Collaborate Calculate industry-specific injury rates Describe the … · 2017-07-12 · Collaborate...
96
Rebecca Jackson California Department of Public Health Council of State and Territorial Epidemiologists Annual Conference June 5, 2017
Transcript of Collaborate Calculate industry-specific injury rates Describe the … · 2017-07-12 · Collaborate...
Rebecca JacksonCalifornia Department of Public HealthCouncil of State and Territorial Epidemiologists Annual ConferenceJune 5 2017
Collaborate
Calculate industry-specific injury rates
Describe the utility and limitations of data
Publicly available dataset
119877119877119877119877119877119877119877119877119894119894119894119894119894119894119894119894119894119894119894119894119894119894119894119894 =119862119862119862119862119877119877119862119862119862119862119862119862119894119894119894119894119894119894119894119894119894119894119894119894119894119894119894119894
119865119865119865119865119862119862119862119862 minus 119877119877119862119862119862119862119877119877 119877119877119890119890119865119865119862119862119890119890119877119877119862119862119877119877119890119890119877119877119894119894119894119894119894119894119894119894119894119894119894119894119894119894119894119894
This might seem like outer space but it isnrsquot rocket science
First Report of Injury (FROI)
Employee
Employer
Injury
Subsequent Report of Injury (SROI)
Medical Billing
ICD-Codes
Facility codes
Revenue codes
Quarterly employer reporting Employee name SSN wages Employer key
Numbers of workers by employer Industry code Ownership code Multi-establishment employer indicator
(MEEI)
bull 150 employment agencies (NAICS 5613)
bull 280K employeesTemp Firms
bull 90 workers in one industrybull 80 without corporate offices
(NAICS 5511)90 Rule
bull Assign unique code to both employers and workers for rate calculation
Remainder
Counts in QCEW multiplied by FTE to EE ratio
Six months of 2015 data Develop methods for matching Evaluate match Compare rates Prepare and plan
And now what yoursquove been waiting forhellip
California
QCEW
Determine industry
Injured
bull 12 million employers bull 16 million employees
bull 119 million employers bull 14 million employees
bull 51000 employersbull 302000 workers
302000 claims
260000 employer match
212000 private sector
184000 industry
Has one job73
Has employer match
9
WONK-y data match
4Did not match
14
WONK-y data match
4
Worker matches multiple employers All employers have
the same industry code One employer has
the same industry code in WCIS Only one employer is
in QCEW
Did not match14
Bad SSN or does not match on SSN Matched multiple employers gt5 employer No WONK-y data match
31 workers per 100 FTE
Rates of Injury by IndustryPrivate sectorJanuary-June 2016
Number of Claims
Rate per 100 FTE
Interurban and Rural Bus Transportation 54 150Couriers and Express Delivery Services 3084 107Building Material and Supplies Dealers 4971 106Animal Slaughtering and Processing 555 90Waste Treatment and Disposal 484 90Poultry and Egg Production 99 89Scheduled Air Transportation 1781 88Motor Vehicle Body and Trailer Manufacturing 243 85Cattle Ranching and Farming 989 81Other General Merchandise Stores 2280 80Other Ambulatory Health Care Services 850 80Foundries 250 79Sheep and Goat Farming 19 77Warehousing and Storage 1349 77Waste Collection 706 76Traveler Accommodation 6780 76Other Furniture Related Product Manufacturing 118 71Forging and Stamping 297 70Logging 58 69Sawmills and Wood Preservation 52 68
Rates of Injury by IndustryPrivate sectorJanuary-June 2016
Number of Claims
Rate per 100 FTE
Interurban and Rural Bus Transportation 54 150Couriers and Express Delivery Services 3084 107Building Material and Supplies Dealers 4971 106Animal Slaughtering and Processing 555 90Waste Treatment and Disposal 484 90Poultry and Egg Production 99 89Scheduled Air Transportation 1781 88Motor Vehicle Body and Trailer Manufacturing 243 85Cattle Ranching and Farming 989 81Other General Merchandise Stores 2280 80Other Ambulatory Health Care Services 850 80Foundries 250 79Sheep and Goat Farming 19 77Warehousing and Storage 1349 77Waste Collection 706 76Traveler Accommodation 6780 76Other Furniture Related Product Manufacturing 118 71Forging and Stamping 297 70Logging 58 69Sawmills and Wood Preservation 52 68
Rates of Injury by IndustryPrivate sectorJanuary-June 2016
Number of Claims
Rate per 100 FTE
Interurban and Rural Bus Transportation 54 150Couriers and Express Delivery Services 3084 107Building Material and Supplies Dealers 4971 106Animal Slaughtering and Processing 555 90Waste Treatment and Disposal 484 90Poultry and Egg Production 99 89Scheduled Air Transportation 1781 88Motor Vehicle Body and Trailer Manufacturing 243 85Cattle Ranching and Farming 989 81Other General Merchandise Stores 2280 80Other Ambulatory Health Care Services 850 80Foundries 250 79Sheep and Goat Farming 19 77Warehousing and Storage 1349 77Waste Collection 706 76Traveler Accommodation 6780 76Other Furniture Related Product Manufacturing 118 71Forging and Stamping 297 70Logging 58 69Sawmills and Wood Preservation 52 68
Rates of Injury by IndustryPrivate sectorJanuary-June 2016
Number of Claims
Rate per 100 FTE
Interurban and Rural Bus Transportation 54 150Couriers and Express Delivery Services 3084 107Building Material and Supplies Dealers 4971 106Animal Slaughtering and Processing 555 90Waste Treatment and Disposal 484 90Poultry and Egg Production 99 89Scheduled Air Transportation 1781 88Motor Vehicle Body and Trailer Manufacturing 243 85Cattle Ranching and Farming 989 81Other General Merchandise Stores 2280 80Other Ambulatory Health Care Services 850 80Foundries 250 79Sheep and Goat Farming 19 77Warehousing and Storage 1349 77Waste Collection 706 76Traveler Accommodation 6780 76Other Furniture Related Product Manufacturing 118 71Forging and Stamping 297 70Logging 58 69Sawmills and Wood Preservation 52 68
Rates of Injury by IndustryPrivate sectorJanuary-June 2016
Number of Claims
Rate per 100 FTE
Interurban and Rural Bus Transportation 54 150Couriers and Express Delivery Services 3084 107Building Material and Supplies Dealers 4971 106Animal Slaughtering and Processing 555 90Waste Treatment and Disposal 484 90Poultry and Egg Production 99 89Scheduled Air Transportation 1781 88Motor Vehicle Body and Trailer Manufacturing 243 85Cattle Ranching and Farming 989 81Other General Merchandise Stores 2280 80Other Ambulatory Health Care Services 850 80Foundries 250 79Sheep and Goat Farming 19 77Warehousing and Storage 1349 77Waste Collection 706 76Traveler Accommodation 6780 76Other Furniture Related Product Manufacturing 118 71Forging and Stamping 297 70Logging 58 69Sawmills and Wood Preservation 52 68
IndustryCA Rate per
100 FTENational Overall SOII
Rate per 100 FTE
Couriers and Express Delivery Services 107 74
Animal Slaughtering and Processing 90 54
Poultry and Egg Production 89 69
Scheduled Air Transportation 88 66
Cattle Ranching and Farming 81 64
Foundries 79 67
Sheep and Goat Farming 77 --
Warehousing and Storage 77 50
Traveler Accommodation 76 50
Forging and Stamping 70 53
Sawmills and Wood Preservation 68 69
IndustryCA Rate per 100
FTENational Overall SOII
Rate per 100 FTE
Interurban and Rural Bus Transportation 150 30
Building Material and Supplies Dealers 106 48
Waste Treatment and Disposal 90 33
Motor Vehicle Body and Trailer Manufacturing 85 79
Other General Merchandise Stores 80 49
Other Ambulatory Health Care Services 80 30
Waste Collection 76 46
Other Furniture Related Product Manufacturing 71 55
Logging 69 37
Collaboration
Data sharing agreements
Pilot rates
Sharable repeatable methods and code
Contribution to national discussions about
use of WC data
Workers not captured by our method
Public sector
People who do not file claims
Data analysis for 2015-2016 Data analysis report Surveillance system evaluation
Publicly available dataset Disseminate findings Sustainability
California Department of Public Health John Beckman Matt Frederick Bob Harrison
California Department of Industrial Relations Genet Daba John Gordon Liza Dizon Glenn Shor Meitong Jin
California Employment Development Department Andy Wong Spencer Wong
Terry Bunn PhDDirector Kentucky Injury Prevention and Research
Center bona fide agent for the Kentucky Department for Public Health
Associate Professor Departments of Epidemiology and Preventive Medicine and Environmental Health University of Kentucky College of Public Health
bull Occupational motor vehicle crash investigations a priority focus area since 2005
KOSHS
Case Example
Case Example
bull Substance abuse a priority focus areabull State injury prevention planbull Legislation data support (HB1)
ndash Pill millsndash Clinical prescribing regulationsndash Decedent controlled substance testing lawndash Inter-state prescription drug monitoring
program (PDMP) data sharing
bull Use of PDMP data for public health surveillance
bull Inform community interventions bull Evaluate and perform cost-benefit
analysis of drug-related laws bull Establish substance use disorder
information and referral service ndash physicians (eg prevention of needle sticks
when lancing drug abuse-related abscesses)ndash first responders (eg handling of fentanyl
analogs at drug overdose scenes) ndash law enforcement (eg naloxone
administration training)ndash general public
bull Increase timeliness of public health data sources
bull Use syndromic surveillance data for drug overdose and injury surveillance
bull Algorithm development for milligram morphine equivalent calculations in PDMP reports
bull Death certificate and PDMP data linkage to identify possible drug diversion
bull State advisory group
bull Link Ky CRASH and trauma registry data with FARS driver drug testing results from fatal crashes in 2014
bull Link 2014 trauma registry toxicology result data with inpatient hospitalization data to assess drug overdose and drug abuse coding
Primary populations
bull Opioid overdose victims
bull Pregnant and parenting women
bull Individuals re-entering society upon criminal justice release
bull Adolescents and young adults
Goals
bull Prevent opioid misuse and abuse
bull Increase access to OUD treatment services (eg MAT)
bull Increase availability of recovery support services
bull Increase availability of naloxone
bull Enhance coordination and evaluation of OUD healthcare and public safety strategies
bull KRS 217186- A person or agency including a peace officer jailer firefighter paramedic or emergency medical technician or a school employee authorized to administer medication under KRS 156502 may ndash Receive a prescription for the drug
naloxonendash Possess naloxone pursuant to this
subsection and any equipment needed for its administration
ndash Administer naloxone to an individual suffering from an apparent opiate-related overdose
bull Reduce prescriber opioid prescribing (physicians APRNs etc) to a 3-day supply for injured workers
bull First line treatment based on non-opioid therapy alternatives (physical therapy acupuncture etc)
bull Revise drug formularies for treatment of pain associated with occupational injuries
Prevention Decrease likelihood that Kentuckians develop a SUD through strategies to decrease overexposure of opioid medications and illicit opioids
bull prescriptions (dosage units) overdose deaths containing fentanyl
Harm Reduction Improve Access to Harm Reduction Services to Save Lives
bull naloxone kits dispensed to first responders and public people in syringe exchange programs who received naloxone
Treatment and Recovery Expand access to treatment and recovery supports
bull peer recovery coaches Emergency Departments with peer recovery coaches people with SUD who interact with peer recovery coaches and enter treatment Emergency Department peer follow-up individuals with SUD who receive residential services calls to SUD treatment locator and portal
bull Louisville Metro Police Department presentation
bull Breakout Session
bull First Responder Opioid Exposure Survey development
bull Focus Groups
bull Survey Administration
bull Data Analysis
bull Use of Data Results
bull UK ERC first responder overdose response exposure pilot project opportunity
bull Multistate or single state applicationsndash Use of survey
ndash development of other first responder-related pilot project
FACE case investigations
bull initiated drug overdose prevention conversations
bull enhanced collaborations
bull provided evidence of need for enhanced multidisciplinary drug overdose prevention efforts1 Interventions
2 Policies
3 Research
Ladder rap
httpswwwyoutubecomwatchv=FsW6eb3aO8gampfeature=youtube
BLS Survey of Employers vs Multi-Source Surveillance of Work-Related Injuries
Kenneth D Rosenman MDProfessor of MedicineMichigan State Universitywwwoemmsuedu
NIOSH Expanding Research Partnerships Conference Denver Colorado June 21-23 2017
Funding NIOSH U60 OH008466
Survey of Occupational Injuries and Illnesses (SOII)
bull Injuries and illnesses (based on OSHArsquos recordkeeping standards) from 230000 establishments (sample by state and NAICS code)
bull Redesigned in 1992 to collect circumstances of injuries and illnesses that lead to days away from work and characteristics of affected workers
bull Scope limitations no small farms private household or self-employed workers (lt 2008 no public sector workers)
NATIONAL ACADEMY OF SCIENCES 1987
New Jersey24 Deaths not covered by OSHA35 Deaths covered by OSHA butemployer had NOT recorded on OSHAlog or did NOT keep OSHA log
TexasNIOSH Fatal Occupational Trauma Surveillance
CENSUS OF FATAL OCCUPATIONAL INJURIES (CFOI) BEGAN IN 1992
Multiple death sourcesDeath certificatesEmployer reportingState PoliceNewspaper Clipping ServiceMedical ExaminersAgricultural Extension Service
Number of deaths doubled from previous BLS estimate
How Much Work-Related Injury and Illness is Missed By the Current National Surveillance System
Rosenman KD Kalush A Reilly MJ Gardiner JC Reeves M Luo Z JOEM 2006 48357-365Funding NIOSH 5 R01 OH004276-03
Summary of Analysis Comparing BLS and Worker Comp data Michigan 2009-2001Days away from workbull BLS estimate
37-41 BLS+ WC31-34 BLS + WC+ CaptureRecapture
1999-2001 Estimates - Michiganbull BLS -281567 vs Our Estimate - 868241
1 in 15 workers vs 1 in 5 workers
(Rosenman et al JOEM 2006)
Simplified Flowchart of Events Necessary to the Documentation of Work-Related Injuries and Illnesses
(Azaroff et al AJPH 2002)
Filters to Identifying Work-Related Injuries and Illnesses
a Filters To Reporting to Supervisorsb Filters To Losing Work Time c Filters to Obtaining Medical Cared Filters to Recognizing Work-Related by Doctore Filters to Workersrsquo Compensation being the Payerf Filters To Recording on OSHA Logg Filters to Reporting by Employers to Workersrsquo
Compensation Agencyh Filters to Reporting by Doctors
(Azaroff et al AJPH 2002)
Capture-Recapture Estimates of Workplace Injury and Illness Reporting by BLS Adjusted for Capture
Heterogeneity Lost-Time Cases 1998-2001
Percent Reported to WA WV OR WI NM MNNo Source Dependence 55 76 56 65 51 68
Source Dependence 52 71 45 53 37 53
(Adapted Boden and Ozonoff Annals Epidemiology 2008)
Workersrsquo CompensationState Specific Program
Mandatory insurance or if large enough self-insured
Michigan WC Excludesbull Federal employeesbull Interstate railroad workersbull Maritime workersbull Less than 3 employees at any one timebull All employees work less than 35 hoursweek or
if more hours less than 13 weeksbull Self-employed
Not computerizedbull Medical claims only
Proportion of Work-Injured Adults for Whom Treatment was paid by Workersrsquo Compensation by State-BRFSS 10 States 2007
State Injured with Payment by Workersrsquo Compensation
Texas 47 (95 CI 35-59)New York 50 (95 CI 39-60)Michigan 56 (95 CI 41-69)Massachusetts 60 (95 CI 45-75)California 61 (95 CI 55-66)Washington 61 (95 CI 55-67)Oregon 62 (95 CI 50-74)Connecticut 63 (95 CI 53-74)New Jersey 64 (95 CI 51-78)Kentucky 77 (95 CI 65-89)
Excludes self-employed
(Adapted Bonauto et al MMWR 2010)
Percentage Received Workersrsquo Compensation by Condition Michigan
WageReplacement
Medical Only
No CompEmployed
No Comp Self -Employed
Amputations 64 22 17 6Burns 17 48 33 2Skull Fractures 36 32 29 3
Percent Applied for Workersrsquo Comp among 2016 Cases of Work-Related Asthma Michigan
Overall 484
Still ExposedConditions Unchanged 239No Longer Exposed 575
Quit on Doctorrsquos Advice 778Sick Leave 727Fired 621New Controls 589Chemical Substitution 536Quit on Own 431Reassigned 360
Reasons Didnrsquot File a Workersrsquo Compensation Claims for a Repetitive Trauma Michigan
Only 397 (251) of 1598 Filed WC Claim
Injury Not Serious Enough 705 (591)Did Not Expect to Miss Work 694 (583)Expect to Receive Sick Leave or
Disability 337 (283) Medical Expenses Covered by
Other Insurance 427 (359)Did Not Think Injury Work Related 242 (204)
(Rosenman et al JOEM 2000)
Goals of Surveillance Population-Based
bull Assess Magnitude of Problembull NumbersRatesTrends
bull Determine Relative Importance vs Other Health Issuesbull Identify High Risk
bull IndustriesOccupationsWorker Populations
bull Prioritize Interventions bull Evaluate Interventionsbull Generate Hypotheses for Researchbull Identify Emerging Problemsbull Identify Workplaces for Intervention
Case-Based
Reportable Conditions in Michigan
Local Health DepartmentsCommunicable Diseases (83)
ldquoUnusual occurrence outbreak or epidemic of any disease or conditionsrdquoMDHHS
AbortionsBirth DefectsCancerChemical Poisonings including Carbon MonoxideInjuries Nursing Home Abuse
LARAOccupational Illnesses
County Department of Social ServicesChild AbuseAdult Abuse
PoliceInjury from Knife Gun or Deadly WeaponMental Health Patient Abuse
On Request Only
Laboratory Reporting Regulations Michigan
bull Arsenicbull Cadmiumbull Carboxyhemoglobinbull Cholinesterasebull IgE Antibodiesbull Leadbull Mercury
Occupational Illness Reporting Requirement in Michigan
bull LARA ndash MIOSHAPhysician hospital clinic or employer
having a known or suspected occupational disease or health condition aggravated by workplace exposures shall report within 10 days after discovery
Misdemeanor punishable by a fine of not more than $50
Methodology of Multi-Source Surveillance
Amputations 2006- DateHospitalsEDOutpatient ClinicsWorkersrsquo Compensation Wage Replacement
Crushing Injuries 2013- Date+ FACE Program
Skull Fractures 2012-DateBurns 2009-Date
+ Poison Control Center
bull Quarterly Reporting Specified ICD codes -134 Hospitalsbull Quarterly Reporting all Work-related Events ndash Poison Control Centerbull Electronic Data Base All Paid Claims ndash Workersrsquo Compensationbull FACE ndash Death CertificatesOSHA Hot LinePolice Reports
Work-Related Burn Reports ndash By Source Total 1461 Michigan 2009
n=1460 individuals
450
BLS
HOSPITALSEDs (1248)
4501054
BLSMIFACE 1(2) 1
16721
5 PCC (106)
1321 79
WC(306)
(Kica and Rosenman JOEM 2012)
Collaborate
Calculate industry-specific injury rates
Describe the utility and limitations of data
Publicly available dataset
119877119877119877119877119877119877119877119877119894119894119894119894119894119894119894119894119894119894119894119894119894119894119894119894 =119862119862119862119862119877119877119862119862119862119862119862119862119894119894119894119894119894119894119894119894119894119894119894119894119894119894119894119894
119865119865119865119865119862119862119862119862 minus 119877119877119862119862119862119862119877119877 119877119877119890119890119865119865119862119862119890119890119877119877119862119862119877119877119890119890119877119877119894119894119894119894119894119894119894119894119894119894119894119894119894119894119894119894
This might seem like outer space but it isnrsquot rocket science
First Report of Injury (FROI)
Employee
Employer
Injury
Subsequent Report of Injury (SROI)
Medical Billing
ICD-Codes
Facility codes
Revenue codes
Quarterly employer reporting Employee name SSN wages Employer key
Numbers of workers by employer Industry code Ownership code Multi-establishment employer indicator
(MEEI)
bull 150 employment agencies (NAICS 5613)
bull 280K employeesTemp Firms
bull 90 workers in one industrybull 80 without corporate offices
(NAICS 5511)90 Rule
bull Assign unique code to both employers and workers for rate calculation
Remainder
Counts in QCEW multiplied by FTE to EE ratio
Six months of 2015 data Develop methods for matching Evaluate match Compare rates Prepare and plan
And now what yoursquove been waiting forhellip
California
QCEW
Determine industry
Injured
bull 12 million employers bull 16 million employees
bull 119 million employers bull 14 million employees
bull 51000 employersbull 302000 workers
302000 claims
260000 employer match
212000 private sector
184000 industry
Has one job73
Has employer match
9
WONK-y data match
4Did not match
14
WONK-y data match
4
Worker matches multiple employers All employers have
the same industry code One employer has
the same industry code in WCIS Only one employer is
in QCEW
Did not match14
Bad SSN or does not match on SSN Matched multiple employers gt5 employer No WONK-y data match
31 workers per 100 FTE
Rates of Injury by IndustryPrivate sectorJanuary-June 2016
Number of Claims
Rate per 100 FTE
Interurban and Rural Bus Transportation 54 150Couriers and Express Delivery Services 3084 107Building Material and Supplies Dealers 4971 106Animal Slaughtering and Processing 555 90Waste Treatment and Disposal 484 90Poultry and Egg Production 99 89Scheduled Air Transportation 1781 88Motor Vehicle Body and Trailer Manufacturing 243 85Cattle Ranching and Farming 989 81Other General Merchandise Stores 2280 80Other Ambulatory Health Care Services 850 80Foundries 250 79Sheep and Goat Farming 19 77Warehousing and Storage 1349 77Waste Collection 706 76Traveler Accommodation 6780 76Other Furniture Related Product Manufacturing 118 71Forging and Stamping 297 70Logging 58 69Sawmills and Wood Preservation 52 68
Rates of Injury by IndustryPrivate sectorJanuary-June 2016
Number of Claims
Rate per 100 FTE
Interurban and Rural Bus Transportation 54 150Couriers and Express Delivery Services 3084 107Building Material and Supplies Dealers 4971 106Animal Slaughtering and Processing 555 90Waste Treatment and Disposal 484 90Poultry and Egg Production 99 89Scheduled Air Transportation 1781 88Motor Vehicle Body and Trailer Manufacturing 243 85Cattle Ranching and Farming 989 81Other General Merchandise Stores 2280 80Other Ambulatory Health Care Services 850 80Foundries 250 79Sheep and Goat Farming 19 77Warehousing and Storage 1349 77Waste Collection 706 76Traveler Accommodation 6780 76Other Furniture Related Product Manufacturing 118 71Forging and Stamping 297 70Logging 58 69Sawmills and Wood Preservation 52 68
Rates of Injury by IndustryPrivate sectorJanuary-June 2016
Number of Claims
Rate per 100 FTE
Interurban and Rural Bus Transportation 54 150Couriers and Express Delivery Services 3084 107Building Material and Supplies Dealers 4971 106Animal Slaughtering and Processing 555 90Waste Treatment and Disposal 484 90Poultry and Egg Production 99 89Scheduled Air Transportation 1781 88Motor Vehicle Body and Trailer Manufacturing 243 85Cattle Ranching and Farming 989 81Other General Merchandise Stores 2280 80Other Ambulatory Health Care Services 850 80Foundries 250 79Sheep and Goat Farming 19 77Warehousing and Storage 1349 77Waste Collection 706 76Traveler Accommodation 6780 76Other Furniture Related Product Manufacturing 118 71Forging and Stamping 297 70Logging 58 69Sawmills and Wood Preservation 52 68
Rates of Injury by IndustryPrivate sectorJanuary-June 2016
Number of Claims
Rate per 100 FTE
Interurban and Rural Bus Transportation 54 150Couriers and Express Delivery Services 3084 107Building Material and Supplies Dealers 4971 106Animal Slaughtering and Processing 555 90Waste Treatment and Disposal 484 90Poultry and Egg Production 99 89Scheduled Air Transportation 1781 88Motor Vehicle Body and Trailer Manufacturing 243 85Cattle Ranching and Farming 989 81Other General Merchandise Stores 2280 80Other Ambulatory Health Care Services 850 80Foundries 250 79Sheep and Goat Farming 19 77Warehousing and Storage 1349 77Waste Collection 706 76Traveler Accommodation 6780 76Other Furniture Related Product Manufacturing 118 71Forging and Stamping 297 70Logging 58 69Sawmills and Wood Preservation 52 68
Rates of Injury by IndustryPrivate sectorJanuary-June 2016
Number of Claims
Rate per 100 FTE
Interurban and Rural Bus Transportation 54 150Couriers and Express Delivery Services 3084 107Building Material and Supplies Dealers 4971 106Animal Slaughtering and Processing 555 90Waste Treatment and Disposal 484 90Poultry and Egg Production 99 89Scheduled Air Transportation 1781 88Motor Vehicle Body and Trailer Manufacturing 243 85Cattle Ranching and Farming 989 81Other General Merchandise Stores 2280 80Other Ambulatory Health Care Services 850 80Foundries 250 79Sheep and Goat Farming 19 77Warehousing and Storage 1349 77Waste Collection 706 76Traveler Accommodation 6780 76Other Furniture Related Product Manufacturing 118 71Forging and Stamping 297 70Logging 58 69Sawmills and Wood Preservation 52 68
IndustryCA Rate per
100 FTENational Overall SOII
Rate per 100 FTE
Couriers and Express Delivery Services 107 74
Animal Slaughtering and Processing 90 54
Poultry and Egg Production 89 69
Scheduled Air Transportation 88 66
Cattle Ranching and Farming 81 64
Foundries 79 67
Sheep and Goat Farming 77 --
Warehousing and Storage 77 50
Traveler Accommodation 76 50
Forging and Stamping 70 53
Sawmills and Wood Preservation 68 69
IndustryCA Rate per 100
FTENational Overall SOII
Rate per 100 FTE
Interurban and Rural Bus Transportation 150 30
Building Material and Supplies Dealers 106 48
Waste Treatment and Disposal 90 33
Motor Vehicle Body and Trailer Manufacturing 85 79
Other General Merchandise Stores 80 49
Other Ambulatory Health Care Services 80 30
Waste Collection 76 46
Other Furniture Related Product Manufacturing 71 55
Logging 69 37
Collaboration
Data sharing agreements
Pilot rates
Sharable repeatable methods and code
Contribution to national discussions about
use of WC data
Workers not captured by our method
Public sector
People who do not file claims
