRISK Learning Series SMARTRISK Learning Series March 29, 2007 March 29, 2007 Dr. Sande Harlos, MOH Dr. Sande Harlos, MOH Winnipeg Regional Health Authority Winnipeg Regional Health Authority

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SETTING INJURY PRIORITIES SMARTRISK Learning Series March 29, 2007 Dr. Sande Harlos, MOH Winnipeg Regional Health Authority. OUTLINE. Priority setting- the challenge Describe an approach to establishing priorities Priorization example. - PowerPoint PPT Presentation

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Page 1: SETTING INJURY PRIORITIES SMARTRISK Learning Series March 29, 2007 Dr. Sande Harlos, MOH

SETTING INJURYSETTING INJURY

PRIORITIESPRIORITIES

SMARTRISK Learning SeriesSMARTRISK Learning Series

March 29, 2007March 29, 2007

Dr. Sande Harlos, MOH Dr. Sande Harlos, MOH

Winnipeg Regional Health AuthorityWinnipeg Regional Health Authority

Page 2: SETTING INJURY PRIORITIES SMARTRISK Learning Series March 29, 2007 Dr. Sande Harlos, MOH

OUTLINEOUTLINE Priority setting- the challengePriority setting- the challenge

Describe an approach to Describe an approach to establishing priorities establishing priorities

Priorization examplePriorization exampleTake Home: a process to establish Take Home: a process to establish injury priorities in your area of injury priorities in your area of workwork

Page 3: SETTING INJURY PRIORITIES SMARTRISK Learning Series March 29, 2007 Dr. Sande Harlos, MOH

PRIORITY SETTING- PRIORITY SETTING-

WHY BOTHER??WHY BOTHER??

Limited resources:Limited resources:• timetime

• fundingfunding•manpowermanpower

Biggest impactBiggest impact

Coordinate efforts of stakeholdersCoordinate efforts of stakeholders

Page 4: SETTING INJURY PRIORITIES SMARTRISK Learning Series March 29, 2007 Dr. Sande Harlos, MOH
Page 5: SETTING INJURY PRIORITIES SMARTRISK Learning Series March 29, 2007 Dr. Sande Harlos, MOH

PRIORITY SETTING- PRIORITY SETTING- BASED ON WHAT CRITERIA?BASED ON WHAT CRITERIA?

Common sense?Common sense?

Data? (If so which?)Data? (If so which?)

Opportunity gaps?Opportunity gaps?

Personal interest?Personal interest?

Media attention?Media attention?

Political agendas?Political agendas?

Advocacy or lobby groups?Advocacy or lobby groups?

Page 6: SETTING INJURY PRIORITIES SMARTRISK Learning Series March 29, 2007 Dr. Sande Harlos, MOH

A PRIORITY SETTING A PRIORITY SETTING PROCESSPROCESS: : ADVANTAGESADVANTAGES

Utilizes available injury dataUtilizes available injury data

Incorporates qualitative and Incorporates qualitative and quantitative considerationsquantitative considerations

Provides structure to stakeholder Provides structure to stakeholder deliberationsdeliberations

Is transparent, can be documentedIs transparent, can be documented

Can be revisited over timeCan be revisited over time

Page 7: SETTING INJURY PRIORITIES SMARTRISK Learning Series March 29, 2007 Dr. Sande Harlos, MOH

The role of “Evidence”

• Focus on “evidence-informed” or “evidence-based” planning, and knowledge translation….

EVIDENCE ACTION?How????

Page 8: SETTING INJURY PRIORITIES SMARTRISK Learning Series March 29, 2007 Dr. Sande Harlos, MOH

Evidence Action

• Not a simple process!• Take into consideration many types of

available “evidence” describing a problem

• Identify priority issues to address• Consider available interventions that

work to address priority issues• Implement and take stock of what’s

working (evaluation)

Page 9: SETTING INJURY PRIORITIES SMARTRISK Learning Series March 29, 2007 Dr. Sande Harlos, MOH

Quantitative Approach: Looking AT – “Falls Among Older People”

Aggregate Data Base Analysis

Primary Data Collection• Local Surveillance • Surveys

Deaths, Hospital Admissions, ER Visits

PCRs, CCHS, AB Survey, CHMS, Incident Reports, In-house reporting systems

Social Environment

Personal Environment

What meaning does my social network and society give to falls?

