For the implementation of a prevention-oriented injury surveillance in the EU valid and reliable indicators for the array of external causes of injury morbidity are needed. Whereas no single EU health statistics fulfil that demand, the integration of two existing data sources - the prevention-oriented European Injury Database (IDB) and the routine Hospital Discharge Registers (HDR) - is considered the most promising approach to that avail.
The INTEGRIS project was proposed to provide the necessary research and technology input for the IDB-HDR integration through an evaluated demonstration project in six Member States.
The goal of the INTEGRIS project was to enhance injury reporting in the official EU health statistics through linking the prevention-oriented European Injury Data Base (IDB) with the routine Hospital Discharge and Emergency Department Registers (HDR, EDR).
INTEGRIS was to demonstrate and evaluate the feasibility of the IDB-HDR integration in six member states. Specifically, the following objectives were proposed:
- Methodological improvement and increased efficiency in the recording and analysis of hospital treated injuries in IDB hospitals
- Reduced burden of data entry for hospital treated injuries
- Increased usability of existing hospital data for injury prevention and research
- Development and testing of an integral methodology of data provision, data analysis and reporting
As a unique feature of the INTEGRIS approach the provision of meaningful indicators for injuries disabilities were proposed; those are hardly covered by current injury monitoring but are most important for guiding prevention (Figure).
As a results of INTEGRIS the following features are available now for enhanced hospital based injury surveillance in the EU:
- Integration of external cause information (intent, activity, place, mechanism - by EU IDB Standard) with routine diagnostic information (WHO ICD-10 and ICD-9).
- Injury disability indicators for temporary and lifelong consequences, enabling a better health impact assessment of injuries and an enhanced comparability of results across countries (through a focus on more severe injuries that - with a high probability - need hospitalization in all health care systems).
- Minimum data set definition allowing for two different levels of hospital participation and data provision depending on available resources.
- Quarterly data uploads - directly from the IDB / INTEGRIS hospitals or via a National Data Administrator (NDA) - provide for a more timely and dynamic injury reporting.
- Customized access and query levels for different user groups: an easy-to-use public access to the INTEGRIS minimum data level, a research access with an advanced tool for all INTEGRIS data levels, an access for each hospital to their complete data and to all INTEGRIS data levels with a simplified query tool.
- The portable and scalable IDB / INTEGRIS database is available for NDAs for data management and reporting.
- ECHI Indicator on Home and Leisure Accidents, ESS conform metadata and estimates of national incidence rates and confidence intervals.
These are also the main results that have been recommended by the INTEGRIS consortium to DG Sanco for implementation in the regular EU IDB data collection through the Joint Action for Injury Monitoring in Europe (JAMIE).
In view of the sustainability and long term usage of IDB data collection the following achievements have been found the most important ones:
- New information for new target groups without additional efforts (European Community Health Indicator / ECHI for Home and Leisure Accidents, disabilities)
- Reduced burden of data collection at the hospital level
- Increased compliance with the ESS quality criteria (European Statistical System, Eurostat)
- Minimum Data Set (MDS) proposal for less resourced hospitals
Gerald Furian, Robert Bauer
Austrian Road Safety Board (KFV)