Data analysis for 2015-2016 Data analysis report Surveillance system evaluation
Publicly available dataset Disseminate findings Sustainability
California Department of Public Health John Beckman Matt Frederick Bob Harrison
California Department of Industrial Relations Genet Daba John Gordon Liza Dizon Glenn Shor Meitong Jin
California Employment Development Department Andy Wong Spencer Wong
Terry Bunn PhDDirector Kentucky Injury Prevention and Research
Center bona fide agent for the Kentucky Department for Public Health
Associate Professor Departments of Epidemiology and Preventive Medicine and Environmental Health University of Kentucky College of Public Health
bull Occupational motor vehicle crash investigations a priority focus area since 2005
KOSHS
Case Example
Case Example
bull Substance abuse a priority focus areabull State injury prevention planbull Legislation data support (HB1)
ndash Pill millsndash Clinical prescribing regulationsndash Decedent controlled substance testing lawndash Inter-state prescription drug monitoring
program (PDMP) data sharing
bull Use of PDMP data for public health surveillance
bull Inform community interventions bull Evaluate and perform cost-benefit
analysis of drug-related laws bull Establish substance use disorder
information and referral service ndash physicians (eg prevention of needle sticks
when lancing drug abuse-related abscesses)ndash first responders (eg handling of fentanyl
analogs at drug overdose scenes) ndash law enforcement (eg naloxone
administration training)ndash general public
bull Increase timeliness of public health data sources
bull Use syndromic surveillance data for drug overdose and injury surveillance
bull Algorithm development for milligram morphine equivalent calculations in PDMP reports
bull Death certificate and PDMP data linkage to identify possible drug diversion
bull State advisory group
bull Link Ky CRASH and trauma registry data with FARS driver drug testing results from fatal crashes in 2014
bull Link 2014 trauma registry toxicology result data with inpatient hospitalization data to assess drug overdose and drug abuse coding
Primary populations
bull Opioid overdose victims
bull Pregnant and parenting women
bull Individuals re-entering society upon criminal justice release
bull Adolescents and young adults
Goals
bull Prevent opioid misuse and abuse
bull Increase access to OUD treatment services (eg MAT)
bull Increase availability of recovery support services
bull Increase availability of naloxone
bull Enhance coordination and evaluation of OUD healthcare and public safety strategies
bull KRS 217186- A person or agency including a peace officer jailer firefighter paramedic or emergency medical technician or a school employee authorized to administer medication under KRS 156502 may ndash Receive a prescription for the drug
naloxonendash Possess naloxone pursuant to this
subsection and any equipment needed for its administration
ndash Administer naloxone to an individual suffering from an apparent opiate-related overdose
bull Reduce prescriber opioid prescribing (physicians APRNs etc) to a 3-day supply for injured workers
bull First line treatment based on non-opioid therapy alternatives (physical therapy acupuncture etc)
bull Revise drug formularies for treatment of pain associated with occupational injuries
Prevention Decrease likelihood that Kentuckians develop a SUD through strategies to decrease overexposure of opioid medications and illicit opioids
bull prescriptions (dosage units) overdose deaths containing fentanyl
Harm Reduction Improve Access to Harm Reduction Services to Save Lives
bull naloxone kits dispensed to first responders and public people in syringe exchange programs who received naloxone
Treatment and Recovery Expand access to treatment and recovery supports
bull peer recovery coaches Emergency Departments with peer recovery coaches people with SUD who interact with peer recovery coaches and enter treatment Emergency Department peer follow-up individuals with SUD who receive residential services calls to SUD treatment locator and portal
bull Louisville Metro Police Department presentation
bull Breakout Session
bull First Responder Opioid Exposure Survey development
bull Focus Groups
bull Survey Administration
bull Data Analysis
bull Use of Data Results
bull UK ERC first responder overdose response exposure pilot project opportunity
bull Multistate or single state applicationsndash Use of survey
ndash development of other first responder-related pilot project
FACE case investigations
bull initiated drug overdose prevention conversations
bull enhanced collaborations
bull provided evidence of need for enhanced multidisciplinary drug overdose prevention efforts1 Interventions
2 Policies
3 Research
Ladder rap
httpswwwyoutubecomwatchv=FsW6eb3aO8gampfeature=youtube
BLS Survey of Employers vs Multi-Source Surveillance of Work-Related Injuries
Kenneth D Rosenman MDProfessor of MedicineMichigan State Universitywwwoemmsuedu
NIOSH Expanding Research Partnerships Conference Denver Colorado June 21-23 2017
Funding NIOSH U60 OH008466
Survey of Occupational Injuries and Illnesses (SOII)
bull Injuries and illnesses (based on OSHArsquos recordkeeping standards) from 230000 establishments (sample by state and NAICS code)
bull Redesigned in 1992 to collect circumstances of injuries and illnesses that lead to days away from work and characteristics of affected workers
bull Scope limitations no small farms private household or self-employed workers (lt 2008 no public sector workers)
NATIONAL ACADEMY OF SCIENCES 1987
New Jersey24 Deaths not covered by OSHA35 Deaths covered by OSHA butemployer had NOT recorded on OSHAlog or did NOT keep OSHA log
TexasNIOSH Fatal Occupational Trauma Surveillance
CENSUS OF FATAL OCCUPATIONAL INJURIES (CFOI) BEGAN IN 1992
Multiple death sourcesDeath certificatesEmployer reportingState PoliceNewspaper Clipping ServiceMedical ExaminersAgricultural Extension Service
Number of deaths doubled from previous BLS estimate
How Much Work-Related Injury and Illness is Missed By the Current National Surveillance System
Rosenman KD Kalush A Reilly MJ Gardiner JC Reeves M Luo Z JOEM 2006 48357-365Funding NIOSH 5 R01 OH004276-03
Summary of Analysis Comparing BLS and Worker Comp data Michigan 2009-2001Days away from workbull BLS estimate
37-41 BLS+ WC31-34 BLS + WC+ CaptureRecapture
1999-2001 Estimates - Michiganbull BLS -281567 vs Our Estimate - 868241
1 in 15 workers vs 1 in 5 workers
(Rosenman et al JOEM 2006)
Simplified Flowchart of Events Necessary to the Documentation of Work-Related Injuries and Illnesses
(Azaroff et al AJPH 2002)
Filters to Identifying Work-Related Injuries and Illnesses
a Filters To Reporting to Supervisorsb Filters To Losing Work Time c Filters to Obtaining Medical Cared Filters to Recognizing Work-Related by Doctore Filters to Workersrsquo Compensation being the Payerf Filters To Recording on OSHA Logg Filters to Reporting by Employers to Workersrsquo
Compensation Agencyh Filters to Reporting by Doctors
(Azaroff et al AJPH 2002)
Capture-Recapture Estimates of Workplace Injury and Illness Reporting by BLS Adjusted for Capture
Heterogeneity Lost-Time Cases 1998-2001
Percent Reported to WA WV OR WI NM MNNo Source Dependence 55 76 56 65 51 68
Source Dependence 52 71 45 53 37 53
(Adapted Boden and Ozonoff Annals Epidemiology 2008)
Workersrsquo CompensationState Specific Program
Mandatory insurance or if large enough self-insured
Michigan WC Excludesbull Federal employeesbull Interstate railroad workersbull Maritime workersbull Less than 3 employees at any one timebull All employees work less than 35 hoursweek or
if more hours less than 13 weeksbull Self-employed
Not computerizedbull Medical claims only
Proportion of Work-Injured Adults for Whom Treatment was paid by Workersrsquo Compensation by State-BRFSS 10 States 2007
State Injured with Payment by Workersrsquo Compensation
Texas 47 (95 CI 35-59)New York 50 (95 CI 39-60)Michigan 56 (95 CI 41-69)Massachusetts 60 (95 CI 45-75)California 61 (95 CI 55-66)Washington 61 (95 CI 55-67)Oregon 62 (95 CI 50-74)Connecticut 63 (95 CI 53-74)New Jersey 64 (95 CI 51-78)Kentucky 77 (95 CI 65-89)
Excludes self-employed
(Adapted Bonauto et al MMWR 2010)
Percentage Received Workersrsquo Compensation by Condition Michigan
WageReplacement
Medical Only
No CompEmployed
No Comp Self -Employed
Amputations 64 22 17 6Burns 17 48 33 2Skull Fractures 36 32 29 3
Percent Applied for Workersrsquo Comp among 2016 Cases of Work-Related Asthma Michigan
Overall 484
Still ExposedConditions Unchanged 239No Longer Exposed 575
Quit on Doctorrsquos Advice 778Sick Leave 727Fired 621New Controls 589Chemical Substitution 536Quit on Own 431Reassigned 360
Reasons Didnrsquot File a Workersrsquo Compensation Claims for a Repetitive Trauma Michigan
Only 397 (251) of 1598 Filed WC Claim
Injury Not Serious Enough 705 (591)Did Not Expect to Miss Work 694 (583)Expect to Receive Sick Leave or
Disability 337 (283) Medical Expenses Covered by
Other Insurance 427 (359)Did Not Think Injury Work Related 242 (204)
(Rosenman et al JOEM 2000)
Goals of Surveillance Population-Based
bull Assess Magnitude of Problembull NumbersRatesTrends
bull Determine Relative Importance vs Other Health Issuesbull Identify High Risk
bull IndustriesOccupationsWorker Populations
bull Prioritize Interventions bull Evaluate Interventionsbull Generate Hypotheses for Researchbull Identify Emerging Problemsbull Identify Workplaces for Intervention
Case-Based
Reportable Conditions in Michigan
Local Health DepartmentsCommunicable Diseases (83)
ldquoUnusual occurrence outbreak or epidemic of any disease or conditionsrdquoMDHHS
AbortionsBirth DefectsCancerChemical Poisonings including Carbon MonoxideInjuries Nursing Home Abuse
LARAOccupational Illnesses
County Department of Social ServicesChild AbuseAdult Abuse
PoliceInjury from Knife Gun or Deadly WeaponMental Health Patient Abuse
On Request Only
Laboratory Reporting Regulations Michigan
bull Arsenicbull Cadmiumbull Carboxyhemoglobinbull Cholinesterasebull IgE Antibodiesbull Leadbull Mercury
Occupational Illness Reporting Requirement in Michigan
bull LARA ndash MIOSHAPhysician hospital clinic or employer
having a known or suspected occupational disease or health condition aggravated by workplace exposures shall report within 10 days after discovery
Misdemeanor punishable by a fine of not more than $50
Methodology of Multi-Source Surveillance
Amputations 2006- DateHospitalsEDOutpatient ClinicsWorkersrsquo Compensation Wage Replacement
Crushing Injuries 2013- Date+ FACE Program
Skull Fractures 2012-DateBurns 2009-Date
+ Poison Control Center
bull Quarterly Reporting Specified ICD codes -134 Hospitalsbull Quarterly Reporting all Work-related Events ndash Poison Control Centerbull Electronic Data Base All Paid Claims ndash Workersrsquo Compensationbull FACE ndash Death CertificatesOSHA Hot LinePolice Reports
Work-Related Burn Reports ndash By Source Total 1461 Michigan 2009
n=1460 individuals
450
BLS
HOSPITALSEDs (1248)
4501054
BLSMIFACE 1(2) 1
16721
5 PCC (106)
1321 79
WC(306)
(Kica and Rosenman JOEM 2012)
119877119877119877119877119877119877119877119877119894119894119894119894119894119894119894119894119894119894119894119894119894119894119894119894 =119862119862119862119862119877119877119862119862119862119862119862119862119894119894119894119894119894119894119894119894119894119894119894119894119894119894119894119894
119865119865119865119865119862119862119862119862 minus 119877119877119862119862119862119862119877119877 119877119877119890119890119865119865119862119862119890119890119877119877119862119862119877119877119890119890119877119877119894119894119894119894119894119894119894119894119894119894119894119894119894119894119894119894
This might seem like outer space but it isnrsquot rocket science
First Report of Injury (FROI)
Employee
Employer
Injury
Subsequent Report of Injury (SROI)
Medical Billing
ICD-Codes
Facility codes
Revenue codes
Quarterly employer reporting Employee name SSN wages Employer key
Numbers of workers by employer Industry code Ownership code Multi-establishment employer indicator
(MEEI)
bull 150 employment agencies (NAICS 5613)
bull 280K employeesTemp Firms
bull 90 workers in one industrybull 80 without corporate offices
(NAICS 5511)90 Rule
bull Assign unique code to both employers and workers for rate calculation
Remainder
Counts in QCEW multiplied by FTE to EE ratio
Six months of 2015 data Develop methods for matching Evaluate match Compare rates Prepare and plan
And now what yoursquove been waiting forhellip
California
QCEW
Determine industry
Injured
bull 12 million employers bull 16 million employees
bull 119 million employers bull 14 million employees
bull 51000 employersbull 302000 workers
302000 claims
260000 employer match
212000 private sector
184000 industry
Has one job73
Has employer match
9
WONK-y data match
4Did not match
14
WONK-y data match
4
Worker matches multiple employers All employers have
the same industry code One employer has
the same industry code in WCIS Only one employer is
in QCEW
Did not match14
Bad SSN or does not match on SSN Matched multiple employers gt5 employer No WONK-y data match
31 workers per 100 FTE
Rates of Injury by IndustryPrivate sectorJanuary-June 2016
Number of Claims
Rate per 100 FTE
Interurban and Rural Bus Transportation 54 150Couriers and Express Delivery Services 3084 107Building Material and Supplies Dealers 4971 106Animal Slaughtering and Processing 555 90Waste Treatment and Disposal 484 90Poultry and Egg Production 99 89Scheduled Air Transportation 1781 88Motor Vehicle Body and Trailer Manufacturing 243 85Cattle Ranching and Farming 989 81Other General Merchandise Stores 2280 80Other Ambulatory Health Care Services 850 80Foundries 250 79Sheep and Goat Farming 19 77Warehousing and Storage 1349 77Waste Collection 706 76Traveler Accommodation 6780 76Other Furniture Related Product Manufacturing 118 71Forging and Stamping 297 70Logging 58 69Sawmills and Wood Preservation 52 68
Rates of Injury by IndustryPrivate sectorJanuary-June 2016
Number of Claims
Rate per 100 FTE
Interurban and Rural Bus Transportation 54 150Couriers and Express Delivery Services 3084 107Building Material and Supplies Dealers 4971 106Animal Slaughtering and Processing 555 90Waste Treatment and Disposal 484 90Poultry and Egg Production 99 89Scheduled Air Transportation 1781 88Motor Vehicle Body and Trailer Manufacturing 243 85Cattle Ranching and Farming 989 81Other General Merchandise Stores 2280 80Other Ambulatory Health Care Services 850 80Foundries 250 79Sheep and Goat Farming 19 77Warehousing and Storage 1349 77Waste Collection 706 76Traveler Accommodation 6780 76Other Furniture Related Product Manufacturing 118 71Forging and Stamping 297 70Logging 58 69Sawmills and Wood Preservation 52 68
Rates of Injury by IndustryPrivate sectorJanuary-June 2016
Number of Claims
Rate per 100 FTE
Interurban and Rural Bus Transportation 54 150Couriers and Express Delivery Services 3084 107Building Material and Supplies Dealers 4971 106Animal Slaughtering and Processing 555 90Waste Treatment and Disposal 484 90Poultry and Egg Production 99 89Scheduled Air Transportation 1781 88Motor Vehicle Body and Trailer Manufacturing 243 85Cattle Ranching and Farming 989 81Other General Merchandise Stores 2280 80Other Ambulatory Health Care Services 850 80Foundries 250 79Sheep and Goat Farming 19 77Warehousing and Storage 1349 77Waste Collection 706 76Traveler Accommodation 6780 76Other Furniture Related Product Manufacturing 118 71Forging and Stamping 297 70Logging 58 69Sawmills and Wood Preservation 52 68
Rates of Injury by IndustryPrivate sectorJanuary-June 2016
Number of Claims
Rate per 100 FTE
Interurban and Rural Bus Transportation 54 150Couriers and Express Delivery Services 3084 107Building Material and Supplies Dealers 4971 106Animal Slaughtering and Processing 555 90Waste Treatment and Disposal 484 90Poultry and Egg Production 99 89Scheduled Air Transportation 1781 88Motor Vehicle Body and Trailer Manufacturing 243 85Cattle Ranching and Farming 989 81Other General Merchandise Stores 2280 80Other Ambulatory Health Care Services 850 80Foundries 250 79Sheep and Goat Farming 19 77Warehousing and Storage 1349 77Waste Collection 706 76Traveler Accommodation 6780 76Other Furniture Related Product Manufacturing 118 71Forging and Stamping 297 70Logging 58 69Sawmills and Wood Preservation 52 68
Rates of Injury by IndustryPrivate sectorJanuary-June 2016
Number of Claims
Rate per 100 FTE
Interurban and Rural Bus Transportation 54 150Couriers and Express Delivery Services 3084 107Building Material and Supplies Dealers 4971 106Animal Slaughtering and Processing 555 90Waste Treatment and Disposal 484 90Poultry and Egg Production 99 89Scheduled Air Transportation 1781 88Motor Vehicle Body and Trailer Manufacturing 243 85Cattle Ranching and Farming 989 81Other General Merchandise Stores 2280 80Other Ambulatory Health Care Services 850 80Foundries 250 79Sheep and Goat Farming 19 77Warehousing and Storage 1349 77Waste Collection 706 76Traveler Accommodation 6780 76Other Furniture Related Product Manufacturing 118 71Forging and Stamping 297 70Logging 58 69Sawmills and Wood Preservation 52 68
IndustryCA Rate per
100 FTENational Overall SOII
Rate per 100 FTE
Couriers and Express Delivery Services 107 74
Animal Slaughtering and Processing 90 54
Poultry and Egg Production 89 69
Scheduled Air Transportation 88 66
Cattle Ranching and Farming 81 64
Foundries 79 67
Sheep and Goat Farming 77 --
Warehousing and Storage 77 50
Traveler Accommodation 76 50
Forging and Stamping 70 53
Sawmills and Wood Preservation 68 69
IndustryCA Rate per 100
FTENational Overall SOII
Rate per 100 FTE
Interurban and Rural Bus Transportation 150 30
Building Material and Supplies Dealers 106 48
Waste Treatment and Disposal 90 33
Motor Vehicle Body and Trailer Manufacturing 85 79
Other General Merchandise Stores 80 49
Other Ambulatory Health Care Services 80 30
Waste Collection 76 46
Other Furniture Related Product Manufacturing 71 55
Logging 69 37
Collaboration
Data sharing agreements
Pilot rates
Sharable repeatable methods and code
Contribution to national discussions about
use of WC data
Workers not captured by our method
Public sector
People who do not file claims
Data analysis for 2015-2016 Data analysis report Surveillance system evaluation
Publicly available dataset Disseminate findings Sustainability
California Department of Public Health John Beckman Matt Frederick Bob Harrison
California Department of Industrial Relations Genet Daba John Gordon Liza Dizon Glenn Shor Meitong Jin
California Employment Development Department Andy Wong Spencer Wong
Terry Bunn PhDDirector Kentucky Injury Prevention and Research
Center bona fide agent for the Kentucky Department for Public Health
Associate Professor Departments of Epidemiology and Preventive Medicine and Environmental Health University of Kentucky College of Public Health
bull Occupational motor vehicle crash investigations a priority focus area since 2005
KOSHS
Case Example
Case Example
bull Substance abuse a priority focus areabull State injury prevention planbull Legislation data support (HB1)
ndash Pill millsndash Clinical prescribing regulationsndash Decedent controlled substance testing lawndash Inter-state prescription drug monitoring
program (PDMP) data sharing
bull Use of PDMP data for public health surveillance
bull Inform community interventions bull Evaluate and perform cost-benefit
analysis of drug-related laws bull Establish substance use disorder
information and referral service ndash physicians (eg prevention of needle sticks
when lancing drug abuse-related abscesses)ndash first responders (eg handling of fentanyl
analogs at drug overdose scenes) ndash law enforcement (eg naloxone
administration training)ndash general public
bull Increase timeliness of public health data sources
bull Use syndromic surveillance data for drug overdose and injury surveillance
bull Algorithm development for milligram morphine equivalent calculations in PDMP reports
bull Death certificate and PDMP data linkage to identify possible drug diversion
bull State advisory group
bull Link Ky CRASH and trauma registry data with FARS driver drug testing results from fatal crashes in 2014
bull Link 2014 trauma registry toxicology result data with inpatient hospitalization data to assess drug overdose and drug abuse coding
Primary populations
bull Opioid overdose victims
bull Pregnant and parenting women
bull Individuals re-entering society upon criminal justice release
bull Adolescents and young adults
Goals
bull Prevent opioid misuse and abuse
bull Increase access to OUD treatment services (eg MAT)
bull Increase availability of recovery support services
bull Increase availability of naloxone
bull Enhance coordination and evaluation of OUD healthcare and public safety strategies
bull KRS 217186- A person or agency including a peace officer jailer firefighter paramedic or emergency medical technician or a school employee authorized to administer medication under KRS 156502 may ndash Receive a prescription for the drug
naloxonendash Possess naloxone pursuant to this
subsection and any equipment needed for its administration
ndash Administer naloxone to an individual suffering from an apparent opiate-related overdose
bull Reduce prescriber opioid prescribing (physicians APRNs etc) to a 3-day supply for injured workers
bull First line treatment based on non-opioid therapy alternatives (physical therapy acupuncture etc)
bull Revise drug formularies for treatment of pain associated with occupational injuries
Prevention Decrease likelihood that Kentuckians develop a SUD through strategies to decrease overexposure of opioid medications and illicit opioids
bull prescriptions (dosage units) overdose deaths containing fentanyl
Harm Reduction Improve Access to Harm Reduction Services to Save Lives
bull naloxone kits dispensed to first responders and public people in syringe exchange programs who received naloxone
Treatment and Recovery Expand access to treatment and recovery supports
bull peer recovery coaches Emergency Departments with peer recovery coaches people with SUD who interact with peer recovery coaches and enter treatment Emergency Department peer follow-up individuals with SUD who receive residential services calls to SUD treatment locator and portal
bull Louisville Metro Police Department presentation
bull Breakout Session
bull First Responder Opioid Exposure Survey development
bull Focus Groups
bull Survey Administration
bull Data Analysis
bull Use of Data Results
bull UK ERC first responder overdose response exposure pilot project opportunity
bull Multistate or single state applicationsndash Use of survey
ndash development of other first responder-related pilot project
FACE case investigations
bull initiated drug overdose prevention conversations
bull enhanced collaborations
bull provided evidence of need for enhanced multidisciplinary drug overdose prevention efforts1 Interventions
2 Policies
3 Research
Ladder rap
httpswwwyoutubecomwatchv=FsW6eb3aO8gampfeature=youtube
BLS Survey of Employers vs Multi-Source Surveillance of Work-Related Injuries
Kenneth D Rosenman MDProfessor of MedicineMichigan State Universitywwwoemmsuedu
NIOSH Expanding Research Partnerships Conference Denver Colorado June 21-23 2017
Funding NIOSH U60 OH008466
Survey of Occupational Injuries and Illnesses (SOII)
bull Injuries and illnesses (based on OSHArsquos recordkeeping standards) from 230000 establishments (sample by state and NAICS code)
bull Redesigned in 1992 to collect circumstances of injuries and illnesses that lead to days away from work and characteristics of affected workers
bull Scope limitations no small farms private household or self-employed workers (lt 2008 no public sector workers)
NATIONAL ACADEMY OF SCIENCES 1987
New Jersey24 Deaths not covered by OSHA35 Deaths covered by OSHA butemployer had NOT recorded on OSHAlog or did NOT keep OSHA log
TexasNIOSH Fatal Occupational Trauma Surveillance
CENSUS OF FATAL OCCUPATIONAL INJURIES (CFOI) BEGAN IN 1992
Multiple death sourcesDeath certificatesEmployer reportingState PoliceNewspaper Clipping ServiceMedical ExaminersAgricultural Extension Service
Number of deaths doubled from previous BLS estimate
How Much Work-Related Injury and Illness is Missed By the Current National Surveillance System
Rosenman KD Kalush A Reilly MJ Gardiner JC Reeves M Luo Z JOEM 2006 48357-365Funding NIOSH 5 R01 OH004276-03
Summary of Analysis Comparing BLS and Worker Comp data Michigan 2009-2001Days away from workbull BLS estimate
37-41 BLS+ WC31-34 BLS + WC+ CaptureRecapture
1999-2001 Estimates - Michiganbull BLS -281567 vs Our Estimate - 868241
1 in 15 workers vs 1 in 5 workers
(Rosenman et al JOEM 2006)
Simplified Flowchart of Events Necessary to the Documentation of Work-Related Injuries and Illnesses
(Azaroff et al AJPH 2002)
Filters to Identifying Work-Related Injuries and Illnesses
a Filters To Reporting to Supervisorsb Filters To Losing Work Time c Filters to Obtaining Medical Cared Filters to Recognizing Work-Related by Doctore Filters to Workersrsquo Compensation being the Payerf Filters To Recording on OSHA Logg Filters to Reporting by Employers to Workersrsquo
Compensation Agencyh Filters to Reporting by Doctors
(Azaroff et al AJPH 2002)
Capture-Recapture Estimates of Workplace Injury and Illness Reporting by BLS Adjusted for Capture
Heterogeneity Lost-Time Cases 1998-2001
Percent Reported to WA WV OR WI NM MNNo Source Dependence 55 76 56 65 51 68
Source Dependence 52 71 45 53 37 53
(Adapted Boden and Ozonoff Annals Epidemiology 2008)
Workersrsquo CompensationState Specific Program
Mandatory insurance or if large enough self-insured
Michigan WC Excludesbull Federal employeesbull Interstate railroad workersbull Maritime workersbull Less than 3 employees at any one timebull All employees work less than 35 hoursweek or
if more hours less than 13 weeksbull Self-employed
Not computerizedbull Medical claims only
Proportion of Work-Injured Adults for Whom Treatment was paid by Workersrsquo Compensation by State-BRFSS 10 States 2007
State Injured with Payment by Workersrsquo Compensation
