he kentucky trauma registry in the era costich

1. Kentucky’s Trauma System: A Work
in Progress
Julia F. Costich, JD, PhD & Svetla S. Slavova, PhD
Kentucky Injury Prevention & Research Center
Depts. of Health Services Management & Biostatistics
Univ. of Kentucky College of Public Health

2. Topics Covered
• Trauma system participating facilities
• Trauma registry characterization
• Trauma registry data
• Trauma system strategic planning
• Trauma system evaluation structure

3. Participating facilities/ACS Verified
• Level I: Univ. of Kentucky & Univ. of Louisville
• Level I Pediatrics: Kosair Children’s Hospital & Ky Children’s
Hospital
• Level II: None
o Pikeville & Owensboro in process
• Level III: Ephraim McDowell, Taylor Regional Medical Center,
Frankfort Regional Medical Center
o Hazard Appalachian Regional Hospital in process

4. Participating facilities/State-verified
• Fort Logan Hospital: Level IV
• James B. Haggin Memorial Hospital: Level IV
• Livingston County Hospital: Level IV
• Marcum and Wallace Hospital: Level IV

5. Level IV status under development
• Crittenden County Hospital
• Harrison Memorial Hospital
• Medical Center at Franklin
• Medical Center at Scottsville
• Methodist Union Hospital
• Parkway Regional Medical Center
• Russell County Hospital
• St. Joseph Berea
• Trigg County Hospital
• Possibly 7 more

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Crittenden Co.
Eph. McDowell
U of L
Trigg Co.
St. Joseph Berea
Livingston Co.
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Fort Logan
UK
Spring View
Pikeville Med. Ctr.
Owensboro Med Ctr
Harrison Memorial
UK Children's.
Taylor Regional.
Kosair Children's
l
Frankfort Regional.
Marcum & Wallace
James B. Haggin.
®v KY Trauma Centers
All Trauma Facilities in Current Reports

7. Trauma Registry vs. Hospital Discharge
Data
• Trauma Registry
o 902 KAR 28:040: regulatory authorization and structure
o Cases that meet ACSCOT case definition
o Verified or applicant facilities
o Extensive clinical information
o ED and inpatient information in same dataset
• Hospital Discharge and Outpatient/ED Data
o 900 KAR 7:030: regulatory authorization and structure
o All non-federal facilities
o Limited clinical information
o Injury analysis includes all injury-related ICD codes, not just ACSCOT
o Inpatient and ED information in different datasets

8. Table 1: Reporting Site Totals, 2012
Univ. of Louisville Hospital 2964 30%
Univ. of Kentucky Hospital 2875 29%
Kosair Children's Hospital 864 9%
Pikeville Medical Center 650 6%
Owensboro Medical Center 633 6%
Kentucky Children's Hospital 442 4%
Frankfort Regional Medical Center 312 3%
Eph. McDowell Regional Med Ctr 299 3%
Taylor Regional Medical Center 228 2%
Haggin Memorial Hospital 147 1%
Eph. McDowell Ft. Logan 142 1%
Harrison Memorial Hospital 139 1%
All others 349 3%
Total 10044 (ED: 2006)

9. Table 2: Primary Body Part Injured
Brain 2285 24%
Lower extremity 2001 21%
Torso 1836 19%
Upper extremity 1386 15%
Other head/face/neck 874 9%
Vertebral column 753 8%
Spinal cord 106 1%
System-wide/late effects 17 0%
Other & unspecified 213 2%

10. Primary Body Part Injured
Brain
24%
Vertebral column
1%
Lower extremity
21%
Torso
20%
Other & unspecified
2%
Other head/face/neck
8%
System-wide/late effects
15%
Spinal cord
0.2% Upper
extremity
9%

11. Table 3: Major Findings by Location & Cause
Other Fire- Cut/
Location MVC transp arm Falls Fire Pierce Struck Other Total
Street & highway 39% 3084 452 85 71 10 25 41 30 3798
Home 38% 21 111 256 2184 273 266 232 362 3705
Farm 2% 13 40 1 55 4 7 17 53 190
Industrial site 3% 11 15 3 127 19 19 46 67 307
Recreational site 6% 34 269 3 167 4 4 56 25 562
Public building 4% 1 24 21 226 5 24 45 27 373
Residential
institution 2% 0 0 0 155 3 7 24 17 206
Other 1% 3 15 3 48 2 4 16 22 113
Unspec/missing 5% 25 69 46 170 23 44 81 76 534
Total 3192 995 418 3203 343 400 558 679 9788

12. Major Findings by Location
Street & highway
39%
Public building
4%
Home
38%
Farm
2%
Industrial site
3%
Recreational site
6%
Residential
institution
2%
Other
1%
Unspecified/
missing
5%

13. Table 4: Pre-Hospital Information
Zip code of the injury is not available for about 30% of the trauma registry records

14. Table 5: Inpatient & ED Discharge
Destinations
ED Discharge Destinations
Same hospital 231 11.7%
Another hospital 950 48.2%
Home 626 31.7%
Other institution 31 1.6%
Died 135 6.8%
Inpatient Discharge
Destinations
Home 5606 69.7%
LTC/ICF/Rehab 1517 18.9%
Home
health/hospice 550 6.8%
Died 311 3.9%
Other hospital 54 0.7%

15. Table 6: Primary Method of Payment
Auto insurance 1972 19.6%
Commercial insurance 1874 18.7%
"Self-pay" 1873 18.6%
Medicare 1768 17.6%
Medicaid 1304 13.0%
Workers compensation 269 2.7%
Other 123 1.2%
Missing 861 8.6%

