A Smarter National Surveillance System for Occupational Safety and Health in the 21st Century (2018) / Chapter Skim
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2 Building a "Smarter" National Surveillance System
2 Building a "Smarter" National Surveillance System
Pages 31-42
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From page 31... ...
. To characterize surveillance further: Systematic refers to using consistent methods over time and ongoing refers to continuous or periodic collection of data useful to identify patterns and trends through analysis, which entails routine and targeted application of statistical methods to data, producing information, which public health practitioners interpret to understand the possible need for public health action.
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From page 32... ...
G uiding Principle 4 -- Disseminate widely: Timely analysis, and inter pretation of surveillance inputs with routine dissemination of informa tion in relevant formats, promotes the use of surveillance information for action by all stakeholders. G uiding Principle 5 -- Support the surveillance workforce: An efficient, reliable national surveillance system requires public health profession als with training in occupational injury, illness, and hazard surveillance, and with the tools and technology necessary to achieve surveillance objectives.
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From page 33... ...
Monitoring trends in these measures consistently at a national scale allows for assessment of the progress toward national occupational health and safety goals and to the identification of unfavorable trends that require further attention. Further characterizing the burden by geographic region, by time period, by the nature and cause of injury or illness, and by the presence of known risk factors will allow intervention efforts to be targeted more efficiently.
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From page 34... ...
Objective 5: Guide the planning, implementation, and evaluation of programs and policies intended to prevent and control work-related injuries, illnesses, and hazardous workplace exposures. Surveillance activities and data at the establishment level and at local, state, or national levels provide essential information upon which to build and implement effective occupational health and safety prevention programs.
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From page 35... ...
BUILDING A "SMARTER" NATIONAL SURVEILLANCE SYSTEM 35 TABLE 2-1 Users and Uses of OSH Surveillance Information Users Examples of Uses of Surveillance Information Federal and state regulatory Standard setting, enforcement targeting, priority setting and and enforcement agencies program evaluation, evaluating state workers' compensation insurance programs, and workers' compensation insurers Federal and state health Research, conducting population- and case-based agencies surveillance, identifying high-risk populations and worksites, identifying emerging work-associated problems, identifying hazardous conditions and exposures, community health needs planning, and targeting and evaluating interventions Federal and state policy Assessing the effectiveness of laws, regulations, and makers programs; identifying problems and unmet needs; and setting priorities for funding and program activities Workers' compensation Advance risk management and loss control activities; insurers, insurance influence premium setting; allocate liability and community, and attorneys work-relatedness Employees and unions Needed at the worksite, industry, and occupational levels for identifying hazardous conditions, jobs exposures, and hazards at the worksite and with the occupation; establish safety priorities; focus training programs; focus advocacy efforts Employers and employer Needed at the worksite, industry, and occupational levels organizations for identifying hazardous conditions, jobs exposures, and hazards at the worksite and with the occupation; establish safety priorities; focus on training programs; focus on advocacy efforts Clinicians Needed for the diagnosis and management of occupational disease; characterizing exposures to physical, chemical, and biological hazards at work; and determining light duty and safe return to work Researchers Conducting research on the relationship between exposures and hazards and injuries and illnesses; effectiveness of control measures; assessing the economic and social impacts of injuries, illnesses, and deaths; determining predictors of return to work; and compiling background data for needs assessment and project justification in research applications Media/communicators Research and background for stories on significant and emerging hazards, regulatory and enforcement actions, and practices of particular employers or industries Community organizations Conducting needs assessment, setting priorities, and supporting targeting interventions (e.g., by coalitions for occupational safety and health worker centers) Equipment manufacturers/ Identify requirements for equipment and technology changes, process/product designers and prevention though design options
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From page 36... ...