Texas 47 (95 CI 35-59)New York 50 (95 CI 39-60)Michigan 56 (95 CI 41-69)Massachusetts 60 (95 CI 45-75)California 61 (95 CI 55-66)Washington 61 (95 CI 55-67)Oregon 62 (95 CI 50-74)Connecticut 63 (95 CI 53-74)New Jersey 64 (95 CI 51-78)Kentucky 77 (95 CI 65-89)
Excludes self-employed
(Adapted Bonauto et al MMWR 2010)
Percentage Received Workersrsquo Compensation by Condition Michigan
WageReplacement
Medical Only
No CompEmployed
No Comp Self -Employed
Amputations 64 22 17 6Burns 17 48 33 2Skull Fractures 36 32 29 3
Percent Applied for Workersrsquo Comp among 2016 Cases of Work-Related Asthma Michigan
Overall 484
Still ExposedConditions Unchanged 239No Longer Exposed 575
Quit on Doctorrsquos Advice 778Sick Leave 727Fired 621New Controls 589Chemical Substitution 536Quit on Own 431Reassigned 360
Reasons Didnrsquot File a Workersrsquo Compensation Claims for a Repetitive Trauma Michigan
Only 397 (251) of 1598 Filed WC Claim
Injury Not Serious Enough 705 (591)Did Not Expect to Miss Work 694 (583)Expect to Receive Sick Leave or
Disability 337 (283) Medical Expenses Covered by
Other Insurance 427 (359)Did Not Think Injury Work Related 242 (204)
(Rosenman et al JOEM 2000)
Goals of Surveillance Population-Based
bull Assess Magnitude of Problembull NumbersRatesTrends
bull Determine Relative Importance vs Other Health Issuesbull Identify High Risk
bull IndustriesOccupationsWorker Populations
bull Prioritize Interventions bull Evaluate Interventionsbull Generate Hypotheses for Researchbull Identify Emerging Problemsbull Identify Workplaces for Intervention
Case-Based
Reportable Conditions in Michigan
Local Health DepartmentsCommunicable Diseases (83)
ldquoUnusual occurrence outbreak or epidemic of any disease or conditionsrdquoMDHHS
AbortionsBirth DefectsCancerChemical Poisonings including Carbon MonoxideInjuries Nursing Home Abuse
LARAOccupational Illnesses
County Department of Social ServicesChild AbuseAdult Abuse
PoliceInjury from Knife Gun or Deadly WeaponMental Health Patient Abuse
On Request Only
Laboratory Reporting Regulations Michigan
bull Arsenicbull Cadmiumbull Carboxyhemoglobinbull Cholinesterasebull IgE Antibodiesbull Leadbull Mercury
Occupational Illness Reporting Requirement in Michigan
bull LARA ndash MIOSHAPhysician hospital clinic or employer
having a known or suspected occupational disease or health condition aggravated by workplace exposures shall report within 10 days after discovery
Misdemeanor punishable by a fine of not more than $50
Methodology of Multi-Source Surveillance
Amputations 2006- DateHospitalsEDOutpatient ClinicsWorkersrsquo Compensation Wage Replacement
Crushing Injuries 2013- Date+ FACE Program
Skull Fractures 2012-DateBurns 2009-Date
+ Poison Control Center
bull Quarterly Reporting Specified ICD codes -134 Hospitalsbull Quarterly Reporting all Work-related Events ndash Poison Control Centerbull Electronic Data Base All Paid Claims ndash Workersrsquo Compensationbull FACE ndash Death CertificatesOSHA Hot LinePolice Reports
Work-Related Burn Reports ndash By Source Total 1461 Michigan 2009
n=1460 individuals
450
BLS
HOSPITALSEDs (1248)
4501054
BLSMIFACE 1(2) 1
16721
5 PCC (106)
1321 79
WC(306)
(Kica and Rosenman JOEM 2012)
This might seem like outer space but it isnrsquot rocket science
First Report of Injury (FROI)
Employee
Employer
Injury
Subsequent Report of Injury (SROI)
Medical Billing
ICD-Codes
Facility codes
Revenue codes
Quarterly employer reporting Employee name SSN wages Employer key
Numbers of workers by employer Industry code Ownership code Multi-establishment employer indicator
(MEEI)
bull 150 employment agencies (NAICS 5613)
bull 280K employeesTemp Firms
bull 90 workers in one industrybull 80 without corporate offices
(NAICS 5511)90 Rule
bull Assign unique code to both employers and workers for rate calculation
Remainder
Counts in QCEW multiplied by FTE to EE ratio
Six months of 2015 data Develop methods for matching Evaluate match Compare rates Prepare and plan
And now what yoursquove been waiting forhellip
California
QCEW
Determine industry
Injured
bull 12 million employers bull 16 million employees
bull 119 million employers bull 14 million employees
bull 51000 employersbull 302000 workers
302000 claims
260000 employer match
212000 private sector
184000 industry
Has one job73
Has employer match
9
WONK-y data match
4Did not match
14
WONK-y data match
4
Worker matches multiple employers All employers have
the same industry code One employer has
the same industry code in WCIS Only one employer is
in QCEW
Did not match14
Bad SSN or does not match on SSN Matched multiple employers gt5 employer No WONK-y data match
31 workers per 100 FTE
Rates of Injury by IndustryPrivate sectorJanuary-June 2016
Number of Claims
Rate per 100 FTE
Interurban and Rural Bus Transportation 54 150Couriers and Express Delivery Services 3084 107Building Material and Supplies Dealers 4971 106Animal Slaughtering and Processing 555 90Waste Treatment and Disposal 484 90Poultry and Egg Production 99 89Scheduled Air Transportation 1781 88Motor Vehicle Body and Trailer Manufacturing 243 85Cattle Ranching and Farming 989 81Other General Merchandise Stores 2280 80Other Ambulatory Health Care Services 850 80Foundries 250 79Sheep and Goat Farming 19 77Warehousing and Storage 1349 77Waste Collection 706 76Traveler Accommodation 6780 76Other Furniture Related Product Manufacturing 118 71Forging and Stamping 297 70Logging 58 69Sawmills and Wood Preservation 52 68
Rates of Injury by IndustryPrivate sectorJanuary-June 2016
Number of Claims
Rate per 100 FTE
Interurban and Rural Bus Transportation 54 150Couriers and Express Delivery Services 3084 107Building Material and Supplies Dealers 4971 106Animal Slaughtering and Processing 555 90Waste Treatment and Disposal 484 90Poultry and Egg Production 99 89Scheduled Air Transportation 1781 88Motor Vehicle Body and Trailer Manufacturing 243 85Cattle Ranching and Farming 989 81Other General Merchandise Stores 2280 80Other Ambulatory Health Care Services 850 80Foundries 250 79Sheep and Goat Farming 19 77Warehousing and Storage 1349 77Waste Collection 706 76Traveler Accommodation 6780 76Other Furniture Related Product Manufacturing 118 71Forging and Stamping 297 70Logging 58 69Sawmills and Wood Preservation 52 68
Rates of Injury by IndustryPrivate sectorJanuary-June 2016
Number of Claims
Rate per 100 FTE
Interurban and Rural Bus Transportation 54 150Couriers and Express Delivery Services 3084 107Building Material and Supplies Dealers 4971 106Animal Slaughtering and Processing 555 90Waste Treatment and Disposal 484 90Poultry and Egg Production 99 89Scheduled Air Transportation 1781 88Motor Vehicle Body and Trailer Manufacturing 243 85Cattle Ranching and Farming 989 81Other General Merchandise Stores 2280 80Other Ambulatory Health Care Services 850 80Foundries 250 79Sheep and Goat Farming 19 77Warehousing and Storage 1349 77Waste Collection 706 76Traveler Accommodation 6780 76Other Furniture Related Product Manufacturing 118 71Forging and Stamping 297 70Logging 58 69Sawmills and Wood Preservation 52 68
Rates of Injury by IndustryPrivate sectorJanuary-June 2016
Number of Claims
Rate per 100 FTE
Interurban and Rural Bus Transportation 54 150Couriers and Express Delivery Services 3084 107Building Material and Supplies Dealers 4971 106Animal Slaughtering and Processing 555 90Waste Treatment and Disposal 484 90Poultry and Egg Production 99 89Scheduled Air Transportation 1781 88Motor Vehicle Body and Trailer Manufacturing 243 85Cattle Ranching and Farming 989 81Other General Merchandise Stores 2280 80Other Ambulatory Health Care Services 850 80Foundries 250 79Sheep and Goat Farming 19 77Warehousing and Storage 1349 77Waste Collection 706 76Traveler Accommodation 6780 76Other Furniture Related Product Manufacturing 118 71Forging and Stamping 297 70Logging 58 69Sawmills and Wood Preservation 52 68
Rates of Injury by IndustryPrivate sectorJanuary-June 2016
Number of Claims
Rate per 100 FTE
Interurban and Rural Bus Transportation 54 150Couriers and Express Delivery Services 3084 107Building Material and Supplies Dealers 4971 106Animal Slaughtering and Processing 555 90Waste Treatment and Disposal 484 90Poultry and Egg Production 99 89Scheduled Air Transportation 1781 88Motor Vehicle Body and Trailer Manufacturing 243 85Cattle Ranching and Farming 989 81Other General Merchandise Stores 2280 80Other Ambulatory Health Care Services 850 80Foundries 250 79Sheep and Goat Farming 19 77Warehousing and Storage 1349 77Waste Collection 706 76Traveler Accommodation 6780 76Other Furniture Related Product Manufacturing 118 71Forging and Stamping 297 70Logging 58 69Sawmills and Wood Preservation 52 68
IndustryCA Rate per
100 FTENational Overall SOII
Rate per 100 FTE
Couriers and Express Delivery Services 107 74
Animal Slaughtering and Processing 90 54
Poultry and Egg Production 89 69
Scheduled Air Transportation 88 66
Cattle Ranching and Farming 81 64
Foundries 79 67
Sheep and Goat Farming 77 --
Warehousing and Storage 77 50
Traveler Accommodation 76 50
Forging and Stamping 70 53
Sawmills and Wood Preservation 68 69
IndustryCA Rate per 100
FTENational Overall SOII
Rate per 100 FTE
Interurban and Rural Bus Transportation 150 30
Building Material and Supplies Dealers 106 48
Waste Treatment and Disposal 90 33
Motor Vehicle Body and Trailer Manufacturing 85 79
Other General Merchandise Stores 80 49
Other Ambulatory Health Care Services 80 30
Waste Collection 76 46
Other Furniture Related Product Manufacturing 71 55
Logging 69 37
Collaboration
Data sharing agreements
Pilot rates
Sharable repeatable methods and code
Contribution to national discussions about
use of WC data
Workers not captured by our method
Public sector
People who do not file claims
Data analysis for 2015-2016 Data analysis report Surveillance system evaluation
Publicly available dataset Disseminate findings Sustainability
California Department of Public Health John Beckman Matt Frederick Bob Harrison
California Department of Industrial Relations Genet Daba John Gordon Liza Dizon Glenn Shor Meitong Jin
California Employment Development Department Andy Wong Spencer Wong
Terry Bunn PhDDirector Kentucky Injury Prevention and Research
Center bona fide agent for the Kentucky Department for Public Health
Associate Professor Departments of Epidemiology and Preventive Medicine and Environmental Health University of Kentucky College of Public Health
bull Occupational motor vehicle crash investigations a priority focus area since 2005
KOSHS
Case Example
Case Example
bull Substance abuse a priority focus areabull State injury prevention planbull Legislation data support (HB1)
ndash Pill millsndash Clinical prescribing regulationsndash Decedent controlled substance testing lawndash Inter-state prescription drug monitoring
program (PDMP) data sharing
bull Use of PDMP data for public health surveillance
bull Inform community interventions bull Evaluate and perform cost-benefit
analysis of drug-related laws bull Establish substance use disorder
information and referral service ndash physicians (eg prevention of needle sticks
when lancing drug abuse-related abscesses)ndash first responders (eg handling of fentanyl
analogs at drug overdose scenes) ndash law enforcement (eg naloxone
administration training)ndash general public
bull Increase timeliness of public health data sources
bull Use syndromic surveillance data for drug overdose and injury surveillance
bull Algorithm development for milligram morphine equivalent calculations in PDMP reports
bull Death certificate and PDMP data linkage to identify possible drug diversion
bull State advisory group
bull Link Ky CRASH and trauma registry data with FARS driver drug testing results from fatal crashes in 2014
bull Link 2014 trauma registry toxicology result data with inpatient hospitalization data to assess drug overdose and drug abuse coding
Primary populations
bull Opioid overdose victims
bull Pregnant and parenting women
bull Individuals re-entering society upon criminal justice release
bull Adolescents and young adults
Goals
bull Prevent opioid misuse and abuse
bull Increase access to OUD treatment services (eg MAT)
bull Increase availability of recovery support services
bull Increase availability of naloxone
bull Enhance coordination and evaluation of OUD healthcare and public safety strategies
bull KRS 217186- A person or agency including a peace officer jailer firefighter paramedic or emergency medical technician or a school employee authorized to administer medication under KRS 156502 may ndash Receive a prescription for the drug
naloxonendash Possess naloxone pursuant to this
subsection and any equipment needed for its administration
ndash Administer naloxone to an individual suffering from an apparent opiate-related overdose
bull Reduce prescriber opioid prescribing (physicians APRNs etc) to a 3-day supply for injured workers
bull First line treatment based on non-opioid therapy alternatives (physical therapy acupuncture etc)
bull Revise drug formularies for treatment of pain associated with occupational injuries
Prevention Decrease likelihood that Kentuckians develop a SUD through strategies to decrease overexposure of opioid medications and illicit opioids
bull prescriptions (dosage units) overdose deaths containing fentanyl
Harm Reduction Improve Access to Harm Reduction Services to Save Lives
bull naloxone kits dispensed to first responders and public people in syringe exchange programs who received naloxone
Treatment and Recovery Expand access to treatment and recovery supports
bull peer recovery coaches Emergency Departments with peer recovery coaches people with SUD who interact with peer recovery coaches and enter treatment Emergency Department peer follow-up individuals with SUD who receive residential services calls to SUD treatment locator and portal
bull Louisville Metro Police Department presentation
bull Breakout Session
bull First Responder Opioid Exposure Survey development
bull Focus Groups
bull Survey Administration
bull Data Analysis
bull Use of Data Results
bull UK ERC first responder overdose response exposure pilot project opportunity
bull Multistate or single state applicationsndash Use of survey
ndash development of other first responder-related pilot project
FACE case investigations
bull initiated drug overdose prevention conversations
bull enhanced collaborations
bull provided evidence of need for enhanced multidisciplinary drug overdose prevention efforts1 Interventions
2 Policies
3 Research
Ladder rap
httpswwwyoutubecomwatchv=FsW6eb3aO8gampfeature=youtube
BLS Survey of Employers vs Multi-Source Surveillance of Work-Related Injuries
Kenneth D Rosenman MDProfessor of MedicineMichigan State Universitywwwoemmsuedu
NIOSH Expanding Research Partnerships Conference Denver Colorado June 21-23 2017
Funding NIOSH U60 OH008466
Survey of Occupational Injuries and Illnesses (SOII)
bull Injuries and illnesses (based on OSHArsquos recordkeeping standards) from 230000 establishments (sample by state and NAICS code)
bull Redesigned in 1992 to collect circumstances of injuries and illnesses that lead to days away from work and characteristics of affected workers
bull Scope limitations no small farms private household or self-employed workers (lt 2008 no public sector workers)
NATIONAL ACADEMY OF SCIENCES 1987
New Jersey24 Deaths not covered by OSHA35 Deaths covered by OSHA butemployer had NOT recorded on OSHAlog or did NOT keep OSHA log
TexasNIOSH Fatal Occupational Trauma Surveillance
CENSUS OF FATAL OCCUPATIONAL INJURIES (CFOI) BEGAN IN 1992
Multiple death sourcesDeath certificatesEmployer reportingState PoliceNewspaper Clipping ServiceMedical ExaminersAgricultural Extension Service
Number of deaths doubled from previous BLS estimate
How Much Work-Related Injury and Illness is Missed By the Current National Surveillance System
Rosenman KD Kalush A Reilly MJ Gardiner JC Reeves M Luo Z JOEM 2006 48357-365Funding NIOSH 5 R01 OH004276-03
Summary of Analysis Comparing BLS and Worker Comp data Michigan 2009-2001Days away from workbull BLS estimate
37-41 BLS+ WC31-34 BLS + WC+ CaptureRecapture
1999-2001 Estimates - Michiganbull BLS -281567 vs Our Estimate - 868241
1 in 15 workers vs 1 in 5 workers
(Rosenman et al JOEM 2006)
Simplified Flowchart of Events Necessary to the Documentation of Work-Related Injuries and Illnesses
(Azaroff et al AJPH 2002)
Filters to Identifying Work-Related Injuries and Illnesses
a Filters To Reporting to Supervisorsb Filters To Losing Work Time c Filters to Obtaining Medical Cared Filters to Recognizing Work-Related by Doctore Filters to Workersrsquo Compensation being the Payerf Filters To Recording on OSHA Logg Filters to Reporting by Employers to Workersrsquo
Compensation Agencyh Filters to Reporting by Doctors
(Azaroff et al AJPH 2002)
Capture-Recapture Estimates of Workplace Injury and Illness Reporting by BLS Adjusted for Capture
Heterogeneity Lost-Time Cases 1998-2001
Percent Reported to WA WV OR WI NM MNNo Source Dependence 55 76 56 65 51 68
Source Dependence 52 71 45 53 37 53
(Adapted Boden and Ozonoff Annals Epidemiology 2008)
Workersrsquo CompensationState Specific Program
Mandatory insurance or if large enough self-insured
Michigan WC Excludesbull Federal employeesbull Interstate railroad workersbull Maritime workersbull Less than 3 employees at any one timebull All employees work less than 35 hoursweek or
if more hours less than 13 weeksbull Self-employed
Not computerizedbull Medical claims only
Proportion of Work-Injured Adults for Whom Treatment was paid by Workersrsquo Compensation by State-BRFSS 10 States 2007
State Injured with Payment by Workersrsquo Compensation
Texas 47 (95 CI 35-59)New York 50 (95 CI 39-60)Michigan 56 (95 CI 41-69)Massachusetts 60 (95 CI 45-75)California 61 (95 CI 55-66)Washington 61 (95 CI 55-67)Oregon 62 (95 CI 50-74)Connecticut 63 (95 CI 53-74)New Jersey 64 (95 CI 51-78)Kentucky 77 (95 CI 65-89)
Excludes self-employed
(Adapted Bonauto et al MMWR 2010)
Percentage Received Workersrsquo Compensation by Condition Michigan
WageReplacement
Medical Only
No CompEmployed
No Comp Self -Employed
Amputations 64 22 17 6Burns 17 48 33 2Skull Fractures 36 32 29 3
Percent Applied for Workersrsquo Comp among 2016 Cases of Work-Related Asthma Michigan
Overall 484
Still ExposedConditions Unchanged 239No Longer Exposed 575
Quit on Doctorrsquos Advice 778Sick Leave 727Fired 621New Controls 589Chemical Substitution 536Quit on Own 431Reassigned 360
Reasons Didnrsquot File a Workersrsquo Compensation Claims for a Repetitive Trauma Michigan
Only 397 (251) of 1598 Filed WC Claim
Injury Not Serious Enough 705 (591)Did Not Expect to Miss Work 694 (583)Expect to Receive Sick Leave or
Disability 337 (283) Medical Expenses Covered by
Other Insurance 427 (359)Did Not Think Injury Work Related 242 (204)
(Rosenman et al JOEM 2000)
Goals of Surveillance Population-Based
bull Assess Magnitude of Problembull NumbersRatesTrends
bull Determine Relative Importance vs Other Health Issuesbull Identify High Risk
bull IndustriesOccupationsWorker Populations
bull Prioritize Interventions bull Evaluate Interventionsbull Generate Hypotheses for Researchbull Identify Emerging Problemsbull Identify Workplaces for Intervention
Case-Based
Reportable Conditions in Michigan
Local Health DepartmentsCommunicable Diseases (83)
ldquoUnusual occurrence outbreak or epidemic of any disease or conditionsrdquoMDHHS
AbortionsBirth DefectsCancerChemical Poisonings including Carbon MonoxideInjuries Nursing Home Abuse
LARAOccupational Illnesses
County Department of Social ServicesChild AbuseAdult Abuse
PoliceInjury from Knife Gun or Deadly WeaponMental Health Patient Abuse
On Request Only
Laboratory Reporting Regulations Michigan
bull Arsenicbull Cadmiumbull Carboxyhemoglobinbull Cholinesterasebull IgE Antibodiesbull Leadbull Mercury
Occupational Illness Reporting Requirement in Michigan
bull LARA ndash MIOSHAPhysician hospital clinic or employer
having a known or suspected occupational disease or health condition aggravated by workplace exposures shall report within 10 days after discovery
Misdemeanor punishable by a fine of not more than $50
Methodology of Multi-Source Surveillance
Amputations 2006- DateHospitalsEDOutpatient ClinicsWorkersrsquo Compensation Wage Replacement
Crushing Injuries 2013- Date+ FACE Program
Skull Fractures 2012-DateBurns 2009-Date
+ Poison Control Center
bull Quarterly Reporting Specified ICD codes -134 Hospitalsbull Quarterly Reporting all Work-related Events ndash Poison Control Centerbull Electronic Data Base All Paid Claims ndash Workersrsquo Compensationbull FACE ndash Death CertificatesOSHA Hot LinePolice Reports
Work-Related Burn Reports ndash By Source Total 1461 Michigan 2009
n=1460 individuals
450
BLS
HOSPITALSEDs (1248)
4501054
BLSMIFACE 1(2) 1
16721
5 PCC (106)
1321 79
WC(306)
(Kica and Rosenman JOEM 2012)
First Report of Injury (FROI)
Employee
Employer
Injury
Subsequent Report of Injury (SROI)
Medical Billing
ICD-Codes
Facility codes
Revenue codes
Quarterly employer reporting Employee name SSN wages Employer key
Numbers of workers by employer Industry code Ownership code Multi-establishment employer indicator
(MEEI)
bull 150 employment agencies (NAICS 5613)
bull 280K employeesTemp Firms
bull 90 workers in one industrybull 80 without corporate offices
(NAICS 5511)90 Rule
bull Assign unique code to both employers and workers for rate calculation
Remainder
Counts in QCEW multiplied by FTE to EE ratio
Six months of 2015 data Develop methods for matching Evaluate match Compare rates Prepare and plan
And now what yoursquove been waiting forhellip
California
QCEW
Determine industry
Injured
bull 12 million employers bull 16 million employees
bull 119 million employers bull 14 million employees
bull 51000 employersbull 302000 workers
302000 claims
260000 employer match
212000 private sector
184000 industry
Has one job73
Has employer match
9
WONK-y data match
4Did not match
14
WONK-y data match
4
Worker matches multiple employers All employers have
the same industry code One employer has
the same industry code in WCIS Only one employer is
in QCEW
Did not match14
Bad SSN or does not match on SSN Matched multiple employers gt5 employer No WONK-y data match
31 workers per 100 FTE
Rates of Injury by IndustryPrivate sectorJanuary-June 2016
Number of Claims
Rate per 100 FTE
Interurban and Rural Bus Transportation 54 150Couriers and Express Delivery Services 3084 107Building Material and Supplies Dealers 4971 106Animal Slaughtering and Processing 555 90Waste Treatment and Disposal 484 90Poultry and Egg Production 99 89Scheduled Air Transportation 1781 88Motor Vehicle Body and Trailer Manufacturing 243 85Cattle Ranching and Farming 989 81Other General Merchandise Stores 2280 80Other Ambulatory Health Care Services 850 80Foundries 250 79Sheep and Goat Farming 19 77Warehousing and Storage 1349 77Waste Collection 706 76Traveler Accommodation 6780 76Other Furniture Related Product Manufacturing 118 71Forging and Stamping 297 70Logging 58 69Sawmills and Wood Preservation 52 68
Rates of Injury by IndustryPrivate sectorJanuary-June 2016
Number of Claims
Rate per 100 FTE
Interurban and Rural Bus Transportation 54 150Couriers and Express Delivery Services 3084 107Building Material and Supplies Dealers 4971 106Animal Slaughtering and Processing 555 90Waste Treatment and Disposal 484 90Poultry and Egg Production 99 89Scheduled Air Transportation 1781 88Motor Vehicle Body and Trailer Manufacturing 243 85Cattle Ranching and Farming 989 81Other General Merchandise Stores 2280 80Other Ambulatory Health Care Services 850 80Foundries 250 79Sheep and Goat Farming 19 77Warehousing and Storage 1349 77Waste Collection 706 76Traveler Accommodation 6780 76Other Furniture Related Product Manufacturing 118 71Forging and Stamping 297 70Logging 58 69Sawmills and Wood Preservation 52 68
Rates of Injury by IndustryPrivate sectorJanuary-June 2016
Number of Claims
Rate per 100 FTE
Interurban and Rural Bus Transportation 54 150Couriers and Express Delivery Services 3084 107Building Material and Supplies Dealers 4971 106Animal Slaughtering and Processing 555 90Waste Treatment and Disposal 484 90Poultry and Egg Production 99 89Scheduled Air Transportation 1781 88Motor Vehicle Body and Trailer Manufacturing 243 85Cattle Ranching and Farming 989 81Other General Merchandise Stores 2280 80Other Ambulatory Health Care Services 850 80Foundries 250 79Sheep and Goat Farming 19 77Warehousing and Storage 1349 77Waste Collection 706 76Traveler Accommodation 6780 76Other Furniture Related Product Manufacturing 118 71Forging and Stamping 297 70Logging 58 69Sawmills and Wood Preservation 52 68
Rates of Injury by IndustryPrivate sectorJanuary-June 2016
Number of Claims
Rate per 100 FTE
Interurban and Rural Bus Transportation 54 150Couriers and Express Delivery Services 3084 107Building Material and Supplies Dealers 4971 106Animal Slaughtering and Processing 555 90Waste Treatment and Disposal 484 90Poultry and Egg Production 99 89Scheduled Air Transportation 1781 88Motor Vehicle Body and Trailer Manufacturing 243 85Cattle Ranching and Farming 989 81Other General Merchandise Stores 2280 80Other Ambulatory Health Care Services 850 80Foundries 250 79Sheep and Goat Farming 19 77Warehousing and Storage 1349 77Waste Collection 706 76Traveler Accommodation 6780 76Other Furniture Related Product Manufacturing 118 71Forging and Stamping 297 70Logging 58 69Sawmills and Wood Preservation 52 68
Rates of Injury by IndustryPrivate sectorJanuary-June 2016
Number of Claims
Rate per 100 FTE
Interurban and Rural Bus Transportation 54 150Couriers and Express Delivery Services 3084 107Building Material and Supplies Dealers 4971 106Animal Slaughtering and Processing 555 90Waste Treatment and Disposal 484 90Poultry and Egg Production 99 89Scheduled Air Transportation 1781 88Motor Vehicle Body and Trailer Manufacturing 243 85Cattle Ranching and Farming 989 81Other General Merchandise Stores 2280 80Other Ambulatory Health Care Services 850 80Foundries 250 79Sheep and Goat Farming 19 77Warehousing and Storage 1349 77Waste Collection 706 76Traveler Accommodation 6780 76Other Furniture Related Product Manufacturing 118 71Forging and Stamping 297 70Logging 58 69Sawmills and Wood Preservation 52 68