What meaning do older people give to falls?

Qualitative Approach: Looking IN – “Falls Among Older People”

Source: Alberta Centre for Injury Control and Research Workshop March 2007 (based on “Undertaking Qualitative Research- Concepts and Cases in Injury, Health and Social Life” by J. Peter Rothe)

Page 10: SETTING INJURY PRIORITIES SMARTRISK Learning Series March 29, 2007 Dr. Sande Harlos, MOH

Quantitative Approach: Looking AT – “Falls Among Older People”

Qualitative Approach: Looking IN – “Falls Among Older People”

Source: Alberta Centre for Injury Control and Research Workshop March 2007 (based on “Undertaking Qualitative Research- Concepts and Cases in Injury, Health and Social Life” by J. Peter Rothe)

Knowledge Translation Program Development “Falls Among

Older People”

Page 11: SETTING INJURY PRIORITIES SMARTRISK Learning Series March 29, 2007 Dr. Sande Harlos, MOH

Evidence Action

• Not a simple process!• Take into consideration many types of

available “evidence” describing a problem

• Identify priority issues to address• Consider available interventions that

work to address priority issues• Implement and take stock of what’s

working (evaluation)

Page 12: SETTING INJURY PRIORITIES SMARTRISK Learning Series March 29, 2007 Dr. Sande Harlos, MOH

Disclaimer!!!

This is …• really really really simple• homemade• mostly a recipe for common sense

Adapt, improve and enhanceat will!

Page 13: SETTING INJURY PRIORITIES SMARTRISK Learning Series March 29, 2007 Dr. Sande Harlos, MOH

BACKGROUND: SAMPLE PRIORITY BACKGROUND: SAMPLE PRIORITY SETTING PROCESSSETTING PROCESS

Arose from WRHA strategic planning Arose from WRHA strategic planning process (2000), reused (2005)process (2000), reused (2005)

Was adapted and used by the F/P/T Was adapted and used by the F/P/T Sub-committee on Injury Prevention Sub-committee on Injury Prevention and Control (2001)and Control (2001)

Interest expressed recently by Safe Interest expressed recently by Safe Communities and othersCommunities and others

To be further refined by partnersTo be further refined by partners

Page 14: SETTING INJURY PRIORITIES SMARTRISK Learning Series March 29, 2007 Dr. Sande Harlos, MOH

PRIORITY SETTING PROCESSPRIORITY SETTING PROCESS

OVERVIEW (“recipe”….)OVERVIEW (“recipe”….)

Quantitative criteria (data)Quantitative criteria (data)

Qualitative criteria (readiness, Qualitative criteria (readiness, potential, capacity to effect change)potential, capacity to effect change)

Ranking and scoringRanking and scoring

Putting it all togetherPutting it all together

Sub-groups- priority populations?Sub-groups- priority populations?

Reality checkReality check

Page 15: SETTING INJURY PRIORITIES SMARTRISK Learning Series March 29, 2007 Dr. Sande Harlos, MOH

PRIORITY SETTING PROCESSPRIORITY SETTING PROCESS

CAUSE CATEGORIES (eg-Wpg)CAUSE CATEGORIES (eg-Wpg)1.1. ViolenceViolence

2.2. Suicide/self-inflictedSuicide/self-inflicted

3.3. FallsFalls

4.4. Motor vehicleMotor vehicle

5.5. PoisoningPoisoning

6.6. DrowningDrowning

7.7. Fire/BurnFire/Burn

8.8. SuffocationSuffocation

Page 16: SETTING INJURY PRIORITIES SMARTRISK Learning Series March 29, 2007 Dr. Sande Harlos, MOH

