setting injury priorities smartrisk learning series march 29, 2007 dr. sande harlos, moh
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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 PresentationTRANSCRIPT
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
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
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
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?
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
The role of “Evidence”
• Focus on “evidence-informed” or “evidence-based” planning, and knowledge translation….
EVIDENCE ACTION?How????
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)
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)
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”
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)
Disclaimer!!!
This is …• really really really simple• homemade• mostly a recipe for common sense
Adapt, improve and enhanceat will!
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
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
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
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)
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
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
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
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
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
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
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
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
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
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
“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
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
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
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?
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
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
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
QUESTIONS AND
DISCUSSION