IndustryCA Rate per
100 FTENational Overall SOII
Rate per 100 FTE
Couriers and Express Delivery Services 107 74
Animal Slaughtering and Processing 90 54
Poultry and Egg Production 89 69
Scheduled Air Transportation 88 66
Cattle Ranching and Farming 81 64
Foundries 79 67
Sheep and Goat Farming 77 --
Warehousing and Storage 77 50
Traveler Accommodation 76 50
Forging and Stamping 70 53
Sawmills and Wood Preservation 68 69
IndustryCA Rate per 100
FTENational Overall SOII
Rate per 100 FTE
Interurban and Rural Bus Transportation 150 30
Building Material and Supplies Dealers 106 48
Waste Treatment and Disposal 90 33
Motor Vehicle Body and Trailer Manufacturing 85 79
Other General Merchandise Stores 80 49
Other Ambulatory Health Care Services 80 30
Waste Collection 76 46
Other Furniture Related Product Manufacturing 71 55
Logging 69 37
Collaboration
Data sharing agreements
Pilot rates
Sharable repeatable methods and code
Contribution to national discussions about
use of WC data
Workers not captured by our method
Public sector
People who do not file claims
Data analysis for 2015-2016 Data analysis report Surveillance system evaluation
Publicly available dataset Disseminate findings Sustainability
California Department of Public Health John Beckman Matt Frederick Bob Harrison
California Department of Industrial Relations Genet Daba John Gordon Liza Dizon Glenn Shor Meitong Jin
California Employment Development Department Andy Wong Spencer Wong
Terry Bunn PhDDirector Kentucky Injury Prevention and Research
Center bona fide agent for the Kentucky Department for Public Health
Associate Professor Departments of Epidemiology and Preventive Medicine and Environmental Health University of Kentucky College of Public Health
bull Occupational motor vehicle crash investigations a priority focus area since 2005
KOSHS
Case Example
Case Example
bull Substance abuse a priority focus areabull State injury prevention planbull Legislation data support (HB1)
ndash Pill millsndash Clinical prescribing regulationsndash Decedent controlled substance testing lawndash Inter-state prescription drug monitoring
program (PDMP) data sharing
bull Use of PDMP data for public health surveillance
bull Inform community interventions bull Evaluate and perform cost-benefit
analysis of drug-related laws bull Establish substance use disorder
information and referral service ndash physicians (eg prevention of needle sticks
when lancing drug abuse-related abscesses)ndash first responders (eg handling of fentanyl
analogs at drug overdose scenes) ndash law enforcement (eg naloxone
administration training)ndash general public
bull Increase timeliness of public health data sources
bull Use syndromic surveillance data for drug overdose and injury surveillance
bull Algorithm development for milligram morphine equivalent calculations in PDMP reports
bull Death certificate and PDMP data linkage to identify possible drug diversion
bull State advisory group
bull Link Ky CRASH and trauma registry data with FARS driver drug testing results from fatal crashes in 2014
bull Link 2014 trauma registry toxicology result data with inpatient hospitalization data to assess drug overdose and drug abuse coding
Primary populations
bull Opioid overdose victims
bull Pregnant and parenting women
bull Individuals re-entering society upon criminal justice release
bull Adolescents and young adults
Goals
bull Prevent opioid misuse and abuse
bull Increase access to OUD treatment services (eg MAT)
bull Increase availability of recovery support services
bull Increase availability of naloxone
bull Enhance coordination and evaluation of OUD healthcare and public safety strategies
bull KRS 217186- A person or agency including a peace officer jailer firefighter paramedic or emergency medical technician or a school employee authorized to administer medication under KRS 156502 may ndash Receive a prescription for the drug
naloxonendash Possess naloxone pursuant to this
subsection and any equipment needed for its administration
ndash Administer naloxone to an individual suffering from an apparent opiate-related overdose
bull Reduce prescriber opioid prescribing (physicians APRNs etc) to a 3-day supply for injured workers
bull First line treatment based on non-opioid therapy alternatives (physical therapy acupuncture etc)
bull Revise drug formularies for treatment of pain associated with occupational injuries
Prevention Decrease likelihood that Kentuckians develop a SUD through strategies to decrease overexposure of opioid medications and illicit opioids
bull prescriptions (dosage units) overdose deaths containing fentanyl
Harm Reduction Improve Access to Harm Reduction Services to Save Lives
bull naloxone kits dispensed to first responders and public people in syringe exchange programs who received naloxone
Treatment and Recovery Expand access to treatment and recovery supports
bull peer recovery coaches Emergency Departments with peer recovery coaches people with SUD who interact with peer recovery coaches and enter treatment Emergency Department peer follow-up individuals with SUD who receive residential services calls to SUD treatment locator and portal
bull Louisville Metro Police Department presentation
bull Breakout Session
bull First Responder Opioid Exposure Survey development
bull Focus Groups
bull Survey Administration
bull Data Analysis
bull Use of Data Results
bull UK ERC first responder overdose response exposure pilot project opportunity
bull Multistate or single state applicationsndash Use of survey
ndash development of other first responder-related pilot project
FACE case investigations
bull initiated drug overdose prevention conversations
bull enhanced collaborations
bull provided evidence of need for enhanced multidisciplinary drug overdose prevention efforts1 Interventions
2 Policies
3 Research
Ladder rap
httpswwwyoutubecomwatchv=FsW6eb3aO8gampfeature=youtube
BLS Survey of Employers vs Multi-Source Surveillance of Work-Related Injuries
Kenneth D Rosenman MDProfessor of MedicineMichigan State Universitywwwoemmsuedu
NIOSH Expanding Research Partnerships Conference Denver Colorado June 21-23 2017
Funding NIOSH U60 OH008466
Survey of Occupational Injuries and Illnesses (SOII)
bull Injuries and illnesses (based on OSHArsquos recordkeeping standards) from 230000 establishments (sample by state and NAICS code)
bull Redesigned in 1992 to collect circumstances of injuries and illnesses that lead to days away from work and characteristics of affected workers
bull Scope limitations no small farms private household or self-employed workers (lt 2008 no public sector workers)
NATIONAL ACADEMY OF SCIENCES 1987
New Jersey24 Deaths not covered by OSHA35 Deaths covered by OSHA butemployer had NOT recorded on OSHAlog or did NOT keep OSHA log
TexasNIOSH Fatal Occupational Trauma Surveillance
CENSUS OF FATAL OCCUPATIONAL INJURIES (CFOI) BEGAN IN 1992
Multiple death sourcesDeath certificatesEmployer reportingState PoliceNewspaper Clipping ServiceMedical ExaminersAgricultural Extension Service
Number of deaths doubled from previous BLS estimate
How Much Work-Related Injury and Illness is Missed By the Current National Surveillance System
Rosenman KD Kalush A Reilly MJ Gardiner JC Reeves M Luo Z JOEM 2006 48357-365Funding NIOSH 5 R01 OH004276-03
Summary of Analysis Comparing BLS and Worker Comp data Michigan 2009-2001Days away from workbull BLS estimate
37-41 BLS+ WC31-34 BLS + WC+ CaptureRecapture
1999-2001 Estimates - Michiganbull BLS -281567 vs Our Estimate - 868241
1 in 15 workers vs 1 in 5 workers
(Rosenman et al JOEM 2006)
Simplified Flowchart of Events Necessary to the Documentation of Work-Related Injuries and Illnesses
(Azaroff et al AJPH 2002)
Filters to Identifying Work-Related Injuries and Illnesses
a Filters To Reporting to Supervisorsb Filters To Losing Work Time c Filters to Obtaining Medical Cared Filters to Recognizing Work-Related by Doctore Filters to Workersrsquo Compensation being the Payerf Filters To Recording on OSHA Logg Filters to Reporting by Employers to Workersrsquo
Compensation Agencyh Filters to Reporting by Doctors
(Azaroff et al AJPH 2002)
Capture-Recapture Estimates of Workplace Injury and Illness Reporting by BLS Adjusted for Capture
Heterogeneity Lost-Time Cases 1998-2001
Percent Reported to WA WV OR WI NM MNNo Source Dependence 55 76 56 65 51 68
Source Dependence 52 71 45 53 37 53
(Adapted Boden and Ozonoff Annals Epidemiology 2008)
Workersrsquo CompensationState Specific Program
Mandatory insurance or if large enough self-insured
Michigan WC Excludesbull Federal employeesbull Interstate railroad workersbull Maritime workersbull Less than 3 employees at any one timebull All employees work less than 35 hoursweek or
if more hours less than 13 weeksbull Self-employed
Not computerizedbull Medical claims only
Proportion of Work-Injured Adults for Whom Treatment was paid by Workersrsquo Compensation by State-BRFSS 10 States 2007
State Injured with Payment by Workersrsquo Compensation
Texas 47 (95 CI 35-59)New York 50 (95 CI 39-60)Michigan 56 (95 CI 41-69)Massachusetts 60 (95 CI 45-75)California 61 (95 CI 55-66)Washington 61 (95 CI 55-67)Oregon 62 (95 CI 50-74)Connecticut 63 (95 CI 53-74)New Jersey 64 (95 CI 51-78)Kentucky 77 (95 CI 65-89)
Excludes self-employed
(Adapted Bonauto et al MMWR 2010)
Percentage Received Workersrsquo Compensation by Condition Michigan
WageReplacement
Medical Only
No CompEmployed
No Comp Self -Employed
Amputations 64 22 17 6Burns 17 48 33 2Skull Fractures 36 32 29 3
Percent Applied for Workersrsquo Comp among 2016 Cases of Work-Related Asthma Michigan
Overall 484
Still ExposedConditions Unchanged 239No Longer Exposed 575
Quit on Doctorrsquos Advice 778Sick Leave 727Fired 621New Controls 589Chemical Substitution 536Quit on Own 431Reassigned 360
Reasons Didnrsquot File a Workersrsquo Compensation Claims for a Repetitive Trauma Michigan
Only 397 (251) of 1598 Filed WC Claim
Injury Not Serious Enough 705 (591)Did Not Expect to Miss Work 694 (583)Expect to Receive Sick Leave or
Disability 337 (283) Medical Expenses Covered by
Other Insurance 427 (359)Did Not Think Injury Work Related 242 (204)
(Rosenman et al JOEM 2000)
Goals of Surveillance Population-Based
bull Assess Magnitude of Problembull NumbersRatesTrends
bull Determine Relative Importance vs Other Health Issuesbull Identify High Risk
bull IndustriesOccupationsWorker Populations
bull Prioritize Interventions bull Evaluate Interventionsbull Generate Hypotheses for Researchbull Identify Emerging Problemsbull Identify Workplaces for Intervention
Case-Based
Reportable Conditions in Michigan
Local Health DepartmentsCommunicable Diseases (83)
ldquoUnusual occurrence outbreak or epidemic of any disease or conditionsrdquoMDHHS
AbortionsBirth DefectsCancerChemical Poisonings including Carbon MonoxideInjuries Nursing Home Abuse
LARAOccupational Illnesses
County Department of Social ServicesChild AbuseAdult Abuse
PoliceInjury from Knife Gun or Deadly WeaponMental Health Patient Abuse
On Request Only
Laboratory Reporting Regulations Michigan
bull Arsenicbull Cadmiumbull Carboxyhemoglobinbull Cholinesterasebull IgE Antibodiesbull Leadbull Mercury
Occupational Illness Reporting Requirement in Michigan
bull LARA ndash MIOSHAPhysician hospital clinic or employer
having a known or suspected occupational disease or health condition aggravated by workplace exposures shall report within 10 days after discovery
Misdemeanor punishable by a fine of not more than $50
Methodology of Multi-Source Surveillance
Amputations 2006- DateHospitalsEDOutpatient ClinicsWorkersrsquo Compensation Wage Replacement
Crushing Injuries 2013- Date+ FACE Program
Skull Fractures 2012-DateBurns 2009-Date
+ Poison Control Center
bull Quarterly Reporting Specified ICD codes -134 Hospitalsbull Quarterly Reporting all Work-related Events ndash Poison Control Centerbull Electronic Data Base All Paid Claims ndash Workersrsquo Compensationbull FACE ndash Death CertificatesOSHA Hot LinePolice Reports
Work-Related Burn Reports ndash By Source Total 1461 Michigan 2009
n=1460 individuals
450
BLS
HOSPITALSEDs (1248)
4501054
BLSMIFACE 1(2) 1
16721
5 PCC (106)
1321 79
WC(306)
(Kica and Rosenman JOEM 2012)
Quarterly employer reporting Employee name SSN wages Employer key
Numbers of workers by employer Industry code Ownership code Multi-establishment employer indicator
(MEEI)
bull 150 employment agencies (NAICS 5613)
bull 280K employeesTemp Firms
bull 90 workers in one industrybull 80 without corporate offices
(NAICS 5511)90 Rule
bull Assign unique code to both employers and workers for rate calculation
Remainder
Counts in QCEW multiplied by FTE to EE ratio
Six months of 2015 data Develop methods for matching Evaluate match Compare rates Prepare and plan
And now what yoursquove been waiting forhellip
California
QCEW
Determine industry
Injured
bull 12 million employers bull 16 million employees
bull 119 million employers bull 14 million employees
bull 51000 employersbull 302000 workers
302000 claims
260000 employer match
212000 private sector
184000 industry
Has one job73
Has employer match
9
WONK-y data match
4Did not match
14
WONK-y data match
4
Worker matches multiple employers All employers have
the same industry code One employer has
the same industry code in WCIS Only one employer is
in QCEW
Did not match14
Bad SSN or does not match on SSN Matched multiple employers gt5 employer No WONK-y data match
31 workers per 100 FTE
Rates of Injury by IndustryPrivate sectorJanuary-June 2016
Number of Claims
Rate per 100 FTE
Interurban and Rural Bus Transportation 54 150Couriers and Express Delivery Services 3084 107Building Material and Supplies Dealers 4971 106Animal Slaughtering and Processing 555 90Waste Treatment and Disposal 484 90Poultry and Egg Production 99 89Scheduled Air Transportation 1781 88Motor Vehicle Body and Trailer Manufacturing 243 85Cattle Ranching and Farming 989 81Other General Merchandise Stores 2280 80Other Ambulatory Health Care Services 850 80Foundries 250 79Sheep and Goat Farming 19 77Warehousing and Storage 1349 77Waste Collection 706 76Traveler Accommodation 6780 76Other Furniture Related Product Manufacturing 118 71Forging and Stamping 297 70Logging 58 69Sawmills and Wood Preservation 52 68
Rates of Injury by IndustryPrivate sectorJanuary-June 2016
Number of Claims
Rate per 100 FTE
Interurban and Rural Bus Transportation 54 150Couriers and Express Delivery Services 3084 107Building Material and Supplies Dealers 4971 106Animal Slaughtering and Processing 555 90Waste Treatment and Disposal 484 90Poultry and Egg Production 99 89Scheduled Air Transportation 1781 88Motor Vehicle Body and Trailer Manufacturing 243 85Cattle Ranching and Farming 989 81Other General Merchandise Stores 2280 80Other Ambulatory Health Care Services 850 80Foundries 250 79Sheep and Goat Farming 19 77Warehousing and Storage 1349 77Waste Collection 706 76Traveler Accommodation 6780 76Other Furniture Related Product Manufacturing 118 71Forging and Stamping 297 70Logging 58 69Sawmills and Wood Preservation 52 68
Rates of Injury by IndustryPrivate sectorJanuary-June 2016
Number of Claims
Rate per 100 FTE
Interurban and Rural Bus Transportation 54 150Couriers and Express Delivery Services 3084 107Building Material and Supplies Dealers 4971 106Animal Slaughtering and Processing 555 90Waste Treatment and Disposal 484 90Poultry and Egg Production 99 89Scheduled Air Transportation 1781 88Motor Vehicle Body and Trailer Manufacturing 243 85Cattle Ranching and Farming 989 81Other General Merchandise Stores 2280 80Other Ambulatory Health Care Services 850 80Foundries 250 79Sheep and Goat Farming 19 77Warehousing and Storage 1349 77Waste Collection 706 76Traveler Accommodation 6780 76Other Furniture Related Product Manufacturing 118 71Forging and Stamping 297 70Logging 58 69Sawmills and Wood Preservation 52 68
Rates of Injury by IndustryPrivate sectorJanuary-June 2016
Number of Claims
Rate per 100 FTE
Interurban and Rural Bus Transportation 54 150Couriers and Express Delivery Services 3084 107Building Material and Supplies Dealers 4971 106Animal Slaughtering and Processing 555 90Waste Treatment and Disposal 484 90Poultry and Egg Production 99 89Scheduled Air Transportation 1781 88Motor Vehicle Body and Trailer Manufacturing 243 85Cattle Ranching and Farming 989 81Other General Merchandise Stores 2280 80Other Ambulatory Health Care Services 850 80Foundries 250 79Sheep and Goat Farming 19 77Warehousing and Storage 1349 77Waste Collection 706 76Traveler Accommodation 6780 76Other Furniture Related Product Manufacturing 118 71Forging and Stamping 297 70Logging 58 69Sawmills and Wood Preservation 52 68
Rates of Injury by IndustryPrivate sectorJanuary-June 2016
Number of Claims
Rate per 100 FTE
Interurban and Rural Bus Transportation 54 150Couriers and Express Delivery Services 3084 107Building Material and Supplies Dealers 4971 106Animal Slaughtering and Processing 555 90Waste Treatment and Disposal 484 90Poultry and Egg Production 99 89Scheduled Air Transportation 1781 88Motor Vehicle Body and Trailer Manufacturing 243 85Cattle Ranching and Farming 989 81Other General Merchandise Stores 2280 80Other Ambulatory Health Care Services 850 80Foundries 250 79Sheep and Goat Farming 19 77Warehousing and Storage 1349 77Waste Collection 706 76Traveler Accommodation 6780 76Other Furniture Related Product Manufacturing 118 71Forging and Stamping 297 70Logging 58 69Sawmills and Wood Preservation 52 68
IndustryCA Rate per
100 FTENational Overall SOII
Rate per 100 FTE
Couriers and Express Delivery Services 107 74
Animal Slaughtering and Processing 90 54
Poultry and Egg Production 89 69
Scheduled Air Transportation 88 66
Cattle Ranching and Farming 81 64
Foundries 79 67
Sheep and Goat Farming 77 --
Warehousing and Storage 77 50
Traveler Accommodation 76 50
Forging and Stamping 70 53
Sawmills and Wood Preservation 68 69
IndustryCA Rate per 100
FTENational Overall SOII
Rate per 100 FTE
Interurban and Rural Bus Transportation 150 30
Building Material and Supplies Dealers 106 48
Waste Treatment and Disposal 90 33
Motor Vehicle Body and Trailer Manufacturing 85 79
Other General Merchandise Stores 80 49
Other Ambulatory Health Care Services 80 30
Waste Collection 76 46
Other Furniture Related Product Manufacturing 71 55
Logging 69 37
Collaboration
Data sharing agreements
Pilot rates
Sharable repeatable methods and code
Contribution to national discussions about
use of WC data
Workers not captured by our method
Public sector
People who do not file claims
Data analysis for 2015-2016 Data analysis report Surveillance system evaluation
Publicly available dataset Disseminate findings Sustainability
California Department of Public Health John Beckman Matt Frederick Bob Harrison
California Department of Industrial Relations Genet Daba John Gordon Liza Dizon Glenn Shor Meitong Jin
California Employment Development Department Andy Wong Spencer Wong
Terry Bunn PhDDirector Kentucky Injury Prevention and Research
Center bona fide agent for the Kentucky Department for Public Health
Associate Professor Departments of Epidemiology and Preventive Medicine and Environmental Health University of Kentucky College of Public Health
bull Occupational motor vehicle crash investigations a priority focus area since 2005
KOSHS
Case Example
Case Example
bull Substance abuse a priority focus areabull State injury prevention planbull Legislation data support (HB1)
ndash Pill millsndash Clinical prescribing regulationsndash Decedent controlled substance testing lawndash Inter-state prescription drug monitoring
program (PDMP) data sharing
bull Use of PDMP data for public health surveillance
bull Inform community interventions bull Evaluate and perform cost-benefit
analysis of drug-related laws bull Establish substance use disorder
information and referral service ndash physicians (eg prevention of needle sticks
when lancing drug abuse-related abscesses)ndash first responders (eg handling of fentanyl
analogs at drug overdose scenes) ndash law enforcement (eg naloxone
administration training)ndash general public
bull Increase timeliness of public health data sources
bull Use syndromic surveillance data for drug overdose and injury surveillance
bull Algorithm development for milligram morphine equivalent calculations in PDMP reports
bull Death certificate and PDMP data linkage to identify possible drug diversion
bull State advisory group
bull Link Ky CRASH and trauma registry data with FARS driver drug testing results from fatal crashes in 2014
bull Link 2014 trauma registry toxicology result data with inpatient hospitalization data to assess drug overdose and drug abuse coding
Primary populations
bull Opioid overdose victims
bull Pregnant and parenting women
bull Individuals re-entering society upon criminal justice release
bull Adolescents and young adults
Goals
bull Prevent opioid misuse and abuse
bull Increase access to OUD treatment services (eg MAT)
bull Increase availability of recovery support services
bull Increase availability of naloxone
bull Enhance coordination and evaluation of OUD healthcare and public safety strategies
bull KRS 217186- A person or agency including a peace officer jailer firefighter paramedic or emergency medical technician or a school employee authorized to administer medication under KRS 156502 may ndash Receive a prescription for the drug
naloxonendash Possess naloxone pursuant to this
subsection and any equipment needed for its administration
ndash Administer naloxone to an individual suffering from an apparent opiate-related overdose
bull Reduce prescriber opioid prescribing (physicians APRNs etc) to a 3-day supply for injured workers
bull First line treatment based on non-opioid therapy alternatives (physical therapy acupuncture etc)
bull Revise drug formularies for treatment of pain associated with occupational injuries
Prevention Decrease likelihood that Kentuckians develop a SUD through strategies to decrease overexposure of opioid medications and illicit opioids
bull prescriptions (dosage units) overdose deaths containing fentanyl
Harm Reduction Improve Access to Harm Reduction Services to Save Lives
bull naloxone kits dispensed to first responders and public people in syringe exchange programs who received naloxone
Treatment and Recovery Expand access to treatment and recovery supports
bull peer recovery coaches Emergency Departments with peer recovery coaches people with SUD who interact with peer recovery coaches and enter treatment Emergency Department peer follow-up individuals with SUD who receive residential services calls to SUD treatment locator and portal
bull Louisville Metro Police Department presentation
bull Breakout Session
bull First Responder Opioid Exposure Survey development
bull Focus Groups
bull Survey Administration
bull Data Analysis
bull Use of Data Results
bull UK ERC first responder overdose response exposure pilot project opportunity
bull Multistate or single state applicationsndash Use of survey
ndash development of other first responder-related pilot project
FACE case investigations
bull initiated drug overdose prevention conversations
bull enhanced collaborations
bull provided evidence of need for enhanced multidisciplinary drug overdose prevention efforts1 Interventions
2 Policies
3 Research
Ladder rap
httpswwwyoutubecomwatchv=FsW6eb3aO8gampfeature=youtube
BLS Survey of Employers vs Multi-Source Surveillance of Work-Related Injuries
Kenneth D Rosenman MDProfessor of MedicineMichigan State Universitywwwoemmsuedu
NIOSH Expanding Research Partnerships Conference Denver Colorado June 21-23 2017
Funding NIOSH U60 OH008466
Survey of Occupational Injuries and Illnesses (SOII)
bull Injuries and illnesses (based on OSHArsquos recordkeeping standards) from 230000 establishments (sample by state and NAICS code)
bull Redesigned in 1992 to collect circumstances of injuries and illnesses that lead to days away from work and characteristics of affected workers
bull Scope limitations no small farms private household or self-employed workers (lt 2008 no public sector workers)
NATIONAL ACADEMY OF SCIENCES 1987
New Jersey24 Deaths not covered by OSHA35 Deaths covered by OSHA butemployer had NOT recorded on OSHAlog or did NOT keep OSHA log
TexasNIOSH Fatal Occupational Trauma Surveillance
CENSUS OF FATAL OCCUPATIONAL INJURIES (CFOI) BEGAN IN 1992
Multiple death sourcesDeath certificatesEmployer reportingState PoliceNewspaper Clipping ServiceMedical ExaminersAgricultural Extension Service
Number of deaths doubled from previous BLS estimate
How Much Work-Related Injury and Illness is Missed By the Current National Surveillance System
Rosenman KD Kalush A Reilly MJ Gardiner JC Reeves M Luo Z JOEM 2006 48357-365Funding NIOSH 5 R01 OH004276-03
Summary of Analysis Comparing BLS and Worker Comp data Michigan 2009-2001Days away from workbull BLS estimate
37-41 BLS+ WC31-34 BLS + WC+ CaptureRecapture
1999-2001 Estimates - Michiganbull BLS -281567 vs Our Estimate - 868241
1 in 15 workers vs 1 in 5 workers
(Rosenman et al JOEM 2006)
Simplified Flowchart of Events Necessary to the Documentation of Work-Related Injuries and Illnesses
(Azaroff et al AJPH 2002)
Filters to Identifying Work-Related Injuries and Illnesses
a Filters To Reporting to Supervisorsb Filters To Losing Work Time c Filters to Obtaining Medical Cared Filters to Recognizing Work-Related by Doctore Filters to Workersrsquo Compensation being the Payerf Filters To Recording on OSHA Logg Filters to Reporting by Employers to Workersrsquo
Compensation Agencyh Filters to Reporting by Doctors
(Azaroff et al AJPH 2002)
Capture-Recapture Estimates of Workplace Injury and Illness Reporting by BLS Adjusted for Capture
Heterogeneity Lost-Time Cases 1998-2001
Percent Reported to WA WV OR WI NM MNNo Source Dependence 55 76 56 65 51 68
Source Dependence 52 71 45 53 37 53
(Adapted Boden and Ozonoff Annals Epidemiology 2008)
Workersrsquo CompensationState Specific Program
Mandatory insurance or if large enough self-insured
Michigan WC Excludesbull Federal employeesbull Interstate railroad workersbull Maritime workersbull Less than 3 employees at any one timebull All employees work less than 35 hoursweek or