The ideal "smart" national OSH surveillance system is best thought of as not a single system but a system of systems that incorporates and coordinates the collection and analysis of a variety of data sources for capturing workplace exposures and hazards, work-related injuries and illnesses, and their determinants and then provides the platforms and coordinating tools to use the information to improve worker safety and health. The ideal system: • Relies on dedicated occupational injury and illness surveillance systems as well as inclusion of occupational information into other public health surveillance systems; • Maximizes the use of new information technologies and changes in health care systems to enhance the efficiency of data collection; provide the flexibility to change the data parameters collected and ensure consistency in data coding; and ensure data quality and timeliness;
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From page 37... ...
Characteristics of workplaces to be collected include size, multiemployer site, public or private status, and union status to identify the extent to which these factors can direct attention to the risks for injury and illness that need attention. The system involves collaboration and information sharing between labor, public health, and multiple agencies at all levels of government, including the Occupational Safety and Health Administration (OSHA)
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From page 38... ...
such that the nation's surveillance system can adapt to emerging workplace safety and health issues, rely on data at established periodic intervals, and be assured of data quality and consistency across data-collection systems. Reflecting the advancing knowledge of how work impacts overall health, all health data-collection systems outside the purview of the occupational safety and health surveillance community would include information characterizing work.
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From page 39... ...
Severity data, as measured through hospitalization, surgery, medication use, medical costs, time loss duration, and measures describing the injury linked to the worker's economic and social well-being, are collected from access to the medical record and from injured worker surveys. DATA CURATION National surveillance data will rest within federal agencies that have the responsibility not only to initiate public health actions in a timely manner but to act in a role as data curator -- acquiring record-level data, maintaining data quality, and sharing data in a usable form over the lifespan of these data -- thus maximizing the use of these data for public benefit.
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From page 40... ...
Systematic efforts to build data repositories which provide record-level individually identifiable data to qualified researchers are enabled through legislation and policy adoption. BARRIERS TO A SMARTER SURVEILLANCE SYSTEM There are numerous impediments to improving the current occupational health surveillance system, let alone to developing an ideal system.
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From page 41... ...
BUILDING A "SMARTER" NATIONAL SURVEILLANCE SYSTEM 41 BOX 2-1 Continued o Grouped data publication rules o Using individual case based reports to initiate follow back action o Merging individual case reports across multiple data sets Cost • New worker survey proposed by BLS • Expanding information collected by BLS in the SOII o Collection of existing exposure data o Generation of exposure data • Minimum state-based occupational disease and injury surveillance at a state agency in all 50 states • Multisource surveillance of priority occupational injuries and illnesses in a limited number of states • Collection of information on injury and illness treatment and management • Adding information on occupation and industry into existing surveys/ databases Expertise and Workforce Structure • Adequate epidemiologic expertise at OSHA to use surveillance data for targeting enforcement and educational intervention • Adequate informatics capacity at NIOSH to advance an approach for collecting occupation/industry/work-relatedness in electronic medical records, autocoding of occupation/industry and other software tools to enhance surveil lance efficiency Culture and Mission of Organizations • Requirements and culture at BLS for confidentiality • Emphasis at NIOSH on research and less commitment to surveillance than other parts of CDC • Lack of data standardization to manage occupational information across data systems • Methods development to utilize exposure data • Auto coding systems to manage occupational information across data systems • Uniqueness of state-based worker compensation agencies • Organization of CDC and lack of appreciation of the effect workplace exposures have by public health practitioners that impedes the interaction of individuals' addressing work-related health issues/exposures with individuals at CDC addressing chronic and communicable diseases • Lack of demand for occupation/industry/exposure information in stan dardized electronic medical records by clinicians and institutions providing health care, which leads to a lack of emphasis on occupation/industry/exposure by agencies and vendors responsible for standardizing electronic medical records and developing software for inclusion of occupational information
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From page 42... ...
These gaps are discussed in Chapters 3 and 4. The committee has provided recommendations that are considered feasible to address many of the major gaps identified in Chapters 3 and 4 but understands that to overcome the key barriers identified, particularly related to cost and agency culture, will require a commitment and prioritization by stakeholders and multiple agencies at the federal and state level.
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