Piloting use of workers’ compensation data for case-based surveillance and prevention of work-related amputations in Massachusetts

Letitia Davis, ScD, EdMElise Pechter MAT, MPH, CIHOccupational Health SurveillanceProgram

CSTE, Pittsburgh 2011 Funded by CDC –NIOSH.

Today’s Objectives

Sentinel surveillance – evolution in MA Criteria for referrals to OSHA

Methods and results

Lessons learned

Sentinel Case Surveillance SENSOR Model

• . Provider reports

Hospital data Other data sources

Massachusetts Department of Public Health Case

InterviewCase Follow-

upEmployer Follow-

upData Analysis and

DisseminationBroad Based Prevention

Fundamental surveillance of urgent sentinel events

“SENSOR lite” Access to readily available timely information

Serious, events that merit immediate worksite follow-up

Knowledge: responsibility to act

Intervention partner: OSHA

Referrals of sentinel cases—concern about taking action

Protected health information Can we share it?

Trust of reporting healthcare providers Jeopardize if inspection? If no inspection?

Workers Retaliation, loss of job?

What we learned - decided

Confidentiality: Varies by data source can release employer information for most sources i

Healthcare providers: Most cases reported by systems not individual

providers

Workers: Less of concern in acute events

7

Criteria for referrals to OSHA

OSHA jurisdiction Serious hazard Others at risk Relevant OSHA standard OSHA priorities Timeliness—6 month

Why amputations?

Serious, traumatic injuries

Readily available information

Disparate impact on minorities

OSHA special emphasis

BLS multisource study

2.4

4.6

1.81.2

Whit

e

Black

Hispan

icAs

ian

Work-related hospitalizations for amputations, MA 1996-2000

Per 1

00,0

00 w

orke

rs

Methods - Data source Indemnity claims available weekly from MA

Workers’ Compensation agency– Personal identifiers (name, address, age)– Employer name and an address– Date of injury– Nature of injury– Body part– No narrative

Search for:– Nature of injury code: 100 (amputation)

Method - Initial steps Review weekly reports

– Eliminate obvious errors

Validate most serious (non digit) (9/09-6/10)– Call employer—limited success

• Guidance center, restaurants, Salvation Army• Miscoded injuries, lacerations, surgery• No answer • Can’t ID location without disclosure

– Call workers - challenging

Methods - Initial steps

Approximately 100 amputations/year– 10 more serious—frequent coding errors – 90 digits

Discussed with OSHA

Decisions– Include digits– Pilot referrals to OSHA area offices

How do we refer?

Case received/triaged Call OSHA area office

– Already involved?– Questions

Fax or email– Date– Injury– Location– Request feedback– Do not disclose

referrer

What OSHA does

No demographics Assign safety or IH Investigate—formal or nonformal Protect source of referral Feedback to DPH

Results - 2010

22 amputation referrals

– 13 inspections, of which 2 OSHA prev notified

– 9, including 2, resulted in related citations (including recordkeeping)

– Amputations occurred at 9

Examples of hazards/citations

Failure to provide LOTO– Snub rollers crushing hazards– $7000

Lack of machine guarding– $6300 jump shear at sign fabricator– $4200 alligator shear at scrap yard– $4000 mechanical power presses

Failure to maintain OSHA 300 log

Tracking for evaluation—factors

Case ID Injury Employer

Name City Zip

Did OSHA know? Date of referral

Action taken– Phone/fax– Site visit– Both/neither

• Date action taken• Results

“Impact”

Lessons learned Low cost, effective approach to serious workplace

hazards

Meets OSHA and MDPH needs to fulfill responsibility and show impact

OSHA region and area offices very positive

“ Thank you for contacting our office to alert us of this condition…The cooperation between our agencies is very important to us and we continue to look forward to working with you.”

Key: working relationships with OSHA staff and familiarity with OSHA

CSTE: Guidelines for state-based OH surveillance:Assurance

“ Maintain sufficient technical expertise to provide referrals in response to reports of serious occupational injuries or illness that signal a need for immediate

intervention to prevent

additional morbidity.”

New CSTE Guidance: Public Health Referrals to OSHA

Available on CSTE website soon.

Marthe Kent, OSHA Region 1 Director