REDUCING THE INJURY BURDEN

Monica S. Vavilala, MD Professor of Anesthesiology and Pediatrics Director, Harborview Injury Prevention & Research Center University of Washington

UW Health Sciences

Rivara

Rivara

BASICS OF INJURY PREVENTION INJURIES ARE NOT ACCIDENTS 1. Injuries are often understandable, predictable, and preventable 2. Specific injuries share similar characteristics of person, place and time 3. By understanding injuries, interventions can be developed and implemented to prevent or limit the extent of a given injury

Rivara

INJURY CONTROL

Prevention Rehabilitation

Acute Care

Vavilala

5 STEP PUBLIC HEALTH APPROACH

1. 2. 3. 4. 5.

Surveillance: What is the problem? Risk identification: What is the cause? Intervention: What works? Implementation: How do you do it? Outcome measurement: Did it work?

Vavilala

Spectrum of Injury Control

Surveillance

Prevention Pre-Hospital Care Vavilala

Hospital Care

Acute care Rehabilitation

Current Injury Control Centers HIPRC, University of Washington

Michigan

Medical College of Wisconsin

Columbus

Mt. Sinai

UCSF Johns Hopkins Colorado State

Washington Univ.

University of Iowa

West Virginia U UNC

Emory

Harborview Injury Prevention & Research Center Regional Partners DOH Region X: WA, OR, ID, AK.

NHTSA Region X: WA, OR, ID, AK, MT

Northwest Trauma Network: WA, ID, AK, MT

ONE DOCTOR CAN MAKE A DIFFERENCE: ABRAHAM BERGMAN, MD Flammable fabric burns •Flammable Fabrics Act ‘67

Aspirin poisoning •Poison Prevention Packaging Act ‘70

Power lawn mower injuries •Consumer Product Safety Commission ‘72

Vavilala

HIPRC MISSION

To reduce the impact of injury and violence on people’s lives through research, education, training and public awareness

30 YEAR HIPRC IMPACT • Bicycle and motorcycle safety improvement • Motor vehicle crash & injury reduction • Traumatic brain injury prevention & treatment • Improving alcohol and injury outcomes • Apartment window guards • Smoke detectors • Violence prevention programs • Training of injury scientists • Depth in injury research • Outreach and Education • Vavilala Reduction of Disparities

Activities Across Lifespan

Vavilala

Survival rate of seriously injured (ISS 16+) trauma patients increased during 1995-2005 while it has leveled out since 2006 (DOH Criteria, excluding transfers-in) 90

Survivors per cent

85 80 75 70 65

13

UW HIPRC

91 Faculty from 33 Departments & Schools

33 Distinct Clinical and Research Units

Faculty

FACULTY DIVERSITY 55 SOM and 28 Other

HIPRC Activity Profile Research • • • • • • • • • •

Interdisciplinary MD & PhD 91 faculty (18 Core) 64 injury projects Outcomes Clinical Translational Pre-award support Methods inquiry Faculty projects

Education* • • • • • • • • • •

Outreach

29 Trainees • Pediatric Injury T32 (4) • Non T32 fellows (3) • 5 departments • Weekly WIP • Weekly journal clubs Summer student program Visiting scholar program Resident projects Early Investigator Research Network

22 Community Partners Partnership with SCH Website Weekly bulletin Newsletter

*126 Injury Scientists over 25 years

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RESEARCH ACTIVITY 2014 - 2015 55 Proposals submitted 24 Grants awarded •Jimenez, Anesthesiology, K23 •Whiteside, Emergency Medicine, K23 3 Contracts awarded 4 Fellowships awarded

HIPRC Methods Core Director, Ali Rowhani, MD, MPH, PHD, Department of Epidemiology, SPH

Principal mission To provide HIPRC faculty, staff, and trainees with assistance and training in the conduct of high-quality research using rigorous methodologies

Education

Data Collection

Core staffed by the Director, Data Analysts, and Trainees (Postdoctoral Fellows and Pre-doctoral Students)

