CLINICAL
EPIDEMIOLOGY IN
SUPPORT FOR TBI
QUALITY OF CARE
POLICIES
Prof. MUDr. Martin Rusnák, CSc
Department of Public Health, Faculty of Health
Care and Social Work, Trnava University
Trnava, 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
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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 ….
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Key characteristics of EBPH
related to epidemiology
Brownson, 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
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Scientific literature in systematic reviews
Scientific literature in one or more journal articles
Public health surveillance data
Program evaluations
Qualitative data
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Objective
Community members
Other stakeholders
Media/marketing data
Word of mouth
Personal experience
Subjective
Different forms of
evidence
Chambers D , Kerner J. Closing the gap between discovery and delivery .
Dissemination and Implementation Research Workshop: Harnessing Science to
Maximize Health , Rockville, MD , 2007 .
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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 practice
Ross 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.
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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.
Public Health Surveillance
Epidemiology of TBI
Rosso, 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 Survival
Rusnak, M., et al., Severe traumatic brain injury in Austria VI: Effects of guidelinebased management. Wiener Klinische Wochenschrift, 2007. 119(1-2): p. 64-71
Assessment of Quality
Brazinova, 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.
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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:
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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
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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 and
Opportunities in Epidemiology
Brownson, R.C. and D.B. Petitti, Applied epidemiology: Theory to
practice. 1998: Oxford University Press on Demand.
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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.