CLINICAL EPIDEMIOLOGY IN SUPPORT FOR TBI QUALITY OF CARE POLICIES

Prof. MUDr. Martin Rusnák, CScDepartment of Public Health, Faculty of Health Care and Social Work, Trnava UniversityTrnava, Slovak Republic

Introduce Epidemiology and Evidence Based Public Health as closely related practical disciplines supporting development and implementation of PH policies

Share several examples from the field of Traumatic Brain Injuries to illustrate the concept

Aims of the presentation

2013 is the bicentenary of the birth of John Snow (1813–58), whose elegant studies of cholera in the mid-19th century earned him iconic status among the founders of epidemiology, the basic science of public health.

PEM Fine, BM Goldacre, A Haines: Epidemiology—a science for the people. The Lancet, Volume 381, Issue 9874 (13–19 April 2013)

John Snow, 1st epidemiologist

Making decisions using the best available peer-reviewed evidence (both quantitative and qualitative research),

Using data and information systems systematically,

Other ….Key characteristics of EBPH related to epidemiologyBrownson, R.C., J.E. Fielding, and C.M. Maylahn, Evidence-based public health: a fundamental concept for public health practice. Annu Rev Public Health, 2009. 30: p. 175-201

Scientific literature in systematic reviews Scientific literature in one or more journal

articles Public health surveillance data Program evaluations Qualitative data

Community members Other stakeholders

Media/marketing data Word of mouth Personal experienceDifferent forms of evidenceChambers D , Kerner J. Closing the gap between discovery and delivery .Dissemination and Implementation Research Workshop: Harnessing Science toMaximize Health , Rockville, MD , 2007 .

Objective

Subjective

Type 1 evidence defines the causes of diseases and the magnitude, severity, and preventability of risk factors and diseases. It suggests that “Something should be done” about a particular disease or risk factor.

Type 2 evidence describes the relative impact of specific interventions that do or do not improve health, adding, “Specifically, this should be done.”

Type 3 evidence shows how and under what contextual conditions interventions were implemented and how they were received, thus informing “how something should be done“.

Types of scientific evidence for public health practiceRoss C. Brownson, E.A.B., Terry L. Leet, Kathleen N. Gillespie, William R. True, Evidence-Based Public Health. 2nd ed. 2010: Oxford University Press, USA.

Public Health Surveillance

Involves the on-going systematic collection, analysis, and interpretation of specific health data, closely integrated with the timely dissemination of these data to those responsible for preventing and controlling disease or injury.

Systems should have a capacity to collect and analyse data, disseminate data to public health programs, and regularly evaluate the effectiveness of the use of the disseminated data.

Epidemiology of TBIRosso, A., Brazinova, A., Janciak, I., Wilbacher, I., Rusnak, M., Mauritz, W., Severe traumatic brain injury in Austria II: epidemiology of hospital admissions. Wien Klin Wochenschr, 2007. 119(1-2): p. 29-34

Guidelines and SurvivalRusnak, M., et al., Severe traumatic brain injury in Austria VI: Effects of guideline-based management. Wiener Klinische Wochenschrift, 2007. 119(1-2): p. 64-71

Assessment of QualityBrazinova, A., Rusnak, M., Mauritz, W., Lecky, F., Kaniansky, M., Evaluation of traumatic brain injury guidelines using AGREE instrument. Bratislava Medical Journal-Bratislavske Lekarske Listy, 2008. 109(8): p. 374-380.

Epidemiologists should recognize the policy system and model that are in place, and adapt their work to that model; there is no use making grand plans if the system will not accommodate them, and no use communicating with the wrong people.

Four main headings: a population focus, health and prevention, health services, and health information.What is the nature of

contributions from epidemiology to policy?Robert A. Spasoff, Epidemiologic Methods for Health Policy. 1999: Oxford University Press Inc. 240.

Linkages Between Program Planning and Evaluation

Applying advances from molecular biology Increasing attention to ethical issues Measuring and communicating weak associations Measuring outcomes and quality of health care Setting priorities and measuring progress Investigating public health outbreaks Preventing chronic diseases and other "modern

epidemics" Measuring the effects of public health interventions Informing public health policies Applying new computer and information

technologies Increasing epidemiologic capacity in applied settings

Summary of Modern Challenges andOpportunities in EpidemiologyBrownson, R.C. and D.B. Petitti, Applied epidemiology: Theory to practice. 1998: Oxford University Press on Demand.

Epidemiology provides tools, results and interpretations to develop evidence

Epidemiologists have to be involved in transforming evidence to policies

Epidemiology methods are to be used in verifying what intervention work and in what extent

Epidemiologists are an integral part of policy processes in health care and social development

Summary

Join us in efforts to get the epidemiology the

voice in policies making.

Thank you.