Methods Core

Data Analysis

Activities of the Methods Core structured around the following components and may apply to either pre-award or post-award phases as needs arise

Rowhani

Data Management

Accessible Datasets for UW Investigators

Rowhani

PUBLICATIONS APRIL 2014 – MARCH 2015

50 45 40 35 30 25 20 15 10 5 0

Core Members

Associate Members

Staff & Trainees

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T32 AND OTHER TRAINEES (13) NAME

HOME DEPARTMENT

DEPARTMENT T32

Alex Quistberg, PhD

Epidemiology

Pediatrics (HIPRC)

Nithya Kannan, MD

Epidemiology

Epidemiology (Maternal-Child Health RPPE)

Molly Fuentes, MD

Rehabilitation Medicine

Pediatrics (HIPRC)

Cordelie Witt, MD

Surgery

Pediatrics (HIPRC)

Vijay Krishnamoorthy, MD

Anesthesiology

Anesthesiology

Jessica Jenness, PhD

Psychology

Pediatrics (HIPRC)

Judith Hagedorn, MD

Urology

Urology

Raquel Capote, DDS

Dentistry

Robert Bonow, MD (Resident)

Neurological Surgery

Joseph Simonetti, MD

Medicine

Stephanie Pan, MD (Resident)

Anesthesiology

Lauren Rakes, MD (Fellow)

Pediatrics

Sarah Farley, MD

Radiology

VISITING SCHOLARS Nophanan Chaikittisilpa, MD, Anesthesiology Mahidol University, Bangkok, Thailand Taniga Kiatchai, MD, Anesthesiology

Mahidol University, Bangkok, Thailand Phuphit Fuangworawong, MD, Anesthesiology Bhumibol Adulyadej Hospital, Bangkok, Thailand Narinrat Ruamthawee, CRNA, Anesthesiology Bhumibol Adulyadej Hospital, Bangkok, Thailand

SUMMER STUDENT PROFILES • 27 Students • 6 Graduate • 15 Undergraduate • 7 High School

27 STUDENTS FROM 16 INSTITUTIONS Georgetown University School of Medicine, Washington, DC Medical College of Georgia, Augusta, GA MPH/MSW Program, Washington University in Saint Louis, MO UW School of Medicine, Seattle, WA

• 22 Faculty Mentors

Naturopathic Medicine, Bastyr University, Kenmore, WA

• Partners • CEDI (UW SOM) • Rainier Scholars

Johns Hopkins University, Baltimore, MD

UW School of Social Work, Seattle, WA

University of Washington, Seattle, WA McGill University, Montreal, CANADA Barnard College, Columbia University, New York, NY Amherst College, Amherst, MA Scripps College, Claremont, CA Engineering, Oregon State University, Corvallis, OR Bioengineering, University of Washington, Seattle, WA Ingraham High School, Seattle, WA Roosevelt High School, Seattle, WA Nathan Hale High School, Seattle, WA Harmony School, Houston, TX

The Northwest School, Seattle, WA Kamiak High School, Mukilteo, WA

Mentorship

2014 HMC TRAUMA CERTIFICATION HIPRC supported HMC in these areas: Outreach, Injury Prevention & Education Consultations with physicians in the community Public injury prevention education programs and activities A written plan for drug and alcohol screening, intervention, and referral A formal trauma education program A research program for adult and pediatric trauma Opening Presentation Materials

Transformation of Care Praised as Highly Innovative Program by DOH

HIPRC FEATURED

Visit: www.hiprc.org Email: [email protected]

The Collaborative Head Injury and Adherence and Outcomes (CHIRAG) Project

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TRANSFORMATION OF CARE Project and Faculty

• Direct Impact

• ED Alcohol Brief Intervention • Zatzick (Psychiatry)

• Imaging in ICU • Bresnahan/Slade/Vavilala (Radiology, Anesthesiology)