if more hours less than 13 weeksbull Self-employed
Not computerizedbull Medical claims only
Proportion of Work-Injured Adults for Whom Treatment was paid by Workersrsquo Compensation by State-BRFSS 10 States 2007
State Injured with Payment by Workersrsquo Compensation
Texas 47 (95 CI 35-59)New York 50 (95 CI 39-60)Michigan 56 (95 CI 41-69)Massachusetts 60 (95 CI 45-75)California 61 (95 CI 55-66)Washington 61 (95 CI 55-67)Oregon 62 (95 CI 50-74)Connecticut 63 (95 CI 53-74)New Jersey 64 (95 CI 51-78)Kentucky 77 (95 CI 65-89)
Excludes self-employed
(Adapted Bonauto et al MMWR 2010)
Percentage Received Workersrsquo Compensation by Condition Michigan
WageReplacement
Medical Only
No CompEmployed
No Comp Self -Employed
Amputations 64 22 17 6Burns 17 48 33 2Skull Fractures 36 32 29 3
Percent Applied for Workersrsquo Comp among 2016 Cases of Work-Related Asthma Michigan
Overall 484
Still ExposedConditions Unchanged 239No Longer Exposed 575
Quit on Doctorrsquos Advice 778Sick Leave 727Fired 621New Controls 589Chemical Substitution 536Quit on Own 431Reassigned 360
Reasons Didnrsquot File a Workersrsquo Compensation Claims for a Repetitive Trauma Michigan
Only 397 (251) of 1598 Filed WC Claim
Injury Not Serious Enough 705 (591)Did Not Expect to Miss Work 694 (583)Expect to Receive Sick Leave or
Disability 337 (283) Medical Expenses Covered by
Other Insurance 427 (359)Did Not Think Injury Work Related 242 (204)
(Rosenman et al JOEM 2000)
Goals of Surveillance Population-Based
bull Assess Magnitude of Problembull NumbersRatesTrends
bull Determine Relative Importance vs Other Health Issuesbull Identify High Risk
bull IndustriesOccupationsWorker Populations
bull Prioritize Interventions bull Evaluate Interventionsbull Generate Hypotheses for Researchbull Identify Emerging Problemsbull Identify Workplaces for Intervention
Case-Based
Reportable Conditions in Michigan
Local Health DepartmentsCommunicable Diseases (83)
ldquoUnusual occurrence outbreak or epidemic of any disease or conditionsrdquoMDHHS
AbortionsBirth DefectsCancerChemical Poisonings including Carbon MonoxideInjuries Nursing Home Abuse
LARAOccupational Illnesses
County Department of Social ServicesChild AbuseAdult Abuse
PoliceInjury from Knife Gun or Deadly WeaponMental Health Patient Abuse
On Request Only
Laboratory Reporting Regulations Michigan
bull Arsenicbull Cadmiumbull Carboxyhemoglobinbull Cholinesterasebull IgE Antibodiesbull Leadbull Mercury
Occupational Illness Reporting Requirement in Michigan
bull LARA ndash MIOSHAPhysician hospital clinic or employer
having a known or suspected occupational disease or health condition aggravated by workplace exposures shall report within 10 days after discovery
Misdemeanor punishable by a fine of not more than $50
Methodology of Multi-Source Surveillance
Amputations 2006- DateHospitalsEDOutpatient ClinicsWorkersrsquo Compensation Wage Replacement
Crushing Injuries 2013- Date+ FACE Program
Skull Fractures 2012-DateBurns 2009-Date
+ Poison Control Center
bull Quarterly Reporting Specified ICD codes -134 Hospitalsbull Quarterly Reporting all Work-related Events ndash Poison Control Centerbull Electronic Data Base All Paid Claims ndash Workersrsquo Compensationbull FACE ndash Death CertificatesOSHA Hot LinePolice Reports
Work-Related Burn Reports ndash By Source Total 1461 Michigan 2009
n=1460 individuals
450
BLS
HOSPITALSEDs (1248)
4501054
BLSMIFACE 1(2) 1
16721
5 PCC (106)
1321 79
WC(306)
(Kica and Rosenman JOEM 2012)
Numbers of workers by employer Industry code Ownership code Multi-establishment employer indicator
(MEEI)
bull 150 employment agencies (NAICS 5613)
bull 280K employeesTemp Firms
bull 90 workers in one industrybull 80 without corporate offices
(NAICS 5511)90 Rule
bull Assign unique code to both employers and workers for rate calculation
Remainder
Counts in QCEW multiplied by FTE to EE ratio
Six months of 2015 data Develop methods for matching Evaluate match Compare rates Prepare and plan
And now what yoursquove been waiting forhellip
California
QCEW
Determine industry
Injured
bull 12 million employers bull 16 million employees
bull 119 million employers bull 14 million employees
bull 51000 employersbull 302000 workers
302000 claims
260000 employer match
212000 private sector
184000 industry
Has one job73
Has employer match
9
WONK-y data match
4Did not match
14
WONK-y data match
4
Worker matches multiple employers All employers have
the same industry code One employer has
the same industry code in WCIS Only one employer is
in QCEW
Did not match14
Bad SSN or does not match on SSN Matched multiple employers gt5 employer No WONK-y data match
31 workers per 100 FTE
Rates of Injury by IndustryPrivate sectorJanuary-June 2016
Number of Claims
Rate per 100 FTE
Interurban and Rural Bus Transportation 54 150Couriers and Express Delivery Services 3084 107Building Material and Supplies Dealers 4971 106Animal Slaughtering and Processing 555 90Waste Treatment and Disposal 484 90Poultry and Egg Production 99 89Scheduled Air Transportation 1781 88Motor Vehicle Body and Trailer Manufacturing 243 85Cattle Ranching and Farming 989 81Other General Merchandise Stores 2280 80Other Ambulatory Health Care Services 850 80Foundries 250 79Sheep and Goat Farming 19 77Warehousing and Storage 1349 77Waste Collection 706 76Traveler Accommodation 6780 76Other Furniture Related Product Manufacturing 118 71Forging and Stamping 297 70Logging 58 69Sawmills and Wood Preservation 52 68
Rates of Injury by IndustryPrivate sectorJanuary-June 2016
Number of Claims
Rate per 100 FTE
Interurban and Rural Bus Transportation 54 150Couriers and Express Delivery Services 3084 107Building Material and Supplies Dealers 4971 106Animal Slaughtering and Processing 555 90Waste Treatment and Disposal 484 90Poultry and Egg Production 99 89Scheduled Air Transportation 1781 88Motor Vehicle Body and Trailer Manufacturing 243 85Cattle Ranching and Farming 989 81Other General Merchandise Stores 2280 80Other Ambulatory Health Care Services 850 80Foundries 250 79Sheep and Goat Farming 19 77Warehousing and Storage 1349 77Waste Collection 706 76Traveler Accommodation 6780 76Other Furniture Related Product Manufacturing 118 71Forging and Stamping 297 70Logging 58 69Sawmills and Wood Preservation 52 68
Rates of Injury by IndustryPrivate sectorJanuary-June 2016
Number of Claims
Rate per 100 FTE
Interurban and Rural Bus Transportation 54 150Couriers and Express Delivery Services 3084 107Building Material and Supplies Dealers 4971 106Animal Slaughtering and Processing 555 90Waste Treatment and Disposal 484 90Poultry and Egg Production 99 89Scheduled Air Transportation 1781 88Motor Vehicle Body and Trailer Manufacturing 243 85Cattle Ranching and Farming 989 81Other General Merchandise Stores 2280 80Other Ambulatory Health Care Services 850 80Foundries 250 79Sheep and Goat Farming 19 77Warehousing and Storage 1349 77Waste Collection 706 76Traveler Accommodation 6780 76Other Furniture Related Product Manufacturing 118 71Forging and Stamping 297 70Logging 58 69Sawmills and Wood Preservation 52 68
Rates of Injury by IndustryPrivate sectorJanuary-June 2016
Number of Claims
Rate per 100 FTE
Interurban and Rural Bus Transportation 54 150Couriers and Express Delivery Services 3084 107Building Material and Supplies Dealers 4971 106Animal Slaughtering and Processing 555 90Waste Treatment and Disposal 484 90Poultry and Egg Production 99 89Scheduled Air Transportation 1781 88Motor Vehicle Body and Trailer Manufacturing 243 85Cattle Ranching and Farming 989 81Other General Merchandise Stores 2280 80Other Ambulatory Health Care Services 850 80Foundries 250 79Sheep and Goat Farming 19 77Warehousing and Storage 1349 77Waste Collection 706 76Traveler Accommodation 6780 76Other Furniture Related Product Manufacturing 118 71Forging and Stamping 297 70Logging 58 69Sawmills and Wood Preservation 52 68
Rates of Injury by IndustryPrivate sectorJanuary-June 2016
Number of Claims
Rate per 100 FTE
Interurban and Rural Bus Transportation 54 150Couriers and Express Delivery Services 3084 107Building Material and Supplies Dealers 4971 106Animal Slaughtering and Processing 555 90Waste Treatment and Disposal 484 90Poultry and Egg Production 99 89Scheduled Air Transportation 1781 88Motor Vehicle Body and Trailer Manufacturing 243 85Cattle Ranching and Farming 989 81Other General Merchandise Stores 2280 80Other Ambulatory Health Care Services 850 80Foundries 250 79Sheep and Goat Farming 19 77Warehousing and Storage 1349 77Waste Collection 706 76Traveler Accommodation 6780 76Other Furniture Related Product Manufacturing 118 71Forging and Stamping 297 70Logging 58 69Sawmills and Wood Preservation 52 68
IndustryCA Rate per
100 FTENational Overall SOII
Rate per 100 FTE
Couriers and Express Delivery Services 107 74
Animal Slaughtering and Processing 90 54
Poultry and Egg Production 89 69
Scheduled Air Transportation 88 66
Cattle Ranching and Farming 81 64
Foundries 79 67
Sheep and Goat Farming 77 --
Warehousing and Storage 77 50
Traveler Accommodation 76 50
Forging and Stamping 70 53
Sawmills and Wood Preservation 68 69
IndustryCA Rate per 100
FTENational Overall SOII
Rate per 100 FTE
Interurban and Rural Bus Transportation 150 30
Building Material and Supplies Dealers 106 48
Waste Treatment and Disposal 90 33
Motor Vehicle Body and Trailer Manufacturing 85 79
Other General Merchandise Stores 80 49
Other Ambulatory Health Care Services 80 30
Waste Collection 76 46
Other Furniture Related Product Manufacturing 71 55
Logging 69 37
Collaboration
Data sharing agreements
Pilot rates
Sharable repeatable methods and code
Contribution to national discussions about
use of WC data
Workers not captured by our method
Public sector
People who do not file claims
Data analysis for 2015-2016 Data analysis report Surveillance system evaluation
Publicly available dataset Disseminate findings Sustainability
California Department of Public Health John Beckman Matt Frederick Bob Harrison
California Department of Industrial Relations Genet Daba John Gordon Liza Dizon Glenn Shor Meitong Jin
California Employment Development Department Andy Wong Spencer Wong
Terry Bunn PhDDirector Kentucky Injury Prevention and Research
Center bona fide agent for the Kentucky Department for Public Health
Associate Professor Departments of Epidemiology and Preventive Medicine and Environmental Health University of Kentucky College of Public Health
bull Occupational motor vehicle crash investigations a priority focus area since 2005
KOSHS
Case Example
Case Example
bull Substance abuse a priority focus areabull State injury prevention planbull Legislation data support (HB1)
ndash Pill millsndash Clinical prescribing regulationsndash Decedent controlled substance testing lawndash Inter-state prescription drug monitoring
program (PDMP) data sharing
bull Use of PDMP data for public health surveillance
bull Inform community interventions bull Evaluate and perform cost-benefit
analysis of drug-related laws bull Establish substance use disorder
information and referral service ndash physicians (eg prevention of needle sticks
when lancing drug abuse-related abscesses)ndash first responders (eg handling of fentanyl
analogs at drug overdose scenes) ndash law enforcement (eg naloxone
administration training)ndash general public
bull Increase timeliness of public health data sources
bull Use syndromic surveillance data for drug overdose and injury surveillance
bull Algorithm development for milligram morphine equivalent calculations in PDMP reports
bull Death certificate and PDMP data linkage to identify possible drug diversion
bull State advisory group
bull Link Ky CRASH and trauma registry data with FARS driver drug testing results from fatal crashes in 2014
bull Link 2014 trauma registry toxicology result data with inpatient hospitalization data to assess drug overdose and drug abuse coding
Primary populations
bull Opioid overdose victims
bull Pregnant and parenting women
bull Individuals re-entering society upon criminal justice release
bull Adolescents and young adults
Goals
bull Prevent opioid misuse and abuse
bull Increase access to OUD treatment services (eg MAT)
bull Increase availability of recovery support services
bull Increase availability of naloxone
bull Enhance coordination and evaluation of OUD healthcare and public safety strategies
bull KRS 217186- A person or agency including a peace officer jailer firefighter paramedic or emergency medical technician or a school employee authorized to administer medication under KRS 156502 may ndash Receive a prescription for the drug
naloxonendash Possess naloxone pursuant to this
subsection and any equipment needed for its administration
ndash Administer naloxone to an individual suffering from an apparent opiate-related overdose
bull Reduce prescriber opioid prescribing (physicians APRNs etc) to a 3-day supply for injured workers
bull First line treatment based on non-opioid therapy alternatives (physical therapy acupuncture etc)
bull Revise drug formularies for treatment of pain associated with occupational injuries
Prevention Decrease likelihood that Kentuckians develop a SUD through strategies to decrease overexposure of opioid medications and illicit opioids
bull prescriptions (dosage units) overdose deaths containing fentanyl
Harm Reduction Improve Access to Harm Reduction Services to Save Lives
bull naloxone kits dispensed to first responders and public people in syringe exchange programs who received naloxone
Treatment and Recovery Expand access to treatment and recovery supports
bull peer recovery coaches Emergency Departments with peer recovery coaches people with SUD who interact with peer recovery coaches and enter treatment Emergency Department peer follow-up individuals with SUD who receive residential services calls to SUD treatment locator and portal
bull Louisville Metro Police Department presentation
bull Breakout Session
bull First Responder Opioid Exposure Survey development
bull Focus Groups
bull Survey Administration
bull Data Analysis
bull Use of Data Results
bull UK ERC first responder overdose response exposure pilot project opportunity
bull Multistate or single state applicationsndash Use of survey
ndash development of other first responder-related pilot project
FACE case investigations
bull initiated drug overdose prevention conversations
bull enhanced collaborations
bull provided evidence of need for enhanced multidisciplinary drug overdose prevention efforts1 Interventions
2 Policies
3 Research
Ladder rap
httpswwwyoutubecomwatchv=FsW6eb3aO8gampfeature=youtube
BLS Survey of Employers vs Multi-Source Surveillance of Work-Related Injuries
Kenneth D Rosenman MDProfessor of MedicineMichigan State Universitywwwoemmsuedu
NIOSH Expanding Research Partnerships Conference Denver Colorado June 21-23 2017
Funding NIOSH U60 OH008466
Survey of Occupational Injuries and Illnesses (SOII)
bull Injuries and illnesses (based on OSHArsquos recordkeeping standards) from 230000 establishments (sample by state and NAICS code)
bull Redesigned in 1992 to collect circumstances of injuries and illnesses that lead to days away from work and characteristics of affected workers
bull Scope limitations no small farms private household or self-employed workers (lt 2008 no public sector workers)
NATIONAL ACADEMY OF SCIENCES 1987
New Jersey24 Deaths not covered by OSHA35 Deaths covered by OSHA butemployer had NOT recorded on OSHAlog or did NOT keep OSHA log
TexasNIOSH Fatal Occupational Trauma Surveillance
CENSUS OF FATAL OCCUPATIONAL INJURIES (CFOI) BEGAN IN 1992
Multiple death sourcesDeath certificatesEmployer reportingState PoliceNewspaper Clipping ServiceMedical ExaminersAgricultural Extension Service
Number of deaths doubled from previous BLS estimate
How Much Work-Related Injury and Illness is Missed By the Current National Surveillance System
Rosenman KD Kalush A Reilly MJ Gardiner JC Reeves M Luo Z JOEM 2006 48357-365Funding NIOSH 5 R01 OH004276-03
Summary of Analysis Comparing BLS and Worker Comp data Michigan 2009-2001Days away from workbull BLS estimate
37-41 BLS+ WC31-34 BLS + WC+ CaptureRecapture
1999-2001 Estimates - Michiganbull BLS -281567 vs Our Estimate - 868241
1 in 15 workers vs 1 in 5 workers
(Rosenman et al JOEM 2006)
Simplified Flowchart of Events Necessary to the Documentation of Work-Related Injuries and Illnesses
(Azaroff et al AJPH 2002)
Filters to Identifying Work-Related Injuries and Illnesses
a Filters To Reporting to Supervisorsb Filters To Losing Work Time c Filters to Obtaining Medical Cared Filters to Recognizing Work-Related by Doctore Filters to Workersrsquo Compensation being the Payerf Filters To Recording on OSHA Logg Filters to Reporting by Employers to Workersrsquo
Compensation Agencyh Filters to Reporting by Doctors
(Azaroff et al AJPH 2002)
Capture-Recapture Estimates of Workplace Injury and Illness Reporting by BLS Adjusted for Capture
Heterogeneity Lost-Time Cases 1998-2001
Percent Reported to WA WV OR WI NM MNNo Source Dependence 55 76 56 65 51 68
Source Dependence 52 71 45 53 37 53
(Adapted Boden and Ozonoff Annals Epidemiology 2008)
Workersrsquo CompensationState Specific Program
Mandatory insurance or if large enough self-insured
Michigan WC Excludesbull Federal employeesbull Interstate railroad workersbull Maritime workersbull Less than 3 employees at any one timebull All employees work less than 35 hoursweek or
if more hours less than 13 weeksbull Self-employed
Not computerizedbull Medical claims only
Proportion of Work-Injured Adults for Whom Treatment was paid by Workersrsquo Compensation by State-BRFSS 10 States 2007
State Injured with Payment by Workersrsquo Compensation
Texas 47 (95 CI 35-59)New York 50 (95 CI 39-60)Michigan 56 (95 CI 41-69)Massachusetts 60 (95 CI 45-75)California 61 (95 CI 55-66)Washington 61 (95 CI 55-67)Oregon 62 (95 CI 50-74)Connecticut 63 (95 CI 53-74)New Jersey 64 (95 CI 51-78)Kentucky 77 (95 CI 65-89)
Excludes self-employed
(Adapted Bonauto et al MMWR 2010)
Percentage Received Workersrsquo Compensation by Condition Michigan
WageReplacement
Medical Only
No CompEmployed
No Comp Self -Employed
Amputations 64 22 17 6Burns 17 48 33 2Skull Fractures 36 32 29 3
Percent Applied for Workersrsquo Comp among 2016 Cases of Work-Related Asthma Michigan
Overall 484
Still ExposedConditions Unchanged 239No Longer Exposed 575
Quit on Doctorrsquos Advice 778Sick Leave 727Fired 621New Controls 589Chemical Substitution 536Quit on Own 431Reassigned 360
Reasons Didnrsquot File a Workersrsquo Compensation Claims for a Repetitive Trauma Michigan
Only 397 (251) of 1598 Filed WC Claim
Injury Not Serious Enough 705 (591)Did Not Expect to Miss Work 694 (583)Expect to Receive Sick Leave or
Disability 337 (283) Medical Expenses Covered by
Other Insurance 427 (359)Did Not Think Injury Work Related 242 (204)
(Rosenman et al JOEM 2000)
Goals of Surveillance Population-Based
bull Assess Magnitude of Problembull NumbersRatesTrends
bull Determine Relative Importance vs Other Health Issuesbull Identify High Risk
bull IndustriesOccupationsWorker Populations
bull Prioritize Interventions bull Evaluate Interventionsbull Generate Hypotheses for Researchbull Identify Emerging Problemsbull Identify Workplaces for Intervention
Case-Based
Reportable Conditions in Michigan
Local Health DepartmentsCommunicable Diseases (83)
ldquoUnusual occurrence outbreak or epidemic of any disease or conditionsrdquoMDHHS
AbortionsBirth DefectsCancerChemical Poisonings including Carbon MonoxideInjuries Nursing Home Abuse
LARAOccupational Illnesses
County Department of Social ServicesChild AbuseAdult Abuse
PoliceInjury from Knife Gun or Deadly WeaponMental Health Patient Abuse
On Request Only
Laboratory Reporting Regulations Michigan
bull Arsenicbull Cadmiumbull Carboxyhemoglobinbull Cholinesterasebull IgE Antibodiesbull Leadbull Mercury
Occupational Illness Reporting Requirement in Michigan
bull LARA ndash MIOSHAPhysician hospital clinic or employer
having a known or suspected occupational disease or health condition aggravated by workplace exposures shall report within 10 days after discovery
Misdemeanor punishable by a fine of not more than $50
Methodology of Multi-Source Surveillance
Amputations 2006- DateHospitalsEDOutpatient ClinicsWorkersrsquo Compensation Wage Replacement
Crushing Injuries 2013- Date+ FACE Program
Skull Fractures 2012-DateBurns 2009-Date
+ Poison Control Center
bull Quarterly Reporting Specified ICD codes -134 Hospitalsbull Quarterly Reporting all Work-related Events ndash Poison Control Centerbull Electronic Data Base All Paid Claims ndash Workersrsquo Compensationbull FACE ndash Death CertificatesOSHA Hot LinePolice Reports
Work-Related Burn Reports ndash By Source Total 1461 Michigan 2009
n=1460 individuals
450
BLS
HOSPITALSEDs (1248)
4501054
BLSMIFACE 1(2) 1
16721
5 PCC (106)
1321 79
WC(306)
(Kica and Rosenman JOEM 2012)
bull 150 employment agencies (NAICS 5613)
bull 280K employeesTemp Firms
bull 90 workers in one industrybull 80 without corporate offices
(NAICS 5511)90 Rule
bull Assign unique code to both employers and workers for rate calculation
Remainder
Counts in QCEW multiplied by FTE to EE ratio
Six months of 2015 data Develop methods for matching Evaluate match Compare rates Prepare and plan
And now what yoursquove been waiting forhellip
California
QCEW
Determine industry
Injured
bull 12 million employers bull 16 million employees
bull 119 million employers bull 14 million employees
bull 51000 employersbull 302000 workers
302000 claims
260000 employer match
212000 private sector
184000 industry
Has one job73
Has employer match
9
WONK-y data match
4Did not match
14
WONK-y data match
4
Worker matches multiple employers All employers have
the same industry code One employer has
the same industry code in WCIS Only one employer is
in QCEW
Did not match14
Bad SSN or does not match on SSN Matched multiple employers gt5 employer No WONK-y data match
31 workers per 100 FTE
Rates of Injury by IndustryPrivate sectorJanuary-June 2016
Number of Claims
Rate per 100 FTE
Interurban and Rural Bus Transportation 54 150Couriers and Express Delivery Services 3084 107Building Material and Supplies Dealers 4971 106Animal Slaughtering and Processing 555 90Waste Treatment and Disposal 484 90Poultry and Egg Production 99 89Scheduled Air Transportation 1781 88Motor Vehicle Body and Trailer Manufacturing 243 85Cattle Ranching and Farming 989 81Other General Merchandise Stores 2280 80Other Ambulatory Health Care Services 850 80Foundries 250 79Sheep and Goat Farming 19 77Warehousing and Storage 1349 77Waste Collection 706 76Traveler Accommodation 6780 76Other Furniture Related Product Manufacturing 118 71Forging and Stamping 297 70Logging 58 69Sawmills and Wood Preservation 52 68
Rates of Injury by IndustryPrivate sectorJanuary-June 2016
Number of Claims
Rate per 100 FTE
Interurban and Rural Bus Transportation 54 150Couriers and Express Delivery Services 3084 107Building Material and Supplies Dealers 4971 106Animal Slaughtering and Processing 555 90Waste Treatment and Disposal 484 90Poultry and Egg Production 99 89Scheduled Air Transportation 1781 88Motor Vehicle Body and Trailer Manufacturing 243 85Cattle Ranching and Farming 989 81Other General Merchandise Stores 2280 80Other Ambulatory Health Care Services 850 80Foundries 250 79Sheep and Goat Farming 19 77Warehousing and Storage 1349 77Waste Collection 706 76Traveler Accommodation 6780 76Other Furniture Related Product Manufacturing 118 71Forging and Stamping 297 70Logging 58 69Sawmills and Wood Preservation 52 68
Rates of Injury by IndustryPrivate sectorJanuary-June 2016
Number of Claims
Rate per 100 FTE
Interurban and Rural Bus Transportation 54 150Couriers and Express Delivery Services 3084 107Building Material and Supplies Dealers 4971 106Animal Slaughtering and Processing 555 90Waste Treatment and Disposal 484 90Poultry and Egg Production 99 89Scheduled Air Transportation 1781 88Motor Vehicle Body and Trailer Manufacturing 243 85Cattle Ranching and Farming 989 81Other General Merchandise Stores 2280 80Other Ambulatory Health Care Services 850 80Foundries 250 79Sheep and Goat Farming 19 77Warehousing and Storage 1349 77Waste Collection 706 76Traveler Accommodation 6780 76Other Furniture Related Product Manufacturing 118 71Forging and Stamping 297 70Logging 58 69Sawmills and Wood Preservation 52 68
Rates of Injury by IndustryPrivate sectorJanuary-June 2016
Number of Claims
Rate per 100 FTE
Interurban and Rural Bus Transportation 54 150Couriers and Express Delivery Services 3084 107Building Material and Supplies Dealers 4971 106Animal Slaughtering and Processing 555 90Waste Treatment and Disposal 484 90Poultry and Egg Production 99 89Scheduled Air Transportation 1781 88Motor Vehicle Body and Trailer Manufacturing 243 85Cattle Ranching and Farming 989 81Other General Merchandise Stores 2280 80Other Ambulatory Health Care Services 850 80Foundries 250 79Sheep and Goat Farming 19 77Warehousing and Storage 1349 77Waste Collection 706 76Traveler Accommodation 6780 76Other Furniture Related Product Manufacturing 118 71Forging and Stamping 297 70Logging 58 69Sawmills and Wood Preservation 52 68
Rates of Injury by IndustryPrivate sectorJanuary-June 2016
Number of Claims
Rate per 100 FTE
Interurban and Rural Bus Transportation 54 150Couriers and Express Delivery Services 3084 107Building Material and Supplies Dealers 4971 106Animal Slaughtering and Processing 555 90Waste Treatment and Disposal 484 90Poultry and Egg Production 99 89Scheduled Air Transportation 1781 88Motor Vehicle Body and Trailer Manufacturing 243 85Cattle Ranching and Farming 989 81Other General Merchandise Stores 2280 80Other Ambulatory Health Care Services 850 80Foundries 250 79Sheep and Goat Farming 19 77Warehousing and Storage 1349 77Waste Collection 706 76Traveler Accommodation 6780 76Other Furniture Related Product Manufacturing 118 71Forging and Stamping 297 70Logging 58 69Sawmills and Wood Preservation 52 68
IndustryCA Rate per
100 FTENational Overall SOII
Rate per 100 FTE
Couriers and Express Delivery Services 107 74
Animal Slaughtering and Processing 90 54
Poultry and Egg Production 89 69
Scheduled Air Transportation 88 66