PRIORITY SETTING PROCESSPRIORITY SETTING PROCESS

QUANTITATIVE CRITERIAQUANTITATIVE CRITERIA

1.1. Number of deathsNumber of deaths

2.2. Potential years of life lost Potential years of life lost

3.3. Number of hospitalizationsNumber of hospitalizations

4.4. Average LOS (severity proxy)Average LOS (severity proxy)

5.5. Use other if available (e.g. ED data, Use other if available (e.g. ED data, cost etc)cost etc)

Page 17: SETTING INJURY PRIORITIES SMARTRISK Learning Series March 29, 2007 Dr. Sande Harlos, MOH

QUANTITATIVE PROCESS:QUANTITATIVE PROCESS:

RANKING AND SCORINGRANKING AND SCORING

1.1. Populate a spreadsheet with dataPopulate a spreadsheet with data

2.2. Rank with highest = 1Rank with highest = 1

3.3. Sum all ranks (rank totals)Sum all ranks (rank totals)

4.4. Rank the totalsRank the totals

5.5. Lowest score denotes highest overall Lowest score denotes highest overall quantitative priority quantitative priority

Page 18: SETTING INJURY PRIORITIES SMARTRISK Learning Series March 29, 2007 Dr. Sande Harlos, MOH

QUANTITATIVE CRITERIA

ViolenceSuicide/

Self-inflicted

Falls Motor Vehicle

Poison DrownFire/Burn

Suffoca-tion

1.Deaths

135 675 398 354 96 78 70 78

1.PYLL (%)

10 36 4 19 4 5 4 3

1.Hospitalizations

3585 3644 24489 3625 1011 58 825 273

1.Ave LOS 10 13 33 16 12 4 22 18

Rank sums

Quantitative Priority Ranking

STEP 1: Populate data

Page 19: SETTING INJURY PRIORITIES SMARTRISK Learning Series March 29, 2007 Dr. Sande Harlos, MOH

QUANTITATIVE CRITERIA

ViolenceSuicide/

Self-inflicted

Falls Motor Vehicle

Poison DrownFire/Burn

Suffoca-tion

1.Deaths

1354

6751

3982

3543

965

786.5

708

786.5

1.PYLL (%)

103

361

42.5

192

42.5

54.5

54.5

38

1.Hospitalizations

35854

36442

244891

36254

10115

588

8256

2737

1.Ave LOS107

135

331

164

126

48

222

183

Rank sums

Quantitative Priority Ranking

STEP 2: Rank the order

Page 20: SETTING INJURY PRIORITIES SMARTRISK Learning Series March 29, 2007 Dr. Sande Harlos, MOH

QUANTITATIVE CRITERIA

ViolenceSuicide/

Self-inflicted

Falls Motor Vehicle

Poison DrownFire/Burn

Suffoca-tion

1.Deaths

1354

6751

3982

3543

965

786.5

708

786.5

1.PYLL (%)

103

361

46.5

192

46.5

54.5

54.5

38

1.Hospitalizations

35854

36442

244891

36253

10115

588

8256

2737

1.Ave LOS107

135

331

164

126

48

222

183

Rank sums 18 9 10.5 12 22.5 27 20.5 24.5Quantitative Priority Ranking

STEP 3: Sum all the ranks

Page 21: SETTING INJURY PRIORITIES SMARTRISK Learning Series March 29, 2007 Dr. Sande Harlos, MOH

QUANTITATIVE CRITERIA

ViolenceSuicide/

Self-inflicted

Falls Motor Vehicle

Poison DrownFire/Burn

Suffoca-tion

1.Deaths

1354

6751

3982

3543

965

786.5

708

786.5

1.PYLL (%)

103

361

42.5

192

42.5

54.5

54.5

38

1.Hospitalizations

35854

36442

244891

36254

10115

588

8256

2737

1.Ave LOS107

135

331

164

126

48

222

183

Rank sums 18 9 10.5 12 22.5 27 20.5 24.5Quantitative Priority Ranking 4 1 2 3 6 8 5 7

