HEALTHCARE AND SOCIAL ASSISTANCE
Outcomes are events, occurrences, or conditions that indicate progress in achieving the purpose of the program. Outcomes reflect the results of a program activity compared with its intended purpose; or, outcomes may answer the question "Will these resources result in success or contribute to the success of what we want to accomplish?"
Outcomes can be viewed from two different perspectives-ultimate and intermediate. For an occupational safety and health research program like the NIOSH Healthcare and Social Assistance Program, ultimate outcomes are reductions in a particular type of worker injury or illness. Injuries and illnesses have complex causes, and any effect of program activities on rates can take years to be seen. Therefore, outcomes are often measured on an intermediate timeframe. Intermediate outcomes are necessary steps that lead to ultimate outcomes-for example, reductions in the risk of a particular type of injury or illness. For occupational safety and health research programs, achieving intermediate risk reductions is as important as achieving the ultimate outcome of decreasing injury and illness incidence rates.
NIOSH researchers working collaboratively with Liberty Mutual Research Center for Safety and Health, Finnish Institute for Occupational Health, BJC Health System and the Veteran's Administration to conduct research into slips, trips and falls in hospital setting. Risk factors were identified; a multi-faceted intervention was developed, implemented and evaluated. Preliminary analyses indicate slips, trips and falls incidents have decreased 25%.
There has been a decline of 46% in TB cases in the U.S. since 1992. The incidence of TB in health care workers during this period has declined from 5.4 per 100,000 workers to 3.7 in 2000. NIOSH researchers have made significant contributions to the prevention of transmission of TB in the workplace. There have been changes implemented in worksites based on recommendations made in TB related HHE reports. NIOSH researchers were key members of the teams developing the guidelines for prevention of the transmission of TB in healthcare and correctional facilities. Multi-media training materials and other products have been developed for use in implementing the guidelines. NIOSH research has resulted in improved particulate respirators and higher efficiency filters in ventilation systems.
The results of three studies conducted at Harvard University (and co-funded by NIOSH) examined the impact of long and extended work hours on medical interns' clinical performance and risk for car crashes and were included in the rationale for standard stetting by the Accreditation Council for Graduate Medical Education (ACGME). In July 2003, the ACGME instituted common standards that limit duty hours for resident physicians in all accredited programs. As the body responsible for the accreditation of more than 8,000 programs that collectively provide for the education of 100,000 residents, the ACGME is the entity to which the medical community and public looks to set and enforce resident duty hour limits. The ACGME and its Residency Review Committees (RRCs) developed the standards in response to a growing body of scientific information about the negative effects of sleep loss and fatigue on resident education and performance, and the potential for adverse consequences for the safety and well-being of patients and residents. The limits also respond to changes in health care delivery that have increased patient acuity in the nation's teaching hospitals.
Two years after the establishment of the ACGME's common duty hour standards the vast majority of residency programs are complying according to a confidential internet survey of more than 50,000 residents.
The publication NIOSH ALERT: Preventing Needlestick Injuries in Healthcare Settings has been instrumental in convincing healthcare facilities to use safer sharps devices. Healthcare facilities in the U.S. have replaced traditional syringes and scalpels with engineered sharps and safety features resulting in reduced needlestick injuries among healthcare workers.
NIOSH research has demonstrated the efficacy of a safe patient lifting program. The program achieved highly significant reductions in injuries, workers' compensation costs and lost and restricted workdays to healthcare workers. The research results showed improved quality of care delivered to patients and nursing home residents. Current research efforts are focused on research to practice activities targeting the nation's 15,000 nursing homes to stimulate widespread replication of these significant findings.
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