1. Piloting use of workers’ compensation data for case-based surveillance and prevention of work- related amputations in Massachusetts Letitia Davis, ScD, EdM Elise Pechter MAT, MPH, CIH Occupational Health Surveillance Program CSTE, Pittsburgh 2011 Funded by CDC –NIOSH.

2. Today’s Objectives  Sentinel surveillance – evolution in MA  Criteria for referrals to OSHA  Methods and results  Lessons learned

3. Sentinel Case Surveillance SENSOR Model. Provider reports Hospital data Other data sources Massachusetts Department of Public Health Case Interview Case Follow-upEmployer Follow-up Data Analysis and Dissemination Broad Based Prevention

4. 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

5. 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?

6. 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. 7 Criteria for referrals to OSHA  OSHA jurisdiction  Serious hazard  Others at risk  Relevant OSHA standard  OSHA priorities  Timeliness—6 month

8. Why amputations?  Serious, traumatic injuries  Readily available information  Disparate impact on minorities  OSHA special emphasis  BLS multisource study White Black Hispanic Asian Work-related hospitalizations for amputations, MA 1996-2000 Per 100,000 workers

9. 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)

10. 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

11. 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

12. 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

13. What OSHA does  No demographics  Assign safety or IH  Investigate—formal or nonformal  Protect source of referral  Feedback to DPH

14. 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

15. 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

16. 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”

17. 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

18. 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.”

19. New CSTE Guidance: Public Health Referrals to OSHA Available on CSTE website soon. Marthe Kent, OSHA Region 1 Director