Cattle Ranching and Farming 81 64
Foundries 79 67
Sheep and Goat Farming 77 --
Warehousing and Storage 77 50
Traveler Accommodation 76 50
Forging and Stamping 70 53
Sawmills and Wood Preservation 68 69
IndustryCA Rate per 100
FTENational Overall SOII
Rate per 100 FTE
Interurban and Rural Bus Transportation 150 30
Building Material and Supplies Dealers 106 48
Waste Treatment and Disposal 90 33
Motor Vehicle Body and Trailer Manufacturing 85 79
Other General Merchandise Stores 80 49
Other Ambulatory Health Care Services 80 30
Waste Collection 76 46
Other Furniture Related Product Manufacturing 71 55
Logging 69 37
Collaboration
Data sharing agreements
Pilot rates
Sharable repeatable methods and code
Contribution to national discussions about
use of WC data
Workers not captured by our method
Public sector
People who do not file claims
Data analysis for 2015-2016 Data analysis report Surveillance system evaluation
Publicly available dataset Disseminate findings Sustainability
California Department of Public Health John Beckman Matt Frederick Bob Harrison
California Department of Industrial Relations Genet Daba John Gordon Liza Dizon Glenn Shor Meitong Jin
California Employment Development Department Andy Wong Spencer Wong
Terry Bunn PhDDirector Kentucky Injury Prevention and Research
Center bona fide agent for the Kentucky Department for Public Health
Associate Professor Departments of Epidemiology and Preventive Medicine and Environmental Health University of Kentucky College of Public Health
bull Occupational motor vehicle crash investigations a priority focus area since 2005
KOSHS
Case Example
Case Example
bull Substance abuse a priority focus areabull State injury prevention planbull Legislation data support (HB1)
ndash Pill millsndash Clinical prescribing regulationsndash Decedent controlled substance testing lawndash Inter-state prescription drug monitoring
program (PDMP) data sharing
bull Use of PDMP data for public health surveillance
bull Inform community interventions bull Evaluate and perform cost-benefit
analysis of drug-related laws bull Establish substance use disorder
information and referral service ndash physicians (eg prevention of needle sticks
when lancing drug abuse-related abscesses)ndash first responders (eg handling of fentanyl
analogs at drug overdose scenes) ndash law enforcement (eg naloxone
administration training)ndash general public
bull Increase timeliness of public health data sources
bull Use syndromic surveillance data for drug overdose and injury surveillance
bull Algorithm development for milligram morphine equivalent calculations in PDMP reports
bull Death certificate and PDMP data linkage to identify possible drug diversion
bull State advisory group
bull Link Ky CRASH and trauma registry data with FARS driver drug testing results from fatal crashes in 2014
bull Link 2014 trauma registry toxicology result data with inpatient hospitalization data to assess drug overdose and drug abuse coding
Primary populations
bull Opioid overdose victims
bull Pregnant and parenting women
bull Individuals re-entering society upon criminal justice release
bull Adolescents and young adults
Goals
bull Prevent opioid misuse and abuse
bull Increase access to OUD treatment services (eg MAT)
bull Increase availability of recovery support services
bull Increase availability of naloxone
bull Enhance coordination and evaluation of OUD healthcare and public safety strategies
bull KRS 217186- A person or agency including a peace officer jailer firefighter paramedic or emergency medical technician or a school employee authorized to administer medication under KRS 156502 may ndash Receive a prescription for the drug
naloxonendash Possess naloxone pursuant to this
subsection and any equipment needed for its administration
ndash Administer naloxone to an individual suffering from an apparent opiate-related overdose
bull Reduce prescriber opioid prescribing (physicians APRNs etc) to a 3-day supply for injured workers
bull First line treatment based on non-opioid therapy alternatives (physical therapy acupuncture etc)
bull Revise drug formularies for treatment of pain associated with occupational injuries
Prevention Decrease likelihood that Kentuckians develop a SUD through strategies to decrease overexposure of opioid medications and illicit opioids
bull prescriptions (dosage units) overdose deaths containing fentanyl
Harm Reduction Improve Access to Harm Reduction Services to Save Lives
bull naloxone kits dispensed to first responders and public people in syringe exchange programs who received naloxone
Treatment and Recovery Expand access to treatment and recovery supports
bull peer recovery coaches Emergency Departments with peer recovery coaches people with SUD who interact with peer recovery coaches and enter treatment Emergency Department peer follow-up individuals with SUD who receive residential services calls to SUD treatment locator and portal
bull Louisville Metro Police Department presentation
bull Breakout Session
bull First Responder Opioid Exposure Survey development
bull Focus Groups
bull Survey Administration
bull Data Analysis
bull Use of Data Results
bull UK ERC first responder overdose response exposure pilot project opportunity
bull Multistate or single state applicationsndash Use of survey
ndash development of other first responder-related pilot project
FACE case investigations
bull initiated drug overdose prevention conversations
bull enhanced collaborations
bull provided evidence of need for enhanced multidisciplinary drug overdose prevention efforts1 Interventions
2 Policies
3 Research
Ladder rap
httpswwwyoutubecomwatchv=FsW6eb3aO8gampfeature=youtube
BLS Survey of Employers vs Multi-Source Surveillance of Work-Related Injuries
Kenneth D Rosenman MDProfessor of MedicineMichigan State Universitywwwoemmsuedu
NIOSH Expanding Research Partnerships Conference Denver Colorado June 21-23 2017
Funding NIOSH U60 OH008466
Survey of Occupational Injuries and Illnesses (SOII)
bull Injuries and illnesses (based on OSHArsquos recordkeeping standards) from 230000 establishments (sample by state and NAICS code)
bull Redesigned in 1992 to collect circumstances of injuries and illnesses that lead to days away from work and characteristics of affected workers
bull Scope limitations no small farms private household or self-employed workers (lt 2008 no public sector workers)
NATIONAL ACADEMY OF SCIENCES 1987
New Jersey24 Deaths not covered by OSHA35 Deaths covered by OSHA butemployer had NOT recorded on OSHAlog or did NOT keep OSHA log
TexasNIOSH Fatal Occupational Trauma Surveillance
CENSUS OF FATAL OCCUPATIONAL INJURIES (CFOI) BEGAN IN 1992
Multiple death sourcesDeath certificatesEmployer reportingState PoliceNewspaper Clipping ServiceMedical ExaminersAgricultural Extension Service
Number of deaths doubled from previous BLS estimate
How Much Work-Related Injury and Illness is Missed By the Current National Surveillance System
Rosenman KD Kalush A Reilly MJ Gardiner JC Reeves M Luo Z JOEM 2006 48357-365Funding NIOSH 5 R01 OH004276-03
Summary of Analysis Comparing BLS and Worker Comp data Michigan 2009-2001Days away from workbull BLS estimate
37-41 BLS+ WC31-34 BLS + WC+ CaptureRecapture
1999-2001 Estimates - Michiganbull BLS -281567 vs Our Estimate - 868241
1 in 15 workers vs 1 in 5 workers
(Rosenman et al JOEM 2006)
Simplified Flowchart of Events Necessary to the Documentation of Work-Related Injuries and Illnesses
(Azaroff et al AJPH 2002)
Filters to Identifying Work-Related Injuries and Illnesses
a Filters To Reporting to Supervisorsb Filters To Losing Work Time c Filters to Obtaining Medical Cared Filters to Recognizing Work-Related by Doctore Filters to Workersrsquo Compensation being the Payerf Filters To Recording on OSHA Logg Filters to Reporting by Employers to Workersrsquo
Compensation Agencyh Filters to Reporting by Doctors
(Azaroff et al AJPH 2002)
Capture-Recapture Estimates of Workplace Injury and Illness Reporting by BLS Adjusted for Capture
Heterogeneity Lost-Time Cases 1998-2001
Percent Reported to WA WV OR WI NM MNNo Source Dependence 55 76 56 65 51 68
Source Dependence 52 71 45 53 37 53
(Adapted Boden and Ozonoff Annals Epidemiology 2008)
Workersrsquo CompensationState Specific Program
Mandatory insurance or if large enough self-insured
Michigan WC Excludesbull Federal employeesbull Interstate railroad workersbull Maritime workersbull Less than 3 employees at any one timebull All employees work less than 35 hoursweek or
if more hours less than 13 weeksbull Self-employed
Not computerizedbull Medical claims only
Proportion of Work-Injured Adults for Whom Treatment was paid by Workersrsquo Compensation by State-BRFSS 10 States 2007
State Injured with Payment by Workersrsquo Compensation
Texas 47 (95 CI 35-59)New York 50 (95 CI 39-60)Michigan 56 (95 CI 41-69)Massachusetts 60 (95 CI 45-75)California 61 (95 CI 55-66)Washington 61 (95 CI 55-67)Oregon 62 (95 CI 50-74)Connecticut 63 (95 CI 53-74)New Jersey 64 (95 CI 51-78)Kentucky 77 (95 CI 65-89)
Excludes self-employed
(Adapted Bonauto et al MMWR 2010)
Percentage Received Workersrsquo Compensation by Condition Michigan
WageReplacement
Medical Only
No CompEmployed
No Comp Self -Employed
Amputations 64 22 17 6Burns 17 48 33 2Skull Fractures 36 32 29 3
Percent Applied for Workersrsquo Comp among 2016 Cases of Work-Related Asthma Michigan
Overall 484
Still ExposedConditions Unchanged 239No Longer Exposed 575
Quit on Doctorrsquos Advice 778Sick Leave 727Fired 621New Controls 589Chemical Substitution 536Quit on Own 431Reassigned 360
Reasons Didnrsquot File a Workersrsquo Compensation Claims for a Repetitive Trauma Michigan
Only 397 (251) of 1598 Filed WC Claim
Injury Not Serious Enough 705 (591)Did Not Expect to Miss Work 694 (583)Expect to Receive Sick Leave or
Disability 337 (283) Medical Expenses Covered by
Other Insurance 427 (359)Did Not Think Injury Work Related 242 (204)
(Rosenman et al JOEM 2000)
Goals of Surveillance Population-Based
bull Assess Magnitude of Problembull NumbersRatesTrends
bull Determine Relative Importance vs Other Health Issuesbull Identify High Risk
bull IndustriesOccupationsWorker Populations
bull Prioritize Interventions bull Evaluate Interventionsbull Generate Hypotheses for Researchbull Identify Emerging Problemsbull Identify Workplaces for Intervention
Case-Based
Reportable Conditions in Michigan
Local Health DepartmentsCommunicable Diseases (83)
ldquoUnusual occurrence outbreak or epidemic of any disease or conditionsrdquoMDHHS
AbortionsBirth DefectsCancerChemical Poisonings including Carbon MonoxideInjuries Nursing Home Abuse
LARAOccupational Illnesses
County Department of Social ServicesChild AbuseAdult Abuse
PoliceInjury from Knife Gun or Deadly WeaponMental Health Patient Abuse
On Request Only
Laboratory Reporting Regulations Michigan
bull Arsenicbull Cadmiumbull Carboxyhemoglobinbull Cholinesterasebull IgE Antibodiesbull Leadbull Mercury
Occupational Illness Reporting Requirement in Michigan
bull LARA ndash MIOSHAPhysician hospital clinic or employer
having a known or suspected occupational disease or health condition aggravated by workplace exposures shall report within 10 days after discovery
Misdemeanor punishable by a fine of not more than $50
Methodology of Multi-Source Surveillance
Amputations 2006- DateHospitalsEDOutpatient ClinicsWorkersrsquo Compensation Wage Replacement
Crushing Injuries 2013- Date+ FACE Program
Skull Fractures 2012-DateBurns 2009-Date
+ Poison Control Center
bull Quarterly Reporting Specified ICD codes -134 Hospitalsbull Quarterly Reporting all Work-related Events ndash Poison Control Centerbull Electronic Data Base All Paid Claims ndash Workersrsquo Compensationbull FACE ndash Death CertificatesOSHA Hot LinePolice Reports
Work-Related Burn Reports ndash By Source Total 1461 Michigan 2009
n=1460 individuals
450
BLS
HOSPITALSEDs (1248)
4501054
BLSMIFACE 1(2) 1
16721
5 PCC (106)
1321 79
WC(306)
(Kica and Rosenman JOEM 2012)
Counts in QCEW multiplied by FTE to EE ratio
Six months of 2015 data Develop methods for matching Evaluate match Compare rates Prepare and plan
And now what yoursquove been waiting forhellip
California
QCEW
Determine industry
Injured
bull 12 million employers bull 16 million employees
bull 119 million employers bull 14 million employees
bull 51000 employersbull 302000 workers
302000 claims
260000 employer match
212000 private sector
184000 industry
Has one job73
Has employer match
9
WONK-y data match
4Did not match
14
WONK-y data match
4
Worker matches multiple employers All employers have
the same industry code One employer has
the same industry code in WCIS Only one employer is
in QCEW
Did not match14
Bad SSN or does not match on SSN Matched multiple employers gt5 employer No WONK-y data match
31 workers per 100 FTE
Rates of Injury by IndustryPrivate sectorJanuary-June 2016
Number of Claims
Rate per 100 FTE
Interurban and Rural Bus Transportation 54 150Couriers and Express Delivery Services 3084 107Building Material and Supplies Dealers 4971 106Animal Slaughtering and Processing 555 90Waste Treatment and Disposal 484 90Poultry and Egg Production 99 89Scheduled Air Transportation 1781 88Motor Vehicle Body and Trailer Manufacturing 243 85Cattle Ranching and Farming 989 81Other General Merchandise Stores 2280 80Other Ambulatory Health Care Services 850 80Foundries 250 79Sheep and Goat Farming 19 77Warehousing and Storage 1349 77Waste Collection 706 76Traveler Accommodation 6780 76Other Furniture Related Product Manufacturing 118 71Forging and Stamping 297 70Logging 58 69Sawmills and Wood Preservation 52 68
Rates of Injury by IndustryPrivate sectorJanuary-June 2016
Number of Claims
Rate per 100 FTE
Interurban and Rural Bus Transportation 54 150Couriers and Express Delivery Services 3084 107Building Material and Supplies Dealers 4971 106Animal Slaughtering and Processing 555 90Waste Treatment and Disposal 484 90Poultry and Egg Production 99 89Scheduled Air Transportation 1781 88Motor Vehicle Body and Trailer Manufacturing 243 85Cattle Ranching and Farming 989 81Other General Merchandise Stores 2280 80Other Ambulatory Health Care Services 850 80Foundries 250 79Sheep and Goat Farming 19 77Warehousing and Storage 1349 77Waste Collection 706 76Traveler Accommodation 6780 76Other Furniture Related Product Manufacturing 118 71Forging and Stamping 297 70Logging 58 69Sawmills and Wood Preservation 52 68
Rates of Injury by IndustryPrivate sectorJanuary-June 2016
Number of Claims
Rate per 100 FTE
Interurban and Rural Bus Transportation 54 150Couriers and Express Delivery Services 3084 107Building Material and Supplies Dealers 4971 106Animal Slaughtering and Processing 555 90Waste Treatment and Disposal 484 90Poultry and Egg Production 99 89Scheduled Air Transportation 1781 88Motor Vehicle Body and Trailer Manufacturing 243 85Cattle Ranching and Farming 989 81Other General Merchandise Stores 2280 80Other Ambulatory Health Care Services 850 80Foundries 250 79Sheep and Goat Farming 19 77Warehousing and Storage 1349 77Waste Collection 706 76Traveler Accommodation 6780 76Other Furniture Related Product Manufacturing 118 71Forging and Stamping 297 70Logging 58 69Sawmills and Wood Preservation 52 68
Rates of Injury by IndustryPrivate sectorJanuary-June 2016
Number of Claims
Rate per 100 FTE
Interurban and Rural Bus Transportation 54 150Couriers and Express Delivery Services 3084 107Building Material and Supplies Dealers 4971 106Animal Slaughtering and Processing 555 90Waste Treatment and Disposal 484 90Poultry and Egg Production 99 89Scheduled Air Transportation 1781 88Motor Vehicle Body and Trailer Manufacturing 243 85Cattle Ranching and Farming 989 81Other General Merchandise Stores 2280 80Other Ambulatory Health Care Services 850 80Foundries 250 79Sheep and Goat Farming 19 77Warehousing and Storage 1349 77Waste Collection 706 76Traveler Accommodation 6780 76Other Furniture Related Product Manufacturing 118 71Forging and Stamping 297 70Logging 58 69Sawmills and Wood Preservation 52 68
Rates of Injury by IndustryPrivate sectorJanuary-June 2016
Number of Claims
Rate per 100 FTE
Interurban and Rural Bus Transportation 54 150Couriers and Express Delivery Services 3084 107Building Material and Supplies Dealers 4971 106Animal Slaughtering and Processing 555 90Waste Treatment and Disposal 484 90Poultry and Egg Production 99 89Scheduled Air Transportation 1781 88Motor Vehicle Body and Trailer Manufacturing 243 85Cattle Ranching and Farming 989 81Other General Merchandise Stores 2280 80Other Ambulatory Health Care Services 850 80Foundries 250 79Sheep and Goat Farming 19 77Warehousing and Storage 1349 77Waste Collection 706 76Traveler Accommodation 6780 76Other Furniture Related Product Manufacturing 118 71Forging and Stamping 297 70Logging 58 69Sawmills and Wood Preservation 52 68
IndustryCA Rate per
100 FTENational Overall SOII
Rate per 100 FTE
Couriers and Express Delivery Services 107 74
Animal Slaughtering and Processing 90 54
Poultry and Egg Production 89 69
Scheduled Air Transportation 88 66
Cattle Ranching and Farming 81 64
Foundries 79 67
Sheep and Goat Farming 77 --
Warehousing and Storage 77 50
Traveler Accommodation 76 50
Forging and Stamping 70 53
Sawmills and Wood Preservation 68 69
IndustryCA Rate per 100
FTENational Overall SOII
Rate per 100 FTE
Interurban and Rural Bus Transportation 150 30
Building Material and Supplies Dealers 106 48
Waste Treatment and Disposal 90 33
Motor Vehicle Body and Trailer Manufacturing 85 79
Other General Merchandise Stores 80 49
Other Ambulatory Health Care Services 80 30
Waste Collection 76 46
Other Furniture Related Product Manufacturing 71 55
Logging 69 37
Collaboration
Data sharing agreements
Pilot rates
Sharable repeatable methods and code
Contribution to national discussions about
use of WC data
Workers not captured by our method
Public sector
People who do not file claims
Data analysis for 2015-2016 Data analysis report Surveillance system evaluation
Publicly available dataset Disseminate findings Sustainability
California Department of Public Health John Beckman Matt Frederick Bob Harrison
California Department of Industrial Relations Genet Daba John Gordon Liza Dizon Glenn Shor Meitong Jin
California Employment Development Department Andy Wong Spencer Wong
Terry Bunn PhDDirector Kentucky Injury Prevention and Research
Center bona fide agent for the Kentucky Department for Public Health
Associate Professor Departments of Epidemiology and Preventive Medicine and Environmental Health University of Kentucky College of Public Health
bull Occupational motor vehicle crash investigations a priority focus area since 2005
KOSHS
Case Example
Case Example
bull Substance abuse a priority focus areabull State injury prevention planbull Legislation data support (HB1)
ndash Pill millsndash Clinical prescribing regulationsndash Decedent controlled substance testing lawndash Inter-state prescription drug monitoring
program (PDMP) data sharing
bull Use of PDMP data for public health surveillance
bull Inform community interventions bull Evaluate and perform cost-benefit
analysis of drug-related laws bull Establish substance use disorder
information and referral service ndash physicians (eg prevention of needle sticks
when lancing drug abuse-related abscesses)ndash first responders (eg handling of fentanyl
analogs at drug overdose scenes) ndash law enforcement (eg naloxone
administration training)ndash general public
bull Increase timeliness of public health data sources
bull Use syndromic surveillance data for drug overdose and injury surveillance
bull Algorithm development for milligram morphine equivalent calculations in PDMP reports
bull Death certificate and PDMP data linkage to identify possible drug diversion
bull State advisory group
bull Link Ky CRASH and trauma registry data with FARS driver drug testing results from fatal crashes in 2014
bull Link 2014 trauma registry toxicology result data with inpatient hospitalization data to assess drug overdose and drug abuse coding
Primary populations
bull Opioid overdose victims
bull Pregnant and parenting women
bull Individuals re-entering society upon criminal justice release
bull Adolescents and young adults
Goals
bull Prevent opioid misuse and abuse
bull Increase access to OUD treatment services (eg MAT)
bull Increase availability of recovery support services
bull Increase availability of naloxone
bull Enhance coordination and evaluation of OUD healthcare and public safety strategies
bull KRS 217186- A person or agency including a peace officer jailer firefighter paramedic or emergency medical technician or a school employee authorized to administer medication under KRS 156502 may ndash Receive a prescription for the drug
naloxonendash Possess naloxone pursuant to this
subsection and any equipment needed for its administration
ndash Administer naloxone to an individual suffering from an apparent opiate-related overdose
bull Reduce prescriber opioid prescribing (physicians APRNs etc) to a 3-day supply for injured workers
bull First line treatment based on non-opioid therapy alternatives (physical therapy acupuncture etc)
bull Revise drug formularies for treatment of pain associated with occupational injuries
Prevention Decrease likelihood that Kentuckians develop a SUD through strategies to decrease overexposure of opioid medications and illicit opioids
bull prescriptions (dosage units) overdose deaths containing fentanyl
Harm Reduction Improve Access to Harm Reduction Services to Save Lives
bull naloxone kits dispensed to first responders and public people in syringe exchange programs who received naloxone
Treatment and Recovery Expand access to treatment and recovery supports
bull peer recovery coaches Emergency Departments with peer recovery coaches people with SUD who interact with peer recovery coaches and enter treatment Emergency Department peer follow-up individuals with SUD who receive residential services calls to SUD treatment locator and portal
bull Louisville Metro Police Department presentation
bull Breakout Session
bull First Responder Opioid Exposure Survey development
bull Focus Groups
bull Survey Administration
bull Data Analysis
bull Use of Data Results
bull UK ERC first responder overdose response exposure pilot project opportunity
bull Multistate or single state applicationsndash Use of survey
ndash development of other first responder-related pilot project
FACE case investigations
bull initiated drug overdose prevention conversations
bull enhanced collaborations
bull provided evidence of need for enhanced multidisciplinary drug overdose prevention efforts1 Interventions
2 Policies
3 Research
Ladder rap
httpswwwyoutubecomwatchv=FsW6eb3aO8gampfeature=youtube
BLS Survey of Employers vs Multi-Source Surveillance of Work-Related Injuries
Kenneth D Rosenman MDProfessor of MedicineMichigan State Universitywwwoemmsuedu
NIOSH Expanding Research Partnerships Conference Denver Colorado June 21-23 2017
Funding NIOSH U60 OH008466
Survey of Occupational Injuries and Illnesses (SOII)
bull Injuries and illnesses (based on OSHArsquos recordkeeping standards) from 230000 establishments (sample by state and NAICS code)
bull Redesigned in 1992 to collect circumstances of injuries and illnesses that lead to days away from work and characteristics of affected workers
bull Scope limitations no small farms private household or self-employed workers (lt 2008 no public sector workers)
NATIONAL ACADEMY OF SCIENCES 1987
New Jersey24 Deaths not covered by OSHA35 Deaths covered by OSHA butemployer had NOT recorded on OSHAlog or did NOT keep OSHA log
TexasNIOSH Fatal Occupational Trauma Surveillance
CENSUS OF FATAL OCCUPATIONAL INJURIES (CFOI) BEGAN IN 1992
Multiple death sourcesDeath certificatesEmployer reportingState PoliceNewspaper Clipping ServiceMedical ExaminersAgricultural Extension Service
Number of deaths doubled from previous BLS estimate
How Much Work-Related Injury and Illness is Missed By the Current National Surveillance System
Rosenman KD Kalush A Reilly MJ Gardiner JC Reeves M Luo Z JOEM 2006 48357-365Funding NIOSH 5 R01 OH004276-03
Summary of Analysis Comparing BLS and Worker Comp data Michigan 2009-2001Days away from workbull BLS estimate
37-41 BLS+ WC31-34 BLS + WC+ CaptureRecapture
1999-2001 Estimates - Michiganbull BLS -281567 vs Our Estimate - 868241
1 in 15 workers vs 1 in 5 workers
(Rosenman et al JOEM 2006)
Simplified Flowchart of Events Necessary to the Documentation of Work-Related Injuries and Illnesses
(Azaroff et al AJPH 2002)
Filters to Identifying Work-Related Injuries and Illnesses
a Filters To Reporting to Supervisorsb Filters To Losing Work Time c Filters to Obtaining Medical Cared Filters to Recognizing Work-Related by Doctore Filters to Workersrsquo Compensation being the Payerf Filters To Recording on OSHA Logg Filters to Reporting by Employers to Workersrsquo
Compensation Agencyh Filters to Reporting by Doctors
(Azaroff et al AJPH 2002)
Capture-Recapture Estimates of Workplace Injury and Illness Reporting by BLS Adjusted for Capture
Heterogeneity Lost-Time Cases 1998-2001
Percent Reported to WA WV OR WI NM MNNo Source Dependence 55 76 56 65 51 68
Source Dependence 52 71 45 53 37 53
(Adapted Boden and Ozonoff Annals Epidemiology 2008)
Workersrsquo CompensationState Specific Program
Mandatory insurance or if large enough self-insured
Michigan WC Excludesbull Federal employeesbull Interstate railroad workersbull Maritime workersbull Less than 3 employees at any one timebull All employees work less than 35 hoursweek or
if more hours less than 13 weeksbull Self-employed
Not computerizedbull Medical claims only
Proportion of Work-Injured Adults for Whom Treatment was paid by Workersrsquo Compensation by State-BRFSS 10 States 2007
State Injured with Payment by Workersrsquo Compensation
Texas 47 (95 CI 35-59)New York 50 (95 CI 39-60)Michigan 56 (95 CI 41-69)Massachusetts 60 (95 CI 45-75)California 61 (95 CI 55-66)Washington 61 (95 CI 55-67)Oregon 62 (95 CI 50-74)Connecticut 63 (95 CI 53-74)New Jersey 64 (95 CI 51-78)Kentucky 77 (95 CI 65-89)
Excludes self-employed
(Adapted Bonauto et al MMWR 2010)
Percentage Received Workersrsquo Compensation by Condition Michigan