• Pediatric Guidelines Adherence & Outcomes

•

Reduced readmission rates

•

Reduced imaging costs

•

Interdisciplinary care pathway and increased evidence based TBI care

•

Brief violence intervention reduces injuries

•

Redefines NPO status, improves nutritional outcomes

• Vavilala/Rivara/Zatzick/Whiteside/Ellenbogen

• Firearm Violence Research • Rivara/Rowhani/Vavilala

• Nutrition in Trauma Patients • O’Keefe/Rowhani/Vavilala

MENTAL HEALTH AND INJURY PTSD Intervention • Intervention to prevent chronic PTSD • 20 trauma sites nationwide • Computerized decision support tool that includes care management, medication, psychotherapy • Follow for 12 months post injury PI: Doug Zatzick, MD 31

CONCUSSION COLLABORATIVE Partnership with Seattle Children’s Hospital

West Study • Prospective cohort study of middle school soccer players • Measured frequency and magnitude of sub-concussive head impacts using accelerometry. • Explored association between head impacts and changes in: 1) symptoms 2) cognitive testing and 3) advanced neuroimaging. • PI: Sarah Chrisman, MD 1. 2. 3. 4. 5. 6. 7. 8. 9.

Adolescent Medicine, Seattle Children’s Hospital, Seattle Center for Child Health, Behavior and Development, Seattle Children’s Research Institute Neurosurgery, University of Washington, Seattle Radiology, Seattle Children’s Hospital Center for Clinical and Translational Research, Seattle Children’s Research Institute Neuroradiology, University of Washington, Seattle Epidemiology, University of Washington, Seattle Applied Biomechanics Laboratory, University of Washington, Seattle Anesthesiology and Pain Medicine, University of Washington, Seattle

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PEGASUS PEDIATRIC GUIDELINE ADHERENCE AND OUTCOMES PROJECT IMPROVES OUTCOMES PROJECT

• NIH project translated research to practice • • • •

Examined Guideline adherence and survival Identified specific protective acute care indicators Implemented interdisciplinary care pathway 08/14 Improved adherence to evidence based guidelines

CIREN PROJECT CRASH INJURY RESEARCH AND ENGINEERING NETWORK/ NATIONAL HIGHWAY SAFETY ADMINISTRATION CIREN at HIPRC for 18 years Mission is to improve the prevention, treatment, and rehabilitation of motor vehicle crash injuries to reduce deaths, disabilities, and human and economic costs Research to improve safety standards PIs: Eileen Bulger and Rob Kaufman Outreach to improve triage and transport of MVC patients

SAFE AND ACTIVE TRANSPORT

CIREN PROJECT • Prospective data collection with professional multidisciplinary analysis of medical and engineering evidence to determine injury causation in every crash investigation conducted. • The mission is to improve the prevention, treatment, and rehabilitation of motor vehicle crash injuries to reduce deaths, disabilities, and human and economic costs. • PI: Bulger, MD 35

CIREN MODELING THE FORCES TO BODIES IN REAL WORLD CRASHES

JOURNAL CLUB & WIP SEMINARS

GUN VIOLENCE WORK Department of Justice and Seattle City Council •

Firearm injury patients are 30 times more likely than other patients to present with a firearm injury in the future

•

•

The study included: •

20,000 patients hospitalized in King County

•

77,000 hospitalized in Washington State

Study found correlation between hospitalization for firearm injury and poor outcomes after discharge

RECENT NOTABLES • •

The Today Show on Treadmill Injuries Seattle Times & KUOW on Firearm Safety

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EDUCATING LAW ENFORCEMENT ON DISTRACTED DRIVING

Ebel, RWJF

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COMMUNITY OUTREACH INFORMATION DISSEMINATION • WEBSITE • NEWSLETTER (QUARTERLY)

• BULLETIN (WEEKLY) • E-BOARD MESSAGING • INFORMATIONAL FLYER

OUTREACH • TRAUMA EDUCATION TRAINING MODULE • SCH PARTNERSHIP: GUN LOCKBOX DISTRIBUTION • DOH PARTNERSHIP: GUN SUMMIT

POLICY • Distracted Driving •

Continued engagement with Washington State

• Trauma •

Special recognition for contribution to HMC Level 1 Trauma designation

• Firearm Safety and Violence Prevention •

Presentation & report to Seattle City Council

• Senator Pramila Jayapal, WA State Senate, 37th District

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OPPORTUNITIES

• • • • • • • •

Trauma systems Trauma anesthesia care Trauma policy Trauma outcomes Datasets, Registries, Studies Mentor summer students Resident projects Promotion support 43

DISCUSSION

How can HIPRC collaborate with you ?

