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
