The development of the Secure Anonymised Information Linkage (SAIL) system in which AWISS operates, has extended opportunities for AWISS to engage in several research projects, including the evaluation of simple and complex interventions.
Over the years AWISS data has been used to plan and evaluate several interventions including the Wales Vitamin D Fracture Prevention Study, the Advocacy for Pedestrian Safety Study, Carmarthenshire Housing Regeneration and Health Study, and CHALICE project (Change in alcohol outlet density and alcohol-related harm to population health).
Listed below are several projects currently supported by AWISS which either aim to improve injury burden estimates, improve the identification of high-risk groups for targeting, or aim to evaluate interventions, trials or natural experiments.
Care and Repair
AWISS are supporting the evaluation of Care & Repair Cymru (C&R); a home improvement programme which provides residents with interventions (eg, grab rails, stair rails) to help them remain healthy in their own homes. The evaluation will specifically explore the impact of these C&R interventions on the health of older people (aged 60 years and over) in terms of emergency admissions to hospital attributed to falls. The risk associated with delayed discharge from hospital will be compared between the intervention and comparator groups. Further, this study will investigate whether individuals are able to return home to live independently in the community, or if the C&R service avoids or postpones the need to move to residential or nursing home care. Further information can be found in the recently published protocol paper: https://bmjopen.bmj.com/content/8/10/e026290
Evaluation of ARBED Energy Efficiency Intervention
The ARBED project aims to examine whether improving the energy-efficiency of houses in low-income neighbourhoods can improve physical and mental health of its occupants. The AWISS system is supporting the evaluation of the ARBED intervention, by enabling admission and consultation rates for cardio-respiratory conditions, mental health and injuries for the intervention group to be compared to the comparator groups in the same periods before and after the ARBED intervention.
Evaluation of Emergency Medicine Transport and Retrieval Service (EMRTS) Cymru
Seconded AWISS Staff are conducting an evaluation of the Emergency Medicine Transport and Retrieval Service Cymru (EMRTS Cymru). EMRTS has been operational since April 2015, which has seen anaesthetists and emergency medicine consultants join Welsh Air Ambulance missions. EMRTS provides Welsh residents with rapid access to consultant led and, time sensitive critical care. The project evaluates the effectiveness of EMRTS on patient and service outcomes. Outcomes will include measures of impact on survival, quality of life, functional status, NHS resource use and costs. Data from EMRTS, the Trauma Audit and Research Network (TARN) and the Intensive Care National Audit and Research Centre (ICNARC) have been acquired into the Secure Anonymised Information Linkage (SAIL) facility and utilised in evaluating EMRTS and answering research aims. Currently, AWISS staff are working on measuring the impact EMRTS has had on trauma survival in Wales. Also, patients are being interviewed six months and one-year post incident for longer-term functional and quality of life outcomes.
Geographic Information System (GIS) techniques will be used in time-saved analyses, model unmet needs, and develop service allocation models using Wales Ambulance Service NHS Trust and EMRTS collected data. Cases from both pre-EMRTS, using historical data, and EMRTS-offline (restricted flying at night/bad weather) will be used as comparators in the evaluation.
Global Burden of Diseases (GBD) Study
The GBD study represents the most influential policy relevant research endeavour globally. It is run from the Institute of Health Metrics and Evaluation at the University of Washington, Seattle and is largely funded by the Bill and Melinda Gates foundation. Its reports are largely published in the Lancet and are used by policy makers to evaluate and target national health policies, including by PHE/DH in England. AWISS expertise is being used to carry out analyses using linked data to supplement knowledge of the incidence of injuries, both for the UK GBD study and also for the global study.
Swansea University are supporting the Injury-VIBES project (http://www.injuryvibes.monash.org.au/) which aims to use data from the six largest and most comprehensive cohort studies across five countries to evaluate methods for determining the disability associated with injury, address issues specific to injury and identify improved methods for burden estimates. The results will direct how injury burden is measured for by the Global Burden of Disease (GBD) Study, and for individual country or region-specific studies. This research will improve outcome measurement in ways that are critical for enhanced clinical, public health policy and planning settings. The disability weights generated by the VIBES project will be applied to AWISS Injury Indicators, and also to the European Injury Database to establish the burden of injury in each of the 28 EU countries, including Wales.
International Collaborative Effort on Injury Statistics and Methods (Injury ICE)
Injury ICE is a global collaborative working on comparability of injury statistics and methods. Its secretariat is supplied by the US National Centre for Health Statistics, a component of the Centres for Disease Control and prevention (CDC). The Steering Committee is drawn from experts across the world, including the World Health Organization. Professor Lyons has chaired the ICE Steering Committee since 2012. ICE has an established work programme using parallel and linked datasets to support the development of methodologies that underpin national and international efforts at injury control.
At a recent ICE meeting, it was agreed AWISS would support the development of an ICD-10 ‘Trauma Mortality Prediction Model’ in collaboration with ICE members Professors Osler (University of Vermont) and Professor Cook (University of Arizona). This work aims to replicate the trauma mortality prediction model which was developed by Osler et al. using ICD 9 data. Currently there are no easy to use, or affordable tools available to measure the severity of injuries using ICD-10 in UK and across the world. If an ICD10 version of the ICD9 based trauma mortality prediction model (TMPM), developed by Osler et al, could be developed it would have considerable functionality within the NHS, including facilitating: evaluation and continuous quality improvement of trauma care; evaluation of the population impact of reorganization of trauma systems; evaluation of preventive strategies, e.g. has the road safety strategy reduced the severity of injuries. This work is currently underway; the datasets have been created and the modelling process has begun.
InfAct (Information for Action!), the Joint Action on Health Information
Over the years the European Commission facilitated joint actions working towards an EU-wide information system on injuries, which resulted in development of the European Injury Data Base (IDB). The IDB was originally funded by the Joint Action on Monitoring Injuries in Europe (JAMIE) program, further funded by the BRIDGE-Health project, and is currently receiving support through the InfAct (Information for Action!), the Joint Action on Health Information programme. The IDB is currently hosted at Swansea University and analysed by AWISS staff.
The Minimum Data Set (MDS), developed as part of the JAMIE & BRIDGE-Health projects, provides an opportunity to implement a common low cost injury surveillance system for Europe to support policy development and prevention. The MDS will be used by the EU and EuroStat for a number of requirements, including compiling the European Community Health Indicator 29b – incidence of home and leisure injuries.