STEP 4: Rank the totals

Page 22: SETTING INJURY PRIORITIES SMARTRISK Learning Series March 29, 2007 Dr. Sande Harlos, MOH

QUALITATIVE PROCESSQUALITATIVE PROCESS

1.1. Establish qualitative criteria by group Establish qualitative criteria by group consensusconsensus

2.2. Assign a score for each qualitative Assign a score for each qualitative criterion for all causes (1-3 or 1-5) criterion for all causes (1-3 or 1-5) where highest = most agreement where highest = most agreement

3.3. Sum all scores (highest score wins)Sum all scores (highest score wins)

4.4. Rank the totalsRank the totals

5.5. Lowest rank denotes highest overall Lowest rank denotes highest overall quantitative priority quantitative priority

Page 23: SETTING INJURY PRIORITIES SMARTRISK Learning Series March 29, 2007 Dr. Sande Harlos, MOH

PRIORITY SETTING PROCESSPRIORITY SETTING PROCESS

QUALITATIVE CRITERIAQUALITATIVE CRITERIA Disproportionate burdenDisproportionate burden Effective interventionsEffective interventions Opportunity gapOpportunity gap Potential cost savingsPotential cost savings Trends Trends Impact within mandateImpact within mandate Ability to influence othersAbility to influence others Lack of readiness in other sectorsLack of readiness in other sectors Readiness of publicReadiness of public Readiness of political systemsReadiness of political systems

Page 24: SETTING INJURY PRIORITIES SMARTRISK Learning Series March 29, 2007 Dr. Sande Harlos, MOH

Qualitative criteriaViol. Suic. Falls MV Pois. Drown Burn Suff

1. Disproportionate burden

2. Effective interventions 1 2 3 3 2 3 3 2

3. Opportunity gap exists

4. Cost savings

5. Worsening Trends

6. Within your mandate

7. Ability to influence others

8. Lack of readiness-other sectors

9. Public readiness

10. Political readiness

Sum Score

Qualitative Priority Ranking

Page 25: SETTING INJURY PRIORITIES SMARTRISK Learning Series March 29, 2007 Dr. Sande Harlos, MOH

Qualitative criteriaViol. Suic. Falls MV Pois. Drown Burn Suff

1. Disproportionate burden 3 3 3 3 3 3 3 2

2. Effective interventions 1 2 3 3 2 3 3 2

3. Opportunity gap exists 1 2 3 3 2 2 3 2

4. Cost savings 2 2 3 3 2 2 2 2

5. Worsening Trends 2 2 3 1 2 1 1 2

6. Within your mandate 3 3 2 1 2 1 1 1

7. Ability to influence others 3 3 3 3 3 3 3 2

8. Lack of readiness-other sectors

1 3 2 1 3 1 1 2

9. Public readiness 3 2 2 2 2 2 2 1

10. Political readiness 2 1 2 3 1 1 1 2

Sum Score 22 23 26 23 21 19 20 18

Qualitative Priority Ranking

Page 26: SETTING INJURY PRIORITIES SMARTRISK Learning Series March 29, 2007 Dr. Sande Harlos, MOH

Qualitative criteriaViol. Suic. Falls MV Pois. Drown Burn Suff

1. Disproportionate burden 3 3 3 3 3 3 3 2

2. Effective interventions 1 2 3 3 2 3 3 2

3. Opportunity gap exists 2 2 3 3 2 2 3 2

4. Cost savings 2 2 3 3 2 2 2 2

5. Worsening Trends 2 2 3 1 1 1 1 2

6. Within your mandate 3 3 2 1 2 1 1 1

7. Ability to influence others 3 3 3 3 3 3 3 2

8. Lack of readiness-other sectors

1 3 2 1 3 1 1 2

9. Public readiness 3 2 2 2 2 2 2 1

10. Political readiness 2 1 2 3 1 1 1 2

Sum Score 22 23 26 23 21 19 20 18

Qualitative Priority Ranking

4 2 1 2 5 7 6 8

Page 27: SETTING INJURY PRIORITIES SMARTRISK Learning Series March 29, 2007 Dr. Sande Harlos, MOH

“BOTTOM LINE”

Violence Suicide Falls Motor Vehicle

Poison Drown/Suff.

