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Aug 14 -- The Centers for Disease Control and Prevention (CDC) invites comments to OMB by September 14, 2023 regarding the information collection request titled “Advancing Violence Epidemiology in Real-Time (AVERT).”

In FY2020, CDC funded the Firearm Injury Surveillance Through Emergency Rooms (FASTER) initiative, which provided funding for 10 U.S. jurisdictions to share firearm injury-related emergency department (ED) visit data with CDC. As firearm injuries increased significantly in recent years and contribute to billions of dollars in medical and lost productivity costs every year, the FASTER initiative was funded to improve the availability and timeliness of nonfatal firearm injury data. As the 3-year FASTER initiative was implemented, the utility of syndromic surveillance data for monitoring other forms of nonfatal violence and mental health conditions (which may increase risk for or be a negative outcome associated with violence victimization) became clear. Timely state- and local-level data on ED visits for firearm injuries, other nonfatal injuries (e.g., intimate partner violence, sexual violence, child abuse and neglect), and mental health conditions are currently limited; thus, the collection of near real-time data on ED visits for these conditions at the state- and local-level could improve the ability to identify, respond to, and prevent violence. These data can also be used to identify, track, and address disparities in ED visits for firearm injuries, other violence-related injuries, and mental health conditions.

The Advancing Violence Epidemiology in Real Time (AVERT) initiative, funded by CDC in FY2023, intends to integrate, expand, and enhance previous data sharing efforts with public health departments initiated under the FASTER program. The goal of AVERT is to build on the FASTER program and provide funding to a minimum of 10 jurisdictions to share timely ED data for all firearm injuries (regardless of intent), other violence-related injuries, and mental health conditions. AVERT will support states to conduct routine monitoring of electronic health record data via syndromic surveillance to identify ED visits related to these conditions, as well as to analyze these data in a timely manner and share these data with CDC. To do this, AVERT will leverage ED syndromic surveillance data already routinely collected by state health departments and the District of Columbia health department through CDC's National Syndromic Surveillance Program (NSSP), which receives near real-time ED data from health departments. Descriptive analyses, such as frequencies and changes in the rate of ED visits involving a firearm injury, other violence-related injury, or mental health condition by region, state, and local jurisdiction, will be conducted. Longitudinal statistical analyses will be used to describe trends.

Understanding the full extent of the problem of firearm violence, other forms of nonfatal violence, and mental health conditions treated in EDs is crucial to informing prevention and response strategies and reducing future incidents.
 
AVERT leverages existing ED data collection efforts deployed across state health departments through CDC’s National ED Syndromic Surveillance program. The Division of Health Informatics and Surveillance (DHIS) in the Center for Surveillance, Epidemiology, and Laboratory Services (CSELS) in CDC operates the National Syndromic Surveillance Program (NSSP) BioSense Platform (OMB #0920-0824) through which state and local health departments share preliminary ED visit data from approximately 73% of ED facilities in the US (>6,000 participating EDs).

Key advantages to AVERT compared to initiating a new ED data collection are:

-- AVERT can be rapidly implemented and scaled to all 50 states and the District of Columbia with minimum burden on state health departments because it relies on sharing and improving ED data already being collected by state and local health departments.
-- AVERT leverages instead of duplicating existing CDC work through CDC NSSP and FASTER to rapidly share state and local health departments ED data with CDC.
-- AVERT ensures that state and local health departments are involved in the collection, ownership and use of the ED data collected because they are primarily responsible for responding to local changes in violence-related ED visits, have extensive local knowledge of their local ED data that fosters identification of data quality problems, and are critical partners in developing tools to monitor illnesses and injury.

All data sharing between CDC and health departments in AVERT is driven by one standardized data forms the ED violence data form (Attachment E), and CDC cases definitions of overall firearm injury, intentional self-directed firearm injury, unintentional firearm injury, assault-
related firearm injury, intimate partner violence, sexual violence, suspected child abuse and neglect, youth violence, and mental health conditions (Attachment D).

AVERT will operate in a minimum of 10 jurisdictions that will be funded from September 2023 through August 2028, through which a competitive process that is underway to select the recipients. AVERT will build upon FASTER and continue to establish and maintain local and state information collection of firearm injuries, other violence-related injuries, and mental health conditions, and provide public health partners and the public with more timely and useful violence surveillance data than is currently available. Currently, the FASTER program operates in the 9 states and the District of Columbia, which are funded through August 2023. All 10 of these jurisdictions provide CDC access to their syndromic surveillance data from EDs in CDC’s NSSP system. Access to this timely data has improved situational awareness of federal, state, and local health departments of upticks in and trends of firearm injuries. Health departments have used this data to populate state data dashboards (see examples below) and develop alerts for local communities. In addition, health departments have used this data in concert with other violence data sources, including the National Violent Death Reporting System, to gain a better overall picture of firearm injuries in their communities.

Health departments sharing syndromic surveillance data with CDC will be required to complete the ED Violence Data Form (Attachment E) on a bimonthly basis using data from existing state and local ED data collection efforts, described previously. The justification and key variables it will collect are described in detail below:

-- Frequency that this data form is reported to CDC: The goal of the program is to have health departments submit bimonthly reports to CDC to detect and respond to upticks or shifts in violence trends in a timely manner.
-- Key variables shared with CDC: Key variables and why they are collected is described in Table 1 below. . . .

CDC firearms research: https://www.cdc.gov/violenceprevention/firearms/funded-research.html
CDC submission to OMB: https://www.reginfo.gov/public/do/PRAViewICR?ref_nbr=202306-0920-015 Click IC List for information collection instrument, View Supporting Statement for technical documentation. Submit comments through this webpage.
FRN: https://www.federalregister.gov/d/2023-17378

For AEA members wishing to submit comments, "A Primer on How to Respond to Calls for Comment on Federal Data Collections" is available at https://www.aeaweb.org/content/file?id=5806

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