1. Thomas Helfer US Army Center for Health Promotion & Preventive Medicine Military Audiology Short Course Salt Lake, UT, April 5-7 2004

2. *Evidence-based Practice 1 st principles *Review Audiology clinic data as basis for population health “situational awareness” *Lessons learned from other Public Health surveillance contexts *Applying lessons learned to Evidence-based Hearing Conservation

3. Agent Vector Environment Host AgeRaceGender Fitting Ambulatory Data Module (ADM) Hearing Losses Into Public Health Surveillance? ICD-9CM multi-purpose data for statistical analysis Monitor Symptom Disease Injury Clusters

4. annual surveillance outcomes STS Follow up (f/u) 1 & out- comes no f/u1 no f/u2 no referral visit record Audiology referral & outcomes Rule out (R/O) sensory loss STS new reference STS f/u2 * & out- comes t-> normal annual audiogram F/u audio F/u audio PTS- Rule in Sensory loss Audiology clinic Clinical Path STS Assessment From DOEHRS/SADR NO New ref Force Health Protection Measure thru Active Surveillance normal

5. Acoustic Trauma/ Tinnitus TM perfs Deploy- ment Related Surveillance PTS Administrative Action Hearing Loss Limiting duties &/or retention (H-3, H-4 - A/AF) Medical Board Audiology Clinic ENT Non-DOEHRS ADM ICD-9CM Codes Periodic Audiogram Other event

6. Real World Events Real World Events Public Health Surveillance Take action based on information Present to Commanders & Med Staff Decision Support Information Health Data Acquisition Clinical Data Storage Refreshment Process Staging Refresh Policy Decision Support Analysis

8. Now recognized that Public Health resources ($$$ & people) need to be fenced in order to be effective

9. Integrate Extensive Current Capabilities DMSS ESSENCE WRAIR-GEIS AFIOH NEHC AF PHSO NHRC AFIP AFMIC Safety Centers CHPPM

11. ADM@ MTF’s @ MDR Raw SADR Source data ASCII SADR Processing 1 copy database 2 Populate injury data set Analysis Reporting * outcomes rate by category * at installations * service-wide * DOD-wide DMSS

15. ADM@ MTF’s @ MDR Raw SADR Source data ASCII SADR Processing *Query target codes *Populate outcome data set Analysis Reporting *n of pt visits by syndrome *situational alerts *multi-level reporting ESSENCE

16. “The first priority is to get actionable health information to the local levels where responses must be conducted.”

18. ADM@ MTF’s @ MDR Raw Data Scrub data Medical Metrics M-2 Database Source data ASCII SADR CHPPM Processing 1 Query target ICD-9 codes 2 Populate outcome data set 1 2 CHPPM HCP Web page Reporting monthly * n of ea hearing injury category * At installations under RMC’s * Total injuries per installation * Gender/age stratification for each injury category

19. MEDCOMPTS Acoustic Tinnitus TM H-3 H-4 Total Trauma perf RMC installation n n n n n n n RMC installation n n n n n n n Army-wide n n n n n n n Grand totals

20. InstallationPTS Acoustic Tinnitus TM H-3 H-4 Total Trauma perf Bn UIC n n n n n n n Web-enabled data collection & monthly reports

21. Visible at multi-levels of Command Empowers installation HCPM’s Show Mobilization Readiness Focus on Force Health Protection

22. Need to keep goals in mind Speed reports generation for installations Apply existing surveillance report formats Apply evidence-based public health practice Provide actionable information to unit Commanders

23. Questions Contact information: Tom Helfer, PHD E-mail: Thomas.Helfer@.US.Army.mil Phone: 410-436-3797 DSN: 584-3797