Using existing workers' compensation medical claims data to improve workplace safety.
Peele-PB; Stockman-CK; Tollerud-DJ
Health Services Research: Shaping the Health System in the New Millenium, AHSRHP Annual Meeting, June 25-27, Los Angeles, California. Washington, DC: Association for Health Services Research, 2000 Jun; :17
Research Objective: When medical claims for injured workers are processed, a claims level workers' compensation database is created. Few, if any, employers currently take advantage of the existence of these data. Many would like to tap into these already existing databases to monitor the safety of their workplace, but lack the analytical techniques necessary to do this. The goal of this project is to improve the welfare of employees by providing employers with explicit guidelines detailing the use of medical claims data to monitor workplace safety and evaluate safety programs. A first step towards this goal is establishing the feasibility of using existing workers' compensation medical claims data to monitor workplace safety and evaluate new safety programs by observing changes in the number and severity of injuries. We also report the gap between the number of injuries receiving medical treatment and all injuries to provide an estimate of the undercounting of injuries associated with using only medical claims data. Study Design: This study uses billing-level workers' compensation medical claims data for the 29,000 FTE employees of the City of Philadelphia for the years 1994-1997. We postulate that changes in the number and severity of injuries (when evaluated together) can signal changes in workplace safety. Accordingly, we develop several proxies for injury severity, such as the length of time between the first and last medical visit attributable to that injury (length of medical supervision) and the ratio of inpatient to outpatient services per injury. Additionally, because medical claims data capture only injuries that receive formal medical services, we estimate the degree to which claims data undercounts injuries by comparing the number of injuries in claims data to the number of filed injury reports.Population Studied: Employees of the City of Philadelphia between 1994 and 1997. Principal Findings: Among the 29,000 employees of the City of Philadelphia, there were, on average, 4,536 injuries annually between the years 1994 and 1997. The number of injuries ranged over the years in question from a low of 3,637 in 1994 to a high of 5,029 in 1996. To be feasible, a surveillance system using workers' compensations claims data must be able to alert employers to changes in workplace safety in a timely fashion so that they have the opportunity to intervene and react to these changes quickly. For example, a system that alerts employers to changes in workplace safety two years after the fact would have less potential for injury prevention than a system that alerted employers to changes in workplace safety four months after they occurred. We find that 29.5% of the 18,144 injuries we examined did not generate a bill for medical treatment after the first day of treatment. In addition, 79% of injured employees received all medical treatment attributable to that injury within 60 days. Hence we find it feasible to use these data to develop a surveillance system to monitor workplace safety. Conclusions: Most employee injuries result in very short courses of medical treatment making the use of workers' compensation medical claims data to establish guidelines for employers to use to monitor workplace safety feasible. We are currently testing algorithms for various time frames from 3 days to 180 days to determine the minimum window of time needed to produce meaningful feedback for employers on changes in workplace safety. Implications for Policy, Delivery or Practice: NIOSH reports that approximately 9,000 U.S. workers a day sustain a disabling injury on the job. The development of a low-cost, easily-accessed surveillance/monitoring system that would alert employers to changes in workplace safety, allowing them to intervene early when negative changes in workplace safety occur has the potential to dramatically decrease the amount of money spent annually on workplace injuries and illnesses. Given that the system we propose to develop relies on data that is already being collected by employers (or their administrator), it will be cost-effective and within the reach of many employers. Given the similar nature of labor mixes across municipalities, the employer guidelines that we develop will be immediately and directly applicable to other municipalities. In addition to other municipalities, we expect our guidelines to have direct application for many other large employers as well.
Surveillance-programs; Injury-prevention; Safety-measures; Work-environment; Occupational-safety-programs; Occupational-health; Medical-treatment; Safety-programs; Safety-practices; Safety-research
Disease and Injury: Traumatic Injuries
Health Services Research: Shaping the Health System in the New Millenium, Academy for Health Services Research and Health Policy Annual Meeting, June 25-27, Los Angeles, California
University of Pittsburgh at Pittsburgh