WageReplacement
Medical Only
No CompEmployed
No Comp Self -Employed
Amputations 64 22 17 6Burns 17 48 33 2Skull Fractures 36 32 29 3
Percent Applied for Workersrsquo Comp among 2016 Cases of Work-Related Asthma Michigan
Overall 484
Still ExposedConditions Unchanged 239No Longer Exposed 575
Quit on Doctorrsquos Advice 778Sick Leave 727Fired 621New Controls 589Chemical Substitution 536Quit on Own 431Reassigned 360
Reasons Didnrsquot File a Workersrsquo Compensation Claims for a Repetitive Trauma Michigan
Only 397 (251) of 1598 Filed WC Claim
Injury Not Serious Enough 705 (591)Did Not Expect to Miss Work 694 (583)Expect to Receive Sick Leave or
Disability 337 (283) Medical Expenses Covered by
Other Insurance 427 (359)Did Not Think Injury Work Related 242 (204)
(Rosenman et al JOEM 2000)
Goals of Surveillance Population-Based
bull Assess Magnitude of Problembull NumbersRatesTrends
bull Determine Relative Importance vs Other Health Issuesbull Identify High Risk
bull IndustriesOccupationsWorker Populations
bull Prioritize Interventions bull Evaluate Interventionsbull Generate Hypotheses for Researchbull Identify Emerging Problemsbull Identify Workplaces for Intervention
Case-Based
Reportable Conditions in Michigan
Local Health DepartmentsCommunicable Diseases (83)
ldquoUnusual occurrence outbreak or epidemic of any disease or conditionsrdquoMDHHS
AbortionsBirth DefectsCancerChemical Poisonings including Carbon MonoxideInjuries Nursing Home Abuse
LARAOccupational Illnesses
County Department of Social ServicesChild AbuseAdult Abuse
PoliceInjury from Knife Gun or Deadly WeaponMental Health Patient Abuse
On Request Only
Laboratory Reporting Regulations Michigan
bull Arsenicbull Cadmiumbull Carboxyhemoglobinbull Cholinesterasebull IgE Antibodiesbull Leadbull Mercury
Occupational Illness Reporting Requirement in Michigan
bull LARA ndash MIOSHAPhysician hospital clinic or employer
having a known or suspected occupational disease or health condition aggravated by workplace exposures shall report within 10 days after discovery
Misdemeanor punishable by a fine of not more than $50
Methodology of Multi-Source Surveillance
Amputations 2006- DateHospitalsEDOutpatient ClinicsWorkersrsquo Compensation Wage Replacement
Crushing Injuries 2013- Date+ FACE Program
Skull Fractures 2012-DateBurns 2009-Date
+ Poison Control Center
bull Quarterly Reporting Specified ICD codes -134 Hospitalsbull Quarterly Reporting all Work-related Events ndash Poison Control Centerbull Electronic Data Base All Paid Claims ndash Workersrsquo Compensationbull FACE ndash Death CertificatesOSHA Hot LinePolice Reports
Work-Related Burn Reports ndash By Source Total 1461 Michigan 2009
n=1460 individuals
450
BLS
HOSPITALSEDs (1248)
4501054
BLSMIFACE 1(2) 1
16721
5 PCC (106)
1321 79
WC(306)
(Kica and Rosenman JOEM 2012)
Six months of 2015 data Develop methods for matching Evaluate match Compare rates Prepare and plan
And now what yoursquove been waiting forhellip
California
QCEW
Determine industry
Injured
bull 12 million employers bull 16 million employees
bull 119 million employers bull 14 million employees
bull 51000 employersbull 302000 workers
302000 claims
260000 employer match
212000 private sector
184000 industry
Has one job73
Has employer match
9
WONK-y data match
4Did not match
14
WONK-y data match
4
Worker matches multiple employers All employers have
the same industry code One employer has
the same industry code in WCIS Only one employer is
in QCEW
Did not match14
Bad SSN or does not match on SSN Matched multiple employers gt5 employer No WONK-y data match
31 workers per 100 FTE
Rates of Injury by IndustryPrivate sectorJanuary-June 2016
Number of Claims
Rate per 100 FTE
Interurban and Rural Bus Transportation 54 150Couriers and Express Delivery Services 3084 107Building Material and Supplies Dealers 4971 106Animal Slaughtering and Processing 555 90Waste Treatment and Disposal 484 90Poultry and Egg Production 99 89Scheduled Air Transportation 1781 88Motor Vehicle Body and Trailer Manufacturing 243 85Cattle Ranching and Farming 989 81Other General Merchandise Stores 2280 80Other Ambulatory Health Care Services 850 80Foundries 250 79Sheep and Goat Farming 19 77Warehousing and Storage 1349 77Waste Collection 706 76Traveler Accommodation 6780 76Other Furniture Related Product Manufacturing 118 71Forging and Stamping 297 70Logging 58 69Sawmills and Wood Preservation 52 68
Rates of Injury by IndustryPrivate sectorJanuary-June 2016
Number of Claims
Rate per 100 FTE
Interurban and Rural Bus Transportation 54 150Couriers and Express Delivery Services 3084 107Building Material and Supplies Dealers 4971 106Animal Slaughtering and Processing 555 90Waste Treatment and Disposal 484 90Poultry and Egg Production 99 89Scheduled Air Transportation 1781 88Motor Vehicle Body and Trailer Manufacturing 243 85Cattle Ranching and Farming 989 81Other General Merchandise Stores 2280 80Other Ambulatory Health Care Services 850 80Foundries 250 79Sheep and Goat Farming 19 77Warehousing and Storage 1349 77Waste Collection 706 76Traveler Accommodation 6780 76Other Furniture Related Product Manufacturing 118 71Forging and Stamping 297 70Logging 58 69Sawmills and Wood Preservation 52 68
Rates of Injury by IndustryPrivate sectorJanuary-June 2016
Number of Claims
Rate per 100 FTE
Interurban and Rural Bus Transportation 54 150Couriers and Express Delivery Services 3084 107Building Material and Supplies Dealers 4971 106Animal Slaughtering and Processing 555 90Waste Treatment and Disposal 484 90Poultry and Egg Production 99 89Scheduled Air Transportation 1781 88Motor Vehicle Body and Trailer Manufacturing 243 85Cattle Ranching and Farming 989 81Other General Merchandise Stores 2280 80Other Ambulatory Health Care Services 850 80Foundries 250 79Sheep and Goat Farming 19 77Warehousing and Storage 1349 77Waste Collection 706 76Traveler Accommodation 6780 76Other Furniture Related Product Manufacturing 118 71Forging and Stamping 297 70Logging 58 69Sawmills and Wood Preservation 52 68
Rates of Injury by IndustryPrivate sectorJanuary-June 2016
Number of Claims
Rate per 100 FTE
Interurban and Rural Bus Transportation 54 150Couriers and Express Delivery Services 3084 107Building Material and Supplies Dealers 4971 106Animal Slaughtering and Processing 555 90Waste Treatment and Disposal 484 90Poultry and Egg Production 99 89Scheduled Air Transportation 1781 88Motor Vehicle Body and Trailer Manufacturing 243 85Cattle Ranching and Farming 989 81Other General Merchandise Stores 2280 80Other Ambulatory Health Care Services 850 80Foundries 250 79Sheep and Goat Farming 19 77Warehousing and Storage 1349 77Waste Collection 706 76Traveler Accommodation 6780 76Other Furniture Related Product Manufacturing 118 71Forging and Stamping 297 70Logging 58 69Sawmills and Wood Preservation 52 68
Rates of Injury by IndustryPrivate sectorJanuary-June 2016
Number of Claims
Rate per 100 FTE
Interurban and Rural Bus Transportation 54 150Couriers and Express Delivery Services 3084 107Building Material and Supplies Dealers 4971 106Animal Slaughtering and Processing 555 90Waste Treatment and Disposal 484 90Poultry and Egg Production 99 89Scheduled Air Transportation 1781 88Motor Vehicle Body and Trailer Manufacturing 243 85Cattle Ranching and Farming 989 81Other General Merchandise Stores 2280 80Other Ambulatory Health Care Services 850 80Foundries 250 79Sheep and Goat Farming 19 77Warehousing and Storage 1349 77Waste Collection 706 76Traveler Accommodation 6780 76Other Furniture Related Product Manufacturing 118 71Forging and Stamping 297 70Logging 58 69Sawmills and Wood Preservation 52 68
IndustryCA Rate per
100 FTENational Overall SOII
Rate per 100 FTE
Couriers and Express Delivery Services 107 74
Animal Slaughtering and Processing 90 54
Poultry and Egg Production 89 69
Scheduled Air Transportation 88 66
Cattle Ranching and Farming 81 64
Foundries 79 67
Sheep and Goat Farming 77 --
Warehousing and Storage 77 50
Traveler Accommodation 76 50
Forging and Stamping 70 53
Sawmills and Wood Preservation 68 69
IndustryCA Rate per 100
FTENational Overall SOII
Rate per 100 FTE
Interurban and Rural Bus Transportation 150 30
Building Material and Supplies Dealers 106 48
Waste Treatment and Disposal 90 33
Motor Vehicle Body and Trailer Manufacturing 85 79
Other General Merchandise Stores 80 49
Other Ambulatory Health Care Services 80 30
Waste Collection 76 46
Other Furniture Related Product Manufacturing 71 55
Logging 69 37
Collaboration
Data sharing agreements
Pilot rates
Sharable repeatable methods and code
Contribution to national discussions about
use of WC data
Workers not captured by our method
Public sector
People who do not file claims
Data analysis for 2015-2016 Data analysis report Surveillance system evaluation
Publicly available dataset Disseminate findings Sustainability
California Department of Public Health John Beckman Matt Frederick Bob Harrison
California Department of Industrial Relations Genet Daba John Gordon Liza Dizon Glenn Shor Meitong Jin
California Employment Development Department Andy Wong Spencer Wong
Terry Bunn PhDDirector Kentucky Injury Prevention and Research
Center bona fide agent for the Kentucky Department for Public Health
Associate Professor Departments of Epidemiology and Preventive Medicine and Environmental Health University of Kentucky College of Public Health
bull Occupational motor vehicle crash investigations a priority focus area since 2005
KOSHS
Case Example
Case Example
bull Substance abuse a priority focus areabull State injury prevention planbull Legislation data support (HB1)
ndash Pill millsndash Clinical prescribing regulationsndash Decedent controlled substance testing lawndash Inter-state prescription drug monitoring
program (PDMP) data sharing
bull Use of PDMP data for public health surveillance
bull Inform community interventions bull Evaluate and perform cost-benefit
analysis of drug-related laws bull Establish substance use disorder
information and referral service ndash physicians (eg prevention of needle sticks
when lancing drug abuse-related abscesses)ndash first responders (eg handling of fentanyl
analogs at drug overdose scenes) ndash law enforcement (eg naloxone
administration training)ndash general public
bull Increase timeliness of public health data sources
bull Use syndromic surveillance data for drug overdose and injury surveillance
bull Algorithm development for milligram morphine equivalent calculations in PDMP reports
bull Death certificate and PDMP data linkage to identify possible drug diversion
bull State advisory group
bull Link Ky CRASH and trauma registry data with FARS driver drug testing results from fatal crashes in 2014
bull Link 2014 trauma registry toxicology result data with inpatient hospitalization data to assess drug overdose and drug abuse coding
Primary populations
bull Opioid overdose victims
bull Pregnant and parenting women
bull Individuals re-entering society upon criminal justice release
bull Adolescents and young adults
Goals
bull Prevent opioid misuse and abuse
bull Increase access to OUD treatment services (eg MAT)
bull Increase availability of recovery support services
bull Increase availability of naloxone
bull Enhance coordination and evaluation of OUD healthcare and public safety strategies
bull KRS 217186- A person or agency including a peace officer jailer firefighter paramedic or emergency medical technician or a school employee authorized to administer medication under KRS 156502 may ndash Receive a prescription for the drug
naloxonendash Possess naloxone pursuant to this
subsection and any equipment needed for its administration
ndash Administer naloxone to an individual suffering from an apparent opiate-related overdose
bull Reduce prescriber opioid prescribing (physicians APRNs etc) to a 3-day supply for injured workers
bull First line treatment based on non-opioid therapy alternatives (physical therapy acupuncture etc)
bull Revise drug formularies for treatment of pain associated with occupational injuries
Prevention Decrease likelihood that Kentuckians develop a SUD through strategies to decrease overexposure of opioid medications and illicit opioids
bull prescriptions (dosage units) overdose deaths containing fentanyl
Harm Reduction Improve Access to Harm Reduction Services to Save Lives
bull naloxone kits dispensed to first responders and public people in syringe exchange programs who received naloxone
Treatment and Recovery Expand access to treatment and recovery supports
bull peer recovery coaches Emergency Departments with peer recovery coaches people with SUD who interact with peer recovery coaches and enter treatment Emergency Department peer follow-up individuals with SUD who receive residential services calls to SUD treatment locator and portal
bull Louisville Metro Police Department presentation
bull Breakout Session
bull First Responder Opioid Exposure Survey development
bull Focus Groups
bull Survey Administration
bull Data Analysis
bull Use of Data Results
bull UK ERC first responder overdose response exposure pilot project opportunity
bull Multistate or single state applicationsndash Use of survey
ndash development of other first responder-related pilot project
FACE case investigations
bull initiated drug overdose prevention conversations
bull enhanced collaborations
bull provided evidence of need for enhanced multidisciplinary drug overdose prevention efforts1 Interventions
2 Policies
3 Research
Ladder rap
httpswwwyoutubecomwatchv=FsW6eb3aO8gampfeature=youtube
BLS Survey of Employers vs Multi-Source Surveillance of Work-Related Injuries
Kenneth D Rosenman MDProfessor of MedicineMichigan State Universitywwwoemmsuedu
NIOSH Expanding Research Partnerships Conference Denver Colorado June 21-23 2017
Funding NIOSH U60 OH008466
Survey of Occupational Injuries and Illnesses (SOII)
bull Injuries and illnesses (based on OSHArsquos recordkeeping standards) from 230000 establishments (sample by state and NAICS code)
bull Redesigned in 1992 to collect circumstances of injuries and illnesses that lead to days away from work and characteristics of affected workers
bull Scope limitations no small farms private household or self-employed workers (lt 2008 no public sector workers)
NATIONAL ACADEMY OF SCIENCES 1987
New Jersey24 Deaths not covered by OSHA35 Deaths covered by OSHA butemployer had NOT recorded on OSHAlog or did NOT keep OSHA log
TexasNIOSH Fatal Occupational Trauma Surveillance
CENSUS OF FATAL OCCUPATIONAL INJURIES (CFOI) BEGAN IN 1992
Multiple death sourcesDeath certificatesEmployer reportingState PoliceNewspaper Clipping ServiceMedical ExaminersAgricultural Extension Service
Number of deaths doubled from previous BLS estimate
How Much Work-Related Injury and Illness is Missed By the Current National Surveillance System
Rosenman KD Kalush A Reilly MJ Gardiner JC Reeves M Luo Z JOEM 2006 48357-365Funding NIOSH 5 R01 OH004276-03
Summary of Analysis Comparing BLS and Worker Comp data Michigan 2009-2001Days away from workbull BLS estimate
37-41 BLS+ WC31-34 BLS + WC+ CaptureRecapture
1999-2001 Estimates - Michiganbull BLS -281567 vs Our Estimate - 868241
1 in 15 workers vs 1 in 5 workers
(Rosenman et al JOEM 2006)
Simplified Flowchart of Events Necessary to the Documentation of Work-Related Injuries and Illnesses
(Azaroff et al AJPH 2002)
Filters to Identifying Work-Related Injuries and Illnesses
a Filters To Reporting to Supervisorsb Filters To Losing Work Time c Filters to Obtaining Medical Cared Filters to Recognizing Work-Related by Doctore Filters to Workersrsquo Compensation being the Payerf Filters To Recording on OSHA Logg Filters to Reporting by Employers to Workersrsquo
Compensation Agencyh Filters to Reporting by Doctors
(Azaroff et al AJPH 2002)
Capture-Recapture Estimates of Workplace Injury and Illness Reporting by BLS Adjusted for Capture
Heterogeneity Lost-Time Cases 1998-2001
Percent Reported to WA WV OR WI NM MNNo Source Dependence 55 76 56 65 51 68
Source Dependence 52 71 45 53 37 53
(Adapted Boden and Ozonoff Annals Epidemiology 2008)
Workersrsquo CompensationState Specific Program
Mandatory insurance or if large enough self-insured
Michigan WC Excludesbull Federal employeesbull Interstate railroad workersbull Maritime workersbull Less than 3 employees at any one timebull All employees work less than 35 hoursweek or
if more hours less than 13 weeksbull Self-employed
Not computerizedbull Medical claims only
Proportion of Work-Injured Adults for Whom Treatment was paid by Workersrsquo Compensation by State-BRFSS 10 States 2007
State Injured with Payment by Workersrsquo Compensation
Texas 47 (95 CI 35-59)New York 50 (95 CI 39-60)Michigan 56 (95 CI 41-69)Massachusetts 60 (95 CI 45-75)California 61 (95 CI 55-66)Washington 61 (95 CI 55-67)Oregon 62 (95 CI 50-74)Connecticut 63 (95 CI 53-74)New Jersey 64 (95 CI 51-78)Kentucky 77 (95 CI 65-89)
Excludes self-employed
(Adapted Bonauto et al MMWR 2010)
Percentage Received Workersrsquo Compensation by Condition Michigan
WageReplacement
Medical Only
No CompEmployed
No Comp Self -Employed
Amputations 64 22 17 6Burns 17 48 33 2Skull Fractures 36 32 29 3
Percent Applied for Workersrsquo Comp among 2016 Cases of Work-Related Asthma Michigan
Overall 484
Still ExposedConditions Unchanged 239No Longer Exposed 575
Quit on Doctorrsquos Advice 778Sick Leave 727Fired 621New Controls 589Chemical Substitution 536Quit on Own 431Reassigned 360
Reasons Didnrsquot File a Workersrsquo Compensation Claims for a Repetitive Trauma Michigan
Only 397 (251) of 1598 Filed WC Claim
Injury Not Serious Enough 705 (591)Did Not Expect to Miss Work 694 (583)Expect to Receive Sick Leave or
Disability 337 (283) Medical Expenses Covered by
Other Insurance 427 (359)Did Not Think Injury Work Related 242 (204)
(Rosenman et al JOEM 2000)
Goals of Surveillance Population-Based
bull Assess Magnitude of Problembull NumbersRatesTrends
bull Determine Relative Importance vs Other Health Issuesbull Identify High Risk
bull IndustriesOccupationsWorker Populations
bull Prioritize Interventions bull Evaluate Interventionsbull Generate Hypotheses for Researchbull Identify Emerging Problemsbull Identify Workplaces for Intervention
Case-Based
Reportable Conditions in Michigan
Local Health DepartmentsCommunicable Diseases (83)
ldquoUnusual occurrence outbreak or epidemic of any disease or conditionsrdquoMDHHS
AbortionsBirth DefectsCancerChemical Poisonings including Carbon MonoxideInjuries Nursing Home Abuse
LARAOccupational Illnesses
County Department of Social ServicesChild AbuseAdult Abuse
PoliceInjury from Knife Gun or Deadly WeaponMental Health Patient Abuse
On Request Only
Laboratory Reporting Regulations Michigan
bull Arsenicbull Cadmiumbull Carboxyhemoglobinbull Cholinesterasebull IgE Antibodiesbull Leadbull Mercury
Occupational Illness Reporting Requirement in Michigan
bull LARA ndash MIOSHAPhysician hospital clinic or employer
having a known or suspected occupational disease or health condition aggravated by workplace exposures shall report within 10 days after discovery
Misdemeanor punishable by a fine of not more than $50
Methodology of Multi-Source Surveillance
Amputations 2006- DateHospitalsEDOutpatient ClinicsWorkersrsquo Compensation Wage Replacement
Crushing Injuries 2013- Date+ FACE Program
Skull Fractures 2012-DateBurns 2009-Date
+ Poison Control Center
bull Quarterly Reporting Specified ICD codes -134 Hospitalsbull Quarterly Reporting all Work-related Events ndash Poison Control Centerbull Electronic Data Base All Paid Claims ndash Workersrsquo Compensationbull FACE ndash Death CertificatesOSHA Hot LinePolice Reports
Work-Related Burn Reports ndash By Source Total 1461 Michigan 2009
n=1460 individuals
450
BLS
HOSPITALSEDs (1248)
4501054
BLSMIFACE 1(2) 1
16721
5 PCC (106)
1321 79
WC(306)
(Kica and Rosenman JOEM 2012)
And now what yoursquove been waiting forhellip
California
QCEW
Determine industry
Injured
bull 12 million employers bull 16 million employees
bull 119 million employers bull 14 million employees
bull 51000 employersbull 302000 workers
302000 claims
260000 employer match
212000 private sector
184000 industry
Has one job73
Has employer match
9
WONK-y data match
4Did not match
14
WONK-y data match
4
Worker matches multiple employers All employers have
the same industry code One employer has
the same industry code in WCIS Only one employer is
in QCEW
Did not match14
Bad SSN or does not match on SSN Matched multiple employers gt5 employer No WONK-y data match
31 workers per 100 FTE
Rates of Injury by IndustryPrivate sectorJanuary-June 2016
Number of Claims
Rate per 100 FTE
Interurban and Rural Bus Transportation 54 150Couriers and Express Delivery Services 3084 107Building Material and Supplies Dealers 4971 106Animal Slaughtering and Processing 555 90Waste Treatment and Disposal 484 90Poultry and Egg Production 99 89Scheduled Air Transportation 1781 88Motor Vehicle Body and Trailer Manufacturing 243 85Cattle Ranching and Farming 989 81Other General Merchandise Stores 2280 80Other Ambulatory Health Care Services 850 80Foundries 250 79Sheep and Goat Farming 19 77Warehousing and Storage 1349 77Waste Collection 706 76Traveler Accommodation 6780 76Other Furniture Related Product Manufacturing 118 71Forging and Stamping 297 70Logging 58 69Sawmills and Wood Preservation 52 68
Rates of Injury by IndustryPrivate sectorJanuary-June 2016
Number of Claims
Rate per 100 FTE
Interurban and Rural Bus Transportation 54 150Couriers and Express Delivery Services 3084 107Building Material and Supplies Dealers 4971 106Animal Slaughtering and Processing 555 90Waste Treatment and Disposal 484 90Poultry and Egg Production 99 89Scheduled Air Transportation 1781 88Motor Vehicle Body and Trailer Manufacturing 243 85Cattle Ranching and Farming 989 81Other General Merchandise Stores 2280 80Other Ambulatory Health Care Services 850 80Foundries 250 79Sheep and Goat Farming 19 77Warehousing and Storage 1349 77Waste Collection 706 76Traveler Accommodation 6780 76Other Furniture Related Product Manufacturing 118 71Forging and Stamping 297 70Logging 58 69Sawmills and Wood Preservation 52 68
Rates of Injury by IndustryPrivate sectorJanuary-June 2016
Number of Claims
Rate per 100 FTE
Interurban and Rural Bus Transportation 54 150Couriers and Express Delivery Services 3084 107Building Material and Supplies Dealers 4971 106Animal Slaughtering and Processing 555 90Waste Treatment and Disposal 484 90Poultry and Egg Production 99 89Scheduled Air Transportation 1781 88Motor Vehicle Body and Trailer Manufacturing 243 85Cattle Ranching and Farming 989 81Other General Merchandise Stores 2280 80Other Ambulatory Health Care Services 850 80Foundries 250 79Sheep and Goat Farming 19 77Warehousing and Storage 1349 77Waste Collection 706 76Traveler Accommodation 6780 76Other Furniture Related Product Manufacturing 118 71Forging and Stamping 297 70Logging 58 69Sawmills and Wood Preservation 52 68
Rates of Injury by IndustryPrivate sectorJanuary-June 2016
Number of Claims
Rate per 100 FTE
Interurban and Rural Bus Transportation 54 150Couriers and Express Delivery Services 3084 107Building Material and Supplies Dealers 4971 106Animal Slaughtering and Processing 555 90Waste Treatment and Disposal 484 90Poultry and Egg Production 99 89Scheduled Air Transportation 1781 88Motor Vehicle Body and Trailer Manufacturing 243 85Cattle Ranching and Farming 989 81Other General Merchandise Stores 2280 80Other Ambulatory Health Care Services 850 80Foundries 250 79Sheep and Goat Farming 19 77Warehousing and Storage 1349 77Waste Collection 706 76Traveler Accommodation 6780 76Other Furniture Related Product Manufacturing 118 71Forging and Stamping 297 70Logging 58 69Sawmills and Wood Preservation 52 68
Rates of Injury by IndustryPrivate sectorJanuary-June 2016
Number of Claims
Rate per 100 FTE
Interurban and Rural Bus Transportation 54 150Couriers and Express Delivery Services 3084 107Building Material and Supplies Dealers 4971 106Animal Slaughtering and Processing 555 90Waste Treatment and Disposal 484 90Poultry and Egg Production 99 89Scheduled Air Transportation 1781 88Motor Vehicle Body and Trailer Manufacturing 243 85Cattle Ranching and Farming 989 81Other General Merchandise Stores 2280 80Other Ambulatory Health Care Services 850 80Foundries 250 79Sheep and Goat Farming 19 77Warehousing and Storage 1349 77Waste Collection 706 76Traveler Accommodation 6780 76Other Furniture Related Product Manufacturing 118 71Forging and Stamping 297 70Logging 58 69Sawmills and Wood Preservation 52 68
IndustryCA Rate per
100 FTENational Overall SOII
Rate per 100 FTE
Couriers and Express Delivery Services 107 74
Animal Slaughtering and Processing 90 54
Poultry and Egg Production 89 69
Scheduled Air Transportation 88 66
Cattle Ranching and Farming 81 64
Foundries 79 67
Sheep and Goat Farming 77 --
Warehousing and Storage 77 50
Traveler Accommodation 76 50
Forging and Stamping 70 53
Sawmills and Wood Preservation 68 69
IndustryCA Rate per 100
FTENational Overall SOII
Rate per 100 FTE
Interurban and Rural Bus Transportation 150 30
Building Material and Supplies Dealers 106 48
Waste Treatment and Disposal 90 33
Motor Vehicle Body and Trailer Manufacturing 85 79
Other General Merchandise Stores 80 49
Other Ambulatory Health Care Services 80 30
Waste Collection 76 46
Other Furniture Related Product Manufacturing 71 55
Logging 69 37
Collaboration
Data sharing agreements
Pilot rates
Sharable repeatable methods and code
Contribution to national discussions about
use of WC data
Workers not captured by our method
Public sector
People who do not file claims
Data analysis for 2015-2016 Data analysis report Surveillance system evaluation
Publicly available dataset Disseminate findings Sustainability
California Department of Public Health John Beckman Matt Frederick Bob Harrison
California Department of Industrial Relations Genet Daba John Gordon Liza Dizon Glenn Shor Meitong Jin
California Employment Development Department Andy Wong Spencer Wong
Terry Bunn PhDDirector Kentucky Injury Prevention and Research
Center bona fide agent for the Kentucky Department for Public Health
Associate Professor Departments of Epidemiology and Preventive Medicine and Environmental Health University of Kentucky College of Public Health
bull Occupational motor vehicle crash investigations a priority focus area since 2005
KOSHS
Case Example
Case Example
bull Substance abuse a priority focus areabull State injury prevention planbull Legislation data support (HB1)
ndash Pill millsndash Clinical prescribing regulationsndash Decedent controlled substance testing lawndash Inter-state prescription drug monitoring
program (PDMP) data sharing
bull Use of PDMP data for public health surveillance
bull Inform community interventions bull Evaluate and perform cost-benefit
analysis of drug-related laws bull Establish substance use disorder
information and referral service ndash physicians (eg prevention of needle sticks
when lancing drug abuse-related abscesses)ndash first responders (eg handling of fentanyl
analogs at drug overdose scenes) ndash law enforcement (eg naloxone
administration training)ndash general public
bull Increase timeliness of public health data sources
bull Use syndromic surveillance data for drug overdose and injury surveillance
bull Algorithm development for milligram morphine equivalent calculations in PDMP reports
bull Death certificate and PDMP data linkage to identify possible drug diversion
bull State advisory group
bull Link Ky CRASH and trauma registry data with FARS driver drug testing results from fatal crashes in 2014
bull Link 2014 trauma registry toxicology result data with inpatient hospitalization data to assess drug overdose and drug abuse coding
Primary populations
bull Opioid overdose victims
bull Pregnant and parenting women
bull Individuals re-entering society upon criminal justice release
bull Adolescents and young adults
Goals
bull Prevent opioid misuse and abuse
bull Increase access to OUD treatment services (eg MAT)
bull Increase availability of recovery support services
bull Increase availability of naloxone
bull Enhance coordination and evaluation of OUD healthcare and public safety strategies
bull KRS 217186- A person or agency including a peace officer jailer firefighter paramedic or emergency medical technician or a school employee authorized to administer medication under KRS 156502 may ndash Receive a prescription for the drug
naloxonendash Possess naloxone pursuant to this
subsection and any equipment needed for its administration
ndash Administer naloxone to an individual suffering from an apparent opiate-related overdose
bull Reduce prescriber opioid prescribing (physicians APRNs etc) to a 3-day supply for injured workers
bull First line treatment based on non-opioid therapy alternatives (physical therapy acupuncture etc)
bull Revise drug formularies for treatment of pain associated with occupational injuries
Prevention Decrease likelihood that Kentuckians develop a SUD through strategies to decrease overexposure of opioid medications and illicit opioids
bull prescriptions (dosage units) overdose deaths containing fentanyl
Harm Reduction Improve Access to Harm Reduction Services to Save Lives
bull naloxone kits dispensed to first responders and public people in syringe exchange programs who received naloxone
Treatment and Recovery Expand access to treatment and recovery supports
bull peer recovery coaches Emergency Departments with peer recovery coaches people with SUD who interact with peer recovery coaches and enter treatment Emergency Department peer follow-up individuals with SUD who receive residential services calls to SUD treatment locator and portal
bull Louisville Metro Police Department presentation
bull Breakout Session
bull First Responder Opioid Exposure Survey development
bull Focus Groups
bull Survey Administration
bull Data Analysis
bull Use of Data Results
bull UK ERC first responder overdose response exposure pilot project opportunity
bull Multistate or single state applicationsndash Use of survey
ndash development of other first responder-related pilot project
FACE case investigations
bull initiated drug overdose prevention conversations
bull enhanced collaborations
bull provided evidence of need for enhanced multidisciplinary drug overdose prevention efforts1 Interventions
2 Policies
3 Research
Ladder rap
httpswwwyoutubecomwatchv=FsW6eb3aO8gampfeature=youtube
BLS Survey of Employers vs Multi-Source Surveillance of Work-Related Injuries
Kenneth D Rosenman MDProfessor of MedicineMichigan State Universitywwwoemmsuedu
NIOSH Expanding Research Partnerships Conference Denver Colorado June 21-23 2017
Funding NIOSH U60 OH008466
Survey of Occupational Injuries and Illnesses (SOII)
bull Injuries and illnesses (based on OSHArsquos recordkeeping standards) from 230000 establishments (sample by state and NAICS code)
bull Redesigned in 1992 to collect circumstances of injuries and illnesses that lead to days away from work and characteristics of affected workers
bull Scope limitations no small farms private household or self-employed workers (lt 2008 no public sector workers)
NATIONAL ACADEMY OF SCIENCES 1987
New Jersey24 Deaths not covered by OSHA35 Deaths covered by OSHA butemployer had NOT recorded on OSHAlog or did NOT keep OSHA log
TexasNIOSH Fatal Occupational Trauma Surveillance
CENSUS OF FATAL OCCUPATIONAL INJURIES (CFOI) BEGAN IN 1992
Multiple death sourcesDeath certificatesEmployer reportingState PoliceNewspaper Clipping ServiceMedical ExaminersAgricultural Extension Service
Number of deaths doubled from previous BLS estimate
How Much Work-Related Injury and Illness is Missed By the Current National Surveillance System
Rosenman KD Kalush A Reilly MJ Gardiner JC Reeves M Luo Z JOEM 2006 48357-365Funding NIOSH 5 R01 OH004276-03
Summary of Analysis Comparing BLS and Worker Comp data Michigan 2009-2001Days away from workbull BLS estimate
37-41 BLS+ WC31-34 BLS + WC+ CaptureRecapture
1999-2001 Estimates - Michiganbull BLS -281567 vs Our Estimate - 868241
1 in 15 workers vs 1 in 5 workers
(Rosenman et al JOEM 2006)
Simplified Flowchart of Events Necessary to the Documentation of Work-Related Injuries and Illnesses
(Azaroff et al AJPH 2002)
Filters to Identifying Work-Related Injuries and Illnesses
a Filters To Reporting to Supervisorsb Filters To Losing Work Time c Filters to Obtaining Medical Cared Filters to Recognizing Work-Related by Doctore Filters to Workersrsquo Compensation being the Payerf Filters To Recording on OSHA Logg Filters to Reporting by Employers to Workersrsquo
Compensation Agencyh Filters to Reporting by Doctors
(Azaroff et al AJPH 2002)
Capture-Recapture Estimates of Workplace Injury and Illness Reporting by BLS Adjusted for Capture
Heterogeneity Lost-Time Cases 1998-2001
Percent Reported to WA WV OR WI NM MNNo Source Dependence 55 76 56 65 51 68
Source Dependence 52 71 45 53 37 53
(Adapted Boden and Ozonoff Annals Epidemiology 2008)
Workersrsquo CompensationState Specific Program
Mandatory insurance or if large enough self-insured
Michigan WC Excludesbull Federal employeesbull Interstate railroad workersbull Maritime workersbull Less than 3 employees at any one timebull All employees work less than 35 hoursweek or
if more hours less than 13 weeksbull Self-employed
Not computerizedbull Medical claims only
Proportion of Work-Injured Adults for Whom Treatment was paid by Workersrsquo Compensation by State-BRFSS 10 States 2007
State Injured with Payment by Workersrsquo Compensation
Texas 47 (95 CI 35-59)New York 50 (95 CI 39-60)Michigan 56 (95 CI 41-69)Massachusetts 60 (95 CI 45-75)California 61 (95 CI 55-66)Washington 61 (95 CI 55-67)Oregon 62 (95 CI 50-74)Connecticut 63 (95 CI 53-74)New Jersey 64 (95 CI 51-78)Kentucky 77 (95 CI 65-89)
Excludes self-employed
(Adapted Bonauto et al MMWR 2010)
Percentage Received Workersrsquo Compensation by Condition Michigan
WageReplacement
Medical Only
No CompEmployed
No Comp Self -Employed
Amputations 64 22 17 6Burns 17 48 33 2Skull Fractures 36 32 29 3
Percent Applied for Workersrsquo Comp among 2016 Cases of Work-Related Asthma Michigan
Overall 484
Still ExposedConditions Unchanged 239No Longer Exposed 575
Quit on Doctorrsquos Advice 778Sick Leave 727Fired 621New Controls 589Chemical Substitution 536Quit on Own 431Reassigned 360
Reasons Didnrsquot File a Workersrsquo Compensation Claims for a Repetitive Trauma Michigan
Only 397 (251) of 1598 Filed WC Claim
Injury Not Serious Enough 705 (591)Did Not Expect to Miss Work 694 (583)Expect to Receive Sick Leave or
Disability 337 (283) Medical Expenses Covered by
Other Insurance 427 (359)Did Not Think Injury Work Related 242 (204)
(Rosenman et al JOEM 2000)
Goals of Surveillance Population-Based
bull Assess Magnitude of Problembull NumbersRatesTrends
bull Determine Relative Importance vs Other Health Issuesbull Identify High Risk
bull IndustriesOccupationsWorker Populations
bull Prioritize Interventions bull Evaluate Interventionsbull Generate Hypotheses for Researchbull Identify Emerging Problemsbull Identify Workplaces for Intervention
Case-Based
Reportable Conditions in Michigan
Local Health DepartmentsCommunicable Diseases (83)
ldquoUnusual occurrence outbreak or epidemic of any disease or conditionsrdquoMDHHS
AbortionsBirth DefectsCancerChemical Poisonings including Carbon MonoxideInjuries Nursing Home Abuse
LARAOccupational Illnesses
County Department of Social ServicesChild AbuseAdult Abuse
PoliceInjury from Knife Gun or Deadly WeaponMental Health Patient Abuse
On Request Only
Laboratory Reporting Regulations Michigan
bull Arsenicbull Cadmiumbull Carboxyhemoglobinbull Cholinesterasebull IgE Antibodiesbull Leadbull Mercury
Occupational Illness Reporting Requirement in Michigan
bull LARA ndash MIOSHAPhysician hospital clinic or employer
having a known or suspected occupational disease or health condition aggravated by workplace exposures shall report within 10 days after discovery
Misdemeanor punishable by a fine of not more than $50
Methodology of Multi-Source Surveillance
Amputations 2006- DateHospitalsEDOutpatient ClinicsWorkersrsquo Compensation Wage Replacement
Crushing Injuries 2013- Date+ FACE Program
Skull Fractures 2012-DateBurns 2009-Date
+ Poison Control Center
bull Quarterly Reporting Specified ICD codes -134 Hospitalsbull Quarterly Reporting all Work-related Events ndash Poison Control Centerbull Electronic Data Base All Paid Claims ndash Workersrsquo Compensationbull FACE ndash Death CertificatesOSHA Hot LinePolice Reports
Work-Related Burn Reports ndash By Source Total 1461 Michigan 2009
n=1460 individuals
450
BLS
HOSPITALSEDs (1248)
4501054
BLSMIFACE 1(2) 1
16721
5 PCC (106)
1321 79
WC(306)
(Kica and Rosenman JOEM 2012)
California
QCEW
Determine industry
Injured
bull 12 million employers bull 16 million employees
bull 119 million employers bull 14 million employees
bull 51000 employersbull 302000 workers
302000 claims
260000 employer match
212000 private sector
184000 industry
Has one job73
Has employer match
9
WONK-y data match
4Did not match
14
WONK-y data match
4
Worker matches multiple employers All employers have
the same industry code One employer has
the same industry code in WCIS Only one employer is
in QCEW
Did not match14
Bad SSN or does not match on SSN Matched multiple employers gt5 employer No WONK-y data match
31 workers per 100 FTE
Rates of Injury by IndustryPrivate sectorJanuary-June 2016
Number of Claims
Rate per 100 FTE
Interurban and Rural Bus Transportation 54 150Couriers and Express Delivery Services 3084 107Building Material and Supplies Dealers 4971 106Animal Slaughtering and Processing 555 90Waste Treatment and Disposal 484 90Poultry and Egg Production 99 89Scheduled Air Transportation 1781 88Motor Vehicle Body and Trailer Manufacturing 243 85Cattle Ranching and Farming 989 81Other General Merchandise Stores 2280 80Other Ambulatory Health Care Services 850 80Foundries 250 79Sheep and Goat Farming 19 77Warehousing and Storage 1349 77Waste Collection 706 76Traveler Accommodation 6780 76Other Furniture Related Product Manufacturing 118 71Forging and Stamping 297 70Logging 58 69Sawmills and Wood Preservation 52 68
Rates of Injury by IndustryPrivate sectorJanuary-June 2016
Number of Claims
Rate per 100 FTE
Interurban and Rural Bus Transportation 54 150Couriers and Express Delivery Services 3084 107Building Material and Supplies Dealers 4971 106Animal Slaughtering and Processing 555 90Waste Treatment and Disposal 484 90Poultry and Egg Production 99 89Scheduled Air Transportation 1781 88Motor Vehicle Body and Trailer Manufacturing 243 85Cattle Ranching and Farming 989 81Other General Merchandise Stores 2280 80Other Ambulatory Health Care Services 850 80Foundries 250 79Sheep and Goat Farming 19 77Warehousing and Storage 1349 77Waste Collection 706 76Traveler Accommodation 6780 76Other Furniture Related Product Manufacturing 118 71Forging and Stamping 297 70Logging 58 69Sawmills and Wood Preservation 52 68
Rates of Injury by IndustryPrivate sectorJanuary-June 2016
Number of Claims
Rate per 100 FTE
Interurban and Rural Bus Transportation 54 150Couriers and Express Delivery Services 3084 107Building Material and Supplies Dealers 4971 106Animal Slaughtering and Processing 555 90Waste Treatment and Disposal 484 90Poultry and Egg Production 99 89Scheduled Air Transportation 1781 88Motor Vehicle Body and Trailer Manufacturing 243 85Cattle Ranching and Farming 989 81Other General Merchandise Stores 2280 80Other Ambulatory Health Care Services 850 80Foundries 250 79Sheep and Goat Farming 19 77Warehousing and Storage 1349 77Waste Collection 706 76Traveler Accommodation 6780 76Other Furniture Related Product Manufacturing 118 71Forging and Stamping 297 70Logging 58 69Sawmills and Wood Preservation 52 68
Rates of Injury by IndustryPrivate sectorJanuary-June 2016
Number of Claims
Rate per 100 FTE
Interurban and Rural Bus Transportation 54 150Couriers and Express Delivery Services 3084 107Building Material and Supplies Dealers 4971 106Animal Slaughtering and Processing 555 90Waste Treatment and Disposal 484 90Poultry and Egg Production 99 89Scheduled Air Transportation 1781 88Motor Vehicle Body and Trailer Manufacturing 243 85Cattle Ranching and Farming 989 81Other General Merchandise Stores 2280 80Other Ambulatory Health Care Services 850 80Foundries 250 79Sheep and Goat Farming 19 77Warehousing and Storage 1349 77Waste Collection 706 76Traveler Accommodation 6780 76Other Furniture Related Product Manufacturing 118 71Forging and Stamping 297 70Logging 58 69Sawmills and Wood Preservation 52 68
Rates of Injury by IndustryPrivate sectorJanuary-June 2016
Number of Claims
Rate per 100 FTE
Interurban and Rural Bus Transportation 54 150Couriers and Express Delivery Services 3084 107Building Material and Supplies Dealers 4971 106Animal Slaughtering and Processing 555 90Waste Treatment and Disposal 484 90Poultry and Egg Production 99 89Scheduled Air Transportation 1781 88Motor Vehicle Body and Trailer Manufacturing 243 85Cattle Ranching and Farming 989 81Other General Merchandise Stores 2280 80Other Ambulatory Health Care Services 850 80Foundries 250 79Sheep and Goat Farming 19 77Warehousing and Storage 1349 77Waste Collection 706 76Traveler Accommodation 6780 76Other Furniture Related Product Manufacturing 118 71Forging and Stamping 297 70Logging 58 69Sawmills and Wood Preservation 52 68
IndustryCA Rate per
100 FTENational Overall SOII
Rate per 100 FTE
Couriers and Express Delivery Services 107 74
Animal Slaughtering and Processing 90 54
Poultry and Egg Production 89 69
Scheduled Air Transportation 88 66
Cattle Ranching and Farming 81 64
Foundries 79 67
Sheep and Goat Farming 77 --
Warehousing and Storage 77 50
Traveler Accommodation 76 50
Forging and Stamping 70 53
Sawmills and Wood Preservation 68 69
IndustryCA Rate per 100
FTENational Overall SOII
Rate per 100 FTE
Interurban and Rural Bus Transportation 150 30
Building Material and Supplies Dealers 106 48
Waste Treatment and Disposal 90 33
Motor Vehicle Body and Trailer Manufacturing 85 79
Other General Merchandise Stores 80 49
Other Ambulatory Health Care Services 80 30
Waste Collection 76 46
Other Furniture Related Product Manufacturing 71 55
Logging 69 37
Collaboration
Data sharing agreements
Pilot rates
Sharable repeatable methods and code
Contribution to national discussions about
use of WC data
Workers not captured by our method
Public sector
People who do not file claims
Data analysis for 2015-2016 Data analysis report Surveillance system evaluation
Publicly available dataset Disseminate findings Sustainability
California Department of Public Health John Beckman Matt Frederick Bob Harrison
California Department of Industrial Relations Genet Daba John Gordon Liza Dizon Glenn Shor Meitong Jin
California Employment Development Department Andy Wong Spencer Wong
Terry Bunn PhDDirector Kentucky Injury Prevention and Research
Center bona fide agent for the Kentucky Department for Public Health
Associate Professor Departments of Epidemiology and Preventive Medicine and Environmental Health University of Kentucky College of Public Health
bull Occupational motor vehicle crash investigations a priority focus area since 2005
KOSHS
Case Example
Case Example
bull Substance abuse a priority focus areabull State injury prevention planbull Legislation data support (HB1)
ndash Pill millsndash Clinical prescribing regulationsndash Decedent controlled substance testing lawndash Inter-state prescription drug monitoring
program (PDMP) data sharing
bull Use of PDMP data for public health surveillance
bull Inform community interventions bull Evaluate and perform cost-benefit
analysis of drug-related laws bull Establish substance use disorder
information and referral service ndash physicians (eg prevention of needle sticks
when lancing drug abuse-related abscesses)ndash first responders (eg handling of fentanyl
analogs at drug overdose scenes) ndash law enforcement (eg naloxone
administration training)ndash general public
bull Increase timeliness of public health data sources
bull Use syndromic surveillance data for drug overdose and injury surveillance
bull Algorithm development for milligram morphine equivalent calculations in PDMP reports
bull Death certificate and PDMP data linkage to identify possible drug diversion
bull State advisory group
bull Link Ky CRASH and trauma registry data with FARS driver drug testing results from fatal crashes in 2014
bull Link 2014 trauma registry toxicology result data with inpatient hospitalization data to assess drug overdose and drug abuse coding
Primary populations
bull Opioid overdose victims
bull Pregnant and parenting women
bull Individuals re-entering society upon criminal justice release
bull Adolescents and young adults
Goals
bull Prevent opioid misuse and abuse
bull Increase access to OUD treatment services (eg MAT)
bull Increase availability of recovery support services
bull Increase availability of naloxone
bull Enhance coordination and evaluation of OUD healthcare and public safety strategies
bull KRS 217186- A person or agency including a peace officer jailer firefighter paramedic or emergency medical technician or a school employee authorized to administer medication under KRS 156502 may ndash Receive a prescription for the drug
naloxonendash Possess naloxone pursuant to this
subsection and any equipment needed for its administration
ndash Administer naloxone to an individual suffering from an apparent opiate-related overdose
bull Reduce prescriber opioid prescribing (physicians APRNs etc) to a 3-day supply for injured workers
bull First line treatment based on non-opioid therapy alternatives (physical therapy acupuncture etc)
bull Revise drug formularies for treatment of pain associated with occupational injuries
Prevention Decrease likelihood that Kentuckians develop a SUD through strategies to decrease overexposure of opioid medications and illicit opioids
bull prescriptions (dosage units) overdose deaths containing fentanyl
Harm Reduction Improve Access to Harm Reduction Services to Save Lives
bull naloxone kits dispensed to first responders and public people in syringe exchange programs who received naloxone
Treatment and Recovery Expand access to treatment and recovery supports
bull peer recovery coaches Emergency Departments with peer recovery coaches people with SUD who interact with peer recovery coaches and enter treatment Emergency Department peer follow-up individuals with SUD who receive residential services calls to SUD treatment locator and portal
bull Louisville Metro Police Department presentation
bull Breakout Session
bull First Responder Opioid Exposure Survey development
bull Focus Groups
bull Survey Administration
bull Data Analysis
bull Use of Data Results
bull UK ERC first responder overdose response exposure pilot project opportunity
bull Multistate or single state applicationsndash Use of survey
ndash development of other first responder-related pilot project
FACE case investigations
bull initiated drug overdose prevention conversations
bull enhanced collaborations
bull provided evidence of need for enhanced multidisciplinary drug overdose prevention efforts1 Interventions
2 Policies
3 Research
Ladder rap
httpswwwyoutubecomwatchv=FsW6eb3aO8gampfeature=youtube
BLS Survey of Employers vs Multi-Source Surveillance of Work-Related Injuries
Kenneth D Rosenman MDProfessor of MedicineMichigan State Universitywwwoemmsuedu
NIOSH Expanding Research Partnerships Conference Denver Colorado June 21-23 2017
Funding NIOSH U60 OH008466
Survey of Occupational Injuries and Illnesses (SOII)
bull Injuries and illnesses (based on OSHArsquos recordkeeping standards) from 230000 establishments (sample by state and NAICS code)
bull Redesigned in 1992 to collect circumstances of injuries and illnesses that lead to days away from work and characteristics of affected workers
bull Scope limitations no small farms private household or self-employed workers (lt 2008 no public sector workers)
NATIONAL ACADEMY OF SCIENCES 1987
New Jersey24 Deaths not covered by OSHA35 Deaths covered by OSHA butemployer had NOT recorded on OSHAlog or did NOT keep OSHA log
TexasNIOSH Fatal Occupational Trauma Surveillance
CENSUS OF FATAL OCCUPATIONAL INJURIES (CFOI) BEGAN IN 1992
Multiple death sourcesDeath certificatesEmployer reportingState PoliceNewspaper Clipping ServiceMedical ExaminersAgricultural Extension Service
Number of deaths doubled from previous BLS estimate
How Much Work-Related Injury and Illness is Missed By the Current National Surveillance System
Rosenman KD Kalush A Reilly MJ Gardiner JC Reeves M Luo Z JOEM 2006 48357-365Funding NIOSH 5 R01 OH004276-03
Summary of Analysis Comparing BLS and Worker Comp data Michigan 2009-2001Days away from workbull BLS estimate
37-41 BLS+ WC31-34 BLS + WC+ CaptureRecapture
1999-2001 Estimates - Michiganbull BLS -281567 vs Our Estimate - 868241
1 in 15 workers vs 1 in 5 workers
(Rosenman et al JOEM 2006)
Simplified Flowchart of Events Necessary to the Documentation of Work-Related Injuries and Illnesses
(Azaroff et al AJPH 2002)
Filters to Identifying Work-Related Injuries and Illnesses
a Filters To Reporting to Supervisorsb Filters To Losing Work Time c Filters to Obtaining Medical Cared Filters to Recognizing Work-Related by Doctore Filters to Workersrsquo Compensation being the Payerf Filters To Recording on OSHA Logg Filters to Reporting by Employers to Workersrsquo
Compensation Agencyh Filters to Reporting by Doctors
(Azaroff et al AJPH 2002)
Capture-Recapture Estimates of Workplace Injury and Illness Reporting by BLS Adjusted for Capture
Heterogeneity Lost-Time Cases 1998-2001
Percent Reported to WA WV OR WI NM MNNo Source Dependence 55 76 56 65 51 68
Source Dependence 52 71 45 53 37 53
(Adapted Boden and Ozonoff Annals Epidemiology 2008)
Workersrsquo CompensationState Specific Program
Mandatory insurance or if large enough self-insured
Michigan WC Excludesbull Federal employeesbull Interstate railroad workersbull Maritime workersbull Less than 3 employees at any one timebull All employees work less than 35 hoursweek or
if more hours less than 13 weeksbull Self-employed
Not computerizedbull Medical claims only
Proportion of Work-Injured Adults for Whom Treatment was paid by Workersrsquo Compensation by State-BRFSS 10 States 2007
State Injured with Payment by Workersrsquo Compensation
Texas 47 (95 CI 35-59)New York 50 (95 CI 39-60)Michigan 56 (95 CI 41-69)Massachusetts 60 (95 CI 45-75)California 61 (95 CI 55-66)Washington 61 (95 CI 55-67)Oregon 62 (95 CI 50-74)Connecticut 63 (95 CI 53-74)New Jersey 64 (95 CI 51-78)Kentucky 77 (95 CI 65-89)
Excludes self-employed
(Adapted Bonauto et al MMWR 2010)
Percentage Received Workersrsquo Compensation by Condition Michigan
WageReplacement
Medical Only
No CompEmployed
No Comp Self -Employed
Amputations 64 22 17 6Burns 17 48 33 2Skull Fractures 36 32 29 3
Percent Applied for Workersrsquo Comp among 2016 Cases of Work-Related Asthma Michigan
Overall 484
Still ExposedConditions Unchanged 239No Longer Exposed 575
Quit on Doctorrsquos Advice 778Sick Leave 727Fired 621New Controls 589Chemical Substitution 536Quit on Own 431Reassigned 360
Reasons Didnrsquot File a Workersrsquo Compensation Claims for a Repetitive Trauma Michigan
Only 397 (251) of 1598 Filed WC Claim
Injury Not Serious Enough 705 (591)Did Not Expect to Miss Work 694 (583)Expect to Receive Sick Leave or
Disability 337 (283) Medical Expenses Covered by
Other Insurance 427 (359)Did Not Think Injury Work Related 242 (204)
(Rosenman et al JOEM 2000)
Goals of Surveillance Population-Based
bull Assess Magnitude of Problembull NumbersRatesTrends
bull Determine Relative Importance vs Other Health Issuesbull Identify High Risk
bull IndustriesOccupationsWorker Populations
bull Prioritize Interventions bull Evaluate Interventionsbull Generate Hypotheses for Researchbull Identify Emerging Problemsbull Identify Workplaces for Intervention
Case-Based
Reportable Conditions in Michigan
Local Health DepartmentsCommunicable Diseases (83)
ldquoUnusual occurrence outbreak or epidemic of any disease or conditionsrdquoMDHHS
AbortionsBirth DefectsCancerChemical Poisonings including Carbon MonoxideInjuries Nursing Home Abuse
LARAOccupational Illnesses
County Department of Social ServicesChild AbuseAdult Abuse
PoliceInjury from Knife Gun or Deadly WeaponMental Health Patient Abuse
On Request Only
Laboratory Reporting Regