Creating a comprehensive injury prevention and research center (IPRC)
James P. Harisiades, MPH, Director, Office of Child Advocacy
Karen
Sheehan, MD, MPH, Associate Chair of Advocacy, Department of Pediatrics,
Children's Memorial Hospital, Chicago, IL
May 2006
Introduction
The creation of an injury prevention and research center (IPRC) at a
children's hospital is dependent on many factors: presidential support; medical
leadership and collaboration among key stakeholders in injury prevention
activities; staff expertise; assessment of community and regional risk factors
to children; resources to frame and evaluate interventions; support to address
injury prevention at a state level through public policy vehicles; the
development of an organizational plan for addressing injury prevention based on
unique hospital assets; and the availability of operational, philanthropic and
other funding mechanisms for supporting its operation. Hospital environments
will vary in their capacity to create an IPRC based on these factors.
The following presents an approach used at Children's Memorial Hospital in
Chicago to address the complexities of designing and implementing an IPRC. Key
elements for a comprehensive IPRC model are discussed. Strategies that may be
adapted by other children's hospitals are highlighted.
Rationale
Injuries are the leading cause of preventable death to children ages 1-19.
More children die each year from injuries than from all other causes, such as
childhood cancers, acute and chronic illnesses combined. Deaths represent only a
fraction of the hospitalizations and long-term disabilities to children who
sustain injuries.
An IPRC model amplifies a more coherent and comprehensive approach to
addressing injury prevention within a children's hospital and academic medical
center. Children's Memorial conceptualized its model by adopting an overarching
vision that the creation of safe, structured environments represents the most
potent approach for reducing preventable injury to children. Moreover, this
vision was inclusive of consolidating and coordinating injury prevention
activities across the spectrum of intentional and unintentional injuries.
Methodology
A planning methodology was developed and included:
- Internal stakeholder interviews: This was an essential pre-requisite for
assessing whether the hospital environment was conducive to establishing an
IPRC. A brief questionnaire was utilized to assess most significant concerns
about injury prevention and willingness to participate at a hospital-wide
level using a model bridging institutional efforts in intentional and
unintentional injury.
- External site visits to four other children's
hospitals with leadership in injury prevention:
This phase examined assets of other hospital programs and
adapted approaches that could be utilized for the design of an IPRC at
Children's Memorial.
- Analysis of internal and external information
to develop “best practice” guidelines:
This third phase was instrumental in formalizing an organizational
structure for an IPRC that would draw from the unique capacities of the
hospital. This process was critical to identifying program and policy
priorities based on information gathered, calculating fiscal assessments for
the start-up and operating costs for an IPRC and in projecting enhanced
outcomes that would benefit injury prevention activities across the medical
center.
An implementation methodology was developed as follows:
- A business plan was developed and presented for the
hospital President and CEO who approved the implementation of an IPRC under
the aegis of the hospital's Office of Child Advocacy. A medical director,
administrative director and coordinator to oversee the operations of the IPRC
were identified. Commitment from the Office of the President and CEO was
secured to fund the medical direction and coordination of the IPRC.
- A hospital steering committee was formed with
representatives of all hospital stakeholders involved in injury prevention and
the creation of the IPRC. Quarterly meetings and the focus for each of these
meetings (e.g. research, education, program/public policy, strategic planning)
was developed to shape ongoing processes.
- An RFP was developed for the solicitation of injury
prevention programs focusing on intentional and unintentional injuries.
Funding for four two-year projects at $25,000 each were provided through the
hospital's Office of Child Advocacy and selected by the hospital's
multidisciplinary Child Advocacy Advisory Committee. Each project was required
to frame outcome objectives and evaluation strategies with the guidance of the
hospital's Child Health Data Lab as a pre-requisite for receiving funding.
- Complementing IPRC projects funded through the Office
of Child Advocacy, other initiatives such as projects operating through the
Injury Free Coalition for Kids, Chicago Safe Kids Coalition, Protective
Services Team, Trauma and Emergency Medicine departments, Institute for Sports
Medicine were combined and coordinated.
- Three-year strategic plans were developed to guide
program development and growth for IPRC programs with principal investigator
responsibilities for executing them.
- Public policy priorities were outlined.
- The Children's Memorial Foundation was engaged to assist in garnering
external funding to expand and enhance the impact of injury prevention
activities.
Significant Outcomes
- Enhanced inter-departmental and inter-disciplinary collaboration in injury
prevention activities within the hospital have been formalized. Best practice
findings have been cross-fertilization among injury-prevention initiatives.
Additionally, collaboration with other related hospital programs such as
obesity prevention has been established.
- Collaboration with external hospitals and medical facilities (Feinberg
School of Medicine, Children's Mercy Hospital) through the IPRC has been
established.
- An IPRC staff member is a co-chair of the Illinois Injury Prevention
Coalition.
- The Illinois Hospital Association has been engaged as a collaborator in
enhancing E-coding for childhood injuries to quantify the burden of injuries
to children more comprehensively with assistance from the hospital's Office of
Government and Community Relations.
- The hospital's Child Health Data Lab has taken an oversight role in
project and program evaluation strategies for all injury prevention projects.
In the future, it will conduct a “meta-analysis” to examine the
cross-fertilization of multi-disciplinary injury prevention programs and the
overall impact of the IPRC.
- At least four academic publications on IPRC programs have been accepted
for publication at the end of the first year of IPRC operations.
- Multiple media strategies amplifying IPRC accomplishments have been
executed.
- More than $3 million has been raised externally and $250,000 mobilized
internally to support the operation of the IPRC.
- Efforts are underway to organize an Illinois Violent Death Reporting
System (IVDRS) and an Illinois Health Interview Survey that will include
leading risk factors for injuries to Illinois children along with other health
indices.
- Web-based modalities are in development for the creation of a
gun-prevention counseling curriculum for pediatric residents and for child
maltreatment awareness to expand educational impact in these areas across
multiple audiences and geographic areas.
- The IPRC medical director has been named as the 2006 Emergency Medical
System for Children (EMSC) Lifetime Achievement Award recipient in recognition
of her extensive contributions in the field of injury prevention and
collaborative leadership in establishing the IPRC.
- The IPRC administrative director has been invited to serve on the National
Association of Children's Hospitals and Related Institutions (NACHRI) Injury
Prevention Co-Op project to collaborate with other hospital leaders in the
development of a NACHRI injury prevention web-page to promote successful
injury prevention projects and materials among all children's hospitals
nationally.
Conclusion
Advocacy for the health and well-being of all children is a fundamental
component of the mission of children's hospitals nationally. As the leading
cause of death to children 1-19 years of age, related hospitalizations and
associated long-term disabilities, injury prevention represents a significant
opportunity to fulfill this commitment. The creation of a comprehensive IPRC
model within a children's hospital offers a critical opportunity to strengthen
and amplify unique hospital capacities to reduce preventable injuries to
children at city, state and national levels.
Special thanks
The generosity of the following children's hospitals and research facilities
that hosted site visits of their prevention programs provided invaluable
guidance for the development of an IPRC at Children's Memorial Hospital in
Chicago:
- Children's Hospital of Philadelphia
- Children's National Medical Center
- Connecticut Children's Medical Center
- Harborview Injury Prevention and Research Center
- Seattle Children's Hospital and Regional Medical
Center