16. Table 7: Age-Related Information
Primary Intentional
Age group Number % Cause % %
Missing 19 0.2%
<1yr 170 1.7% Falls 41.8% 25.9%
1-4yr 418 4.2% Falls 39.7% 5.5%
5-14yr 912 9.1% Falls 35.4% 1.2%
15-24 1453 14.5% MVC 46.5% 13.9%
25-34 1324 13.2% MVC 44.0% 17.5%
35-44 1217 12.1% MVC 38.9% 14.3%
45-54 1311 13.1% MVC 36.2% 10.6%
55-64 1101 11.0% Falls 39.2% 6.2%
65-74 844 8.4% Falls 50.2% 3.3%
75-84 785 7.8% Falls 68.8% 2.3%
85+ 490 4.9% Falls 81.2% 0.4%
Total 10044

17. Other Data
Drug or Alcohol Involvement
N= %
Alcohol 776 7.7%
Rx drug 777 7.7%
Illegal drug 264 2.6%
1817 18.1%
Patient Sex N= %
Female 3834 38.2%
Male 6209 61.8%
Total 10043
Race & Ethnicity N= %
White 9009 89.7%
African-American 767 7.6%
Other/missing 268 0.8%
Hispanic/Latino 191 1.9%
Length of
Stay N= %
1-7 days 6714 66.8%
8-30 days 98 1.0%
> 30 days 1262 12.6%
Missing 1970 19.6%

18. Mission
Right Patient, Right Care, Right Time
Trauma Advisory Council Retreat
Vision
Provide a comprehensive, coordinated
accessible trauma care system,
striving for optimal prevention,
management and mitigation of injury
in the Commonwealth of Kentucky.

19. Values
• Inclusivity (starting with
EMS, first responders
through all levels of care)
• Accessibility
• Cost-efficiency
• Evidence-based care
• High quality
• Timeliness
• Performance improvement
• Collaboration
• Consistency
(standardization)
• Professionalism
• Reliability
• Equitability
• Appropriate funding

20. Strengths of current system
• Leadership
• Trauma Advisory Council
• Existing trauma centers and
future potential
• Statute and regulations
• Funding from outside
sources
• State Trauma Registry
• Air ambulance availability
• Modular educational
programs
• Telemedicine and tele-
health availability
• CDM (registry data
management vendor)
• RTTDC (rural training)
• Statewide registrar meeting
• Inclusiveness
• KHA support
• State Public Health support

21. Weaknesses of current system
• Funding
• Public perception
• Perception of injury
• Perception of trauma centers
• Geographic distribution
• Law without funding
• Inadequate regional support &
coordination
• MD buy-in
• EMS systems & turnover in
some areas
• EMS reluctant to transport to
trauma center
• Shortage of burn beds and
burn training
• Rural EMS agencies poorly
funded
• Database doesn’t capture non-
verified centers/lack of
statewide participation
• TAC has no executive power
• Education deficit (clinical
trauma knowledge)
• Challenging geography
• Lack of specialists in rural
facilities

22. Strategic Initiatives
1. Achieve state general funding using TAC, trauma centers,
EMS, KHA and the legislation.
2. Educate legislators, public and providers about the value and
relevance of the trauma system.
3. Enhance EMS engagement in the system, and enhance EMS
relevance as defined by role, purpose and identity.
4. Support hospital initiatives to achieve trauma
reimbursement.
5. Use state trauma data to provide a dashboard for legislature
and public, enhanced by personal stories.

25. What would a well-developed
trauma system look like?
(based on Amer. Coll. of Surgeons guidelines)
Key Elements:
System Assessment
Policy Development
System Assurance

26. System Assessment
Category Standard
Injury Epidemiology Thorough description of
injury epidemiology
Trauma Management
Information System
Established trauma MIS
Resource Assessment Assessment completed and
updated
Emergency Preparedness
Assessment
Assessment completed
including coordination
Cost/Benefit and Societal
Investment
Assesses and monitors
values to constituents

27. Policy Development
Category Standard Category Standard
Statutory
Authority/
Administrative
Rules
Statutory Authority
& Administrative
rules
System
Performance Data
Data used to
evaluate
performance and
develop policy
System Leadership Process used to
establish, maintain,
improve system
Performance
Reports and
Reviews
System leaders
review system
performance
reports
Statewide Trauma
System, Plan
Comprehensive
written system plan
Inform/Educate
Partnerships
Lead agency
informs and
educates State,
fosters
collaboration
Financial &
Infrastructure
related resources
Sufficient resources
exist, financial and
infrastructure
Public Health
Emergency
Preparedness Links
Trauma, public
health and
emergency
preparedness are
linked

28. System Assurance
Category Standard Category Standard
Trauma MIS &
Outcomes
Trauma MIS used to
assess & assure
system
performance
Integration of
Trauma Plan
Trauma plan
integrated with
mass casualty plan
EMS System
Support
System supported
by EMS, trauma,
EMS, public health
integrated
Outreach and
Prevention
Trauma system
demonstrates
prevention &
outreach activities
Role for all Acute
Care Facilities
All acute care
facilities integrated
into network that
meets standards;
optimal care for all
injured patients
Continuous Trauma
Care Improvement
Each hospital must
improve care as
measured by
outcomes
Analytic Monitoring
Tools
Agency uses tools
to monitor
performance
Rehabilitation
Availability
Adequate rehab
facilities integrated
into system

29. Contact Information
Kentucky Injury Prevention & Research Center
333 Waller Ave.
Lexington, KY 40504
859-257-4954
www.mc.uky.edu/kiprc