Using state administrative data to study nonfatal worker injuries: challenges and opportunities

Use of employer administrative databases to identify systematic causes of injury in aluminum manufacturing

BACKGROUND

Employer administrative files are an underutilized source of data in epidemiologic studies of occupational injuries.

METHODS

Personnel files, occupational health surveillance data, industrial hygiene data, and a real-time incident and injury management system from a large multi-site aluminum manufacturer were linked deterministically. An ecological-level measure of physical job demand was also linked. This method successfully created a database containing over 100 variables for 9,101 hourly employees from eight geographically dispersed U.S. plants.

RESULTS

Between 2002 and 2004, there were 3,563 traumatic injuries to 2,495 employees. The most common injuries were sprain/strains (32%), contusions (24%), and lacerations (14%). A multivariable logistic regression model revealed that physical job demand was the strongest predictor of injury risk, in a dose dependent fashion. Other strong predictors of injury included female gender, young age, short company tenure and short time on current job.

CONCLUSIONS

Employer administrative files are a useful source of data, as they permit the exploration of risk factors and potential confounders that are not included in many population-based surveys. The ability to link employer administrative files with injury surveillance data is a valuable analysis strategy for comprehensively studying workplace injuries, identifying salient risk factors, and targeting workforce populations disproportionately affected.

Nurse Practitioners as Attending Providers for Workers With Uncomplicated Back Injuries: Using Administrative Data to Evaluate Quality and Process of Care

OBJECTIVE

The objectives of this study were 1) to identify quality and process of care indicators available in administrative workers' compensation data and to document their association with work disability outcomes, and 2) to use these indicators to assess whether nurse practitioners (NPs), recently authorized to serve as attending providers for injured workers in Washington State, performed differently than did primary care physicians (PCPs).

METHODS

Quality and process of care indicators for NP and PCP back injury claims from Washington State were compared using direct standardization and logistic regression.

RESULTS

This study found little evidence of differences between NP and PCP claims in case mix or quality of care.

CONCLUSIONS

The process of care indicators that we identified were highly associated with the duration of work disability and have potential for further development to assess and promote quality improvement.

The use of state workers' compensation administrative data to identify injury scenarios and quantify costs of work-related traumatic brain injuries

PROBLEM

Traumatic brain injury (TBI) is a public health problem but little is known about the nature of that problem in the working population.

METHOD

The author used a national definition to identify cases in Washington State from workers' compensation (WC) hospital billing data, quantified the cost of WC insurance benefits using actuarial cost estimates, and identified high risk industries using ANSI Z16.2 typology.

RESULTS

There were 928 cases of TBI with a lifetime claim cost of $159 million from the Washington State Fund (1994-2001). Sixty percent of injuries resulted in death or disability. The highest risks of TBI are concentrated in 16 industrial insurance risk classes and the highest costs in 19 North American Industry Classification codes. Injury scenarios were identified for nine industrial insurance risk classes.

CONCLUSIONS

TBI is a disabling and costly workplace injury in the state of Washington, affecting even teenagers and seniors who are not generally considered to be part of the workforce. Injury typology codes provide useful information for improving workplace safety.

IMPACT ON INDUSTRY

This research provides industry with quantitative information regarding the cost of work-related traumatic brain injury and the usefulness of using workers' compensation claims data to reduce the burden of workplace injury.

Staffing and worker injury in nursing homes

OBJECTIVES

We examined the relationship between nursing home staffing levels and worker injury rates in 445 nursing homes in 3 states.

METHODS

We obtained First Reports of Injury and workers' compensation data from 3 states (Ohio, West Virginia, and Maryland) for the year 2000. We then linked these data to Medicare's Online Survey, Certification and Reporting system to obtain nursing home staffing details and organizational descriptors. We used ordinary least squares and log-transformed regression models to examine the association between worker injury rate and nursing home staffing and organizational characteristics.

RESULTS

Total nursing hours per resident day were significantly associated with worker injury rates in nursing homes after we adjusted for organizational characteristics and state dummy variables (P=.0004).

CONCLUSIONS

Our findings suggest that nursing home staffing levels have an important impact on worker health. These findings were supported for multiple facilities across different states; therefore, policies and resources that increase staffing levels in nursing homes are warranted.