Examples of Partnerships Academic Centers

National Regional

State HIPRC

King County Public Health NWCPHP

Washington State Injury Control Program

Global Safe States

DSHS Regional Network Leadership Group

SAVIR

Global burden of disease

CDC/NCIPC/NIH ICRCs NW Regional Trauma System

American Academy of Pediatrics

Washington Traffic Safety Commission NHTSA Northwest Region

Safe Kids ISCAIP NHTSA

Academic Centers

WHO

2014 FALL NEWSLETTER

STRENGTHS •

•

•

•

Established research infrastructure •

Weekly WIP and Journal Club seminars

•

33 Datasets

Interdisciplinary collaboration •

7 Schools across UW

•

12 Departments in UW SOM

Robust methods core •

Epidemiology faculty

•

Data analysis services

•

Research design and methodology guidance

•

Evidence-based research expertise

Interdisciplinary training and mentorship •

T-32 Training program

•

Resident scholar mentorship

•

Junior faculty career development support

47

FACULTY & TRAINEES 2015 • • • •

18 Core faculty 58 Associate faculty 13 Trainees 3 Visiting scholars

48

FACULTY DIVERSITY 55 SOM and 28 Other

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TRANSFORMATION OF CARE • Project and Faculty

• Direct Impact

•

•

Reduced readmission rates

•

Reduced imaging costs

ED Alcohol Brief Intervention •

Zatzick/Rivara

•

Imaging in ICU • Bresnahan/Slade/Vavilala

•

Pediatric Guidelines Adherence & Outcomes • • Vavilala/Rivara/Zatzick/Whiteside/Ellenbogen

Interdisciplinary care pathway and increased evidence based TBI care

•

Firearm Violence Research • Rivara/Rowhani/Vavilala

•

Brief violence intervention reduces injuries

•

Nutrition in Trauma Patients • O’Keefe/Rowhani/Raftery

•

Improves nutritional outcomes

•

Hip fractures in Elderly • Arbabi/Bentov/Taitsman/Pham

•

Development of geriatric trauma care pathway

50

T32 AND OTHER TRAINEES (13) NAME

HOME DEPARTMENT

DEPARTMENT T32

Alex Quistberg, PhD

Epidemiology

Pediatrics (HIPRC)

Nithya Kannan, MD

Epidemiology

Epidemiology (Maternal-Child Health RPPE)

Molly Fuentes, MD

Rehabilitation Medicine

Pediatrics (HIPRC)

Cordelie Witt, MD

Surgery

Pediatrics (HIPRC)

Vijay Krishnamoorthy, MD

Anesthesiology

Anesthesiology

Jessica Jenness, PhD

Psychology

Pediatrics (HIPRC)

Judith Hagedorn, MD

Urology

Urology

Raquel Capote, DDS

Dentistry

Robert Bonow, MD (Resident)

Neurological Surgery

Joseph Simonetti, MD

Medicine

Stephanie Pan, MD (Resident)

Anesthesiology

Lauren Rakes, MD

Pediatrics

Sarah Farley, MD

Radiology

Early Investigator Research Network

51

Study Design and Analytic Capacity – – – – –

– – – – – –

Continuous data analysis (Advanced) Categorical data analysis (Advanced) Count data analysis (Advanced) Survival data analysis (Advanced) Correlated data analysis including hierarchical/mixedeffects models to perform analyses of multilevel, panel/clustered, and longitudinal data (Advanced) Multiple imputation (Advanced) Propensity score analysis (Intermediate) Risk prediction model building (Intermediate) Multiple comparison methods (Intermediate) Instrumental variable analysis (Intermediate) Factor analysis and principal component analysis (Intermediate)

Rowhani