Fire/Burn

Suffocation

QUANTITATIVE CRITERIA

4 1 2 3 6 8 5 7

QUALITATIVE CRITERIA

4 2 1 2 5 7 6 8

OVERALL X X X

PUTTING IT ALL TOGETHERPUTTING IT ALL TOGETHER

Page 28: SETTING INJURY PRIORITIES SMARTRISK Learning Series March 29, 2007 Dr. Sande Harlos, MOH

PRIORITY SETTING PROCESSPRIORITY SETTING PROCESS

PUTTING IT ALL TOGETHERPUTTING IT ALL TOGETHER

Making sense of the wholeMaking sense of the whole

Establishing your “bottom line”Establishing your “bottom line”

Examining priority populationsExamining priority populations

Page 29: SETTING INJURY PRIORITIES SMARTRISK Learning Series March 29, 2007 Dr. Sande Harlos, MOH

PRIORITY SETTING PROCESSPRIORITY SETTING PROCESS

PRIORITY POPULATIONSPRIORITY POPULATIONS

Examples from F/P/T subcommittee:Examples from F/P/T subcommittee:

Priority: FALLSPriority: FALLSFalls in older adultsFalls in older adultsFalls in older childrenFalls in older children

Priority: SUICIDEPriority: SUICIDESuicide in young peopleSuicide in young peopleSuicide in Aboriginal peopleSuicide in Aboriginal people

Page 30: SETTING INJURY PRIORITIES SMARTRISK Learning Series March 29, 2007 Dr. Sande Harlos, MOH

REALITY CHECKREALITY CHECK

Do the priorities make sense?Do the priorities make sense?

Are there any barriers to action that Are there any barriers to action that have been overlooked?have been overlooked?

Does the outcome fit with general Does the outcome fit with general priorities/directions?priorities/directions?

Page 31: SETTING INJURY PRIORITIES SMARTRISK Learning Series March 29, 2007 Dr. Sande Harlos, MOH

NOW WHAT?NOW WHAT?

Priority issues have been identifiedPriority issues have been identified

NOW- developing plans to address NOW- developing plans to address each issue begins!each issue begins!

We have existing tools:We have existing tools:

EG: Haddon’s MatrixEG: Haddon’s Matrix

Page 32: SETTING INJURY PRIORITIES SMARTRISK Learning Series March 29, 2007 Dr. Sande Harlos, MOH

Overall planning processOverall planning process

1.1. Brainstorm possible interventions for Brainstorm possible interventions for each priority issue (Haddon’s Matrix)each priority issue (Haddon’s Matrix)

2.2. Establish effectiveness of potential Establish effectiveness of potential actions identified actions identified

3.3. Explore feasibility/ cost of potential Explore feasibility/ cost of potential actionaction

4.4. Identify relevant partners, connectIdentify relevant partners, connect

5.5. Plan details, implement, evaluatePlan details, implement, evaluate

Page 33: SETTING INJURY PRIORITIES SMARTRISK Learning Series March 29, 2007 Dr. Sande Harlos, MOH

SUMMARYSUMMARY Sample approach to priority setting Sample approach to priority setting

has been presentedhas been presented

Organizations, Communities can Organizations, Communities can adapt the process to their planning adapt the process to their planning needsneeds

Utilizes available injury dataUtilizes available injury data

Considers important qualitative Considers important qualitative factorsfactors

Involves a consensus building processInvolves a consensus building process

Identifying priority issues is the first Identifying priority issues is the first step in developing a planstep in developing a plan

Page 34: SETTING INJURY PRIORITIES SMARTRISK Learning Series March 29, 2007 Dr. Sande Harlos, MOH

QUESTIONS AND

DISCUSSION