A comprehensive occupational safety and surveillance system for health care workers (HCW) and related workers was developed and implemented by this project. This new surveillance system, known as the Duke Health and Safety Surveillance System (DHSSS), represents a unique collaboration across multiple organizational units within a large health system. These organizational groups included Human Resources, Employee Occupational Health, the Occupational and Environmental Safety Office (OESO), employee health promotion programs, and the Department of Community and Family Medicine, Division of Occupational and Environmental Medicine. The DHSSS is a model system for surveillance of occupational and personal risk factors and health outcomes among a large and diverse population of HCWs and provides data useful for problem identification as well as evaluation of intervention/prevention measures. The DHSSS maximizes use of existing data sources and current coding schemes for important variables such as departments, jobs, and work locations. Linkage of information across multiple data sources allows appropriate group level data analyses, while protecting information confidentiality and individual privacy through use of a HIPAA compliant limited use dataset. This project and the procedures for assuring confidentiality have been reviewed and approved by the Duke University Health System Institutional Review Board. The DHSSS can be viewed as a 'data warehouse', consisting of multiple data partitions which can be linked to extract individual level variables of interest to form specific population-based analysis datasets. These data sources are updated annually, or more often if needed to address specific project needs. Health claims extraction and HIPAA compliant file generation services for this project are provided by the outside contractor used by Duke Human Resources for health claims data processing. The DHSSS provides data useful for cross-sectional, longitudinal, and case-control study designs. The DHSSS has been used for a number of internal analyses and reports, as well as peer-reviewed publications. These analyses have included: 1) Workers' compensation analyses addressing overall injuries and illness rates, patient lifting and back injuries, and musculoskeletal injuries; 2) Blood and body fluid exposures and exposure rates; 3) Latex exposures and latex allergy; 4) Health risk factors and predictors of health insurance utilization; 5) Obesity and workers' compensation claims; 5) Analyses of health risk factors from health risk appraisals; and 6) Evaluation of intervention and prevention programs. Findings from the different descriptive, analytical, and prevention evaluation studies using the DHSSS should be generalizable and have broad application to other health care settings. Furthermore, most of the data sources included in the surveillance system are available in most health care settings; therefore, the surveillance model should have broad application to other health care organizations, and possibly other occupational settings.
John M. Dement, Ph.D., Professor, Division of Occupational & Environmental Medicine Department of Community & Family Medicine Duke University Medical Center 2200 W. Main Street, Suite 700 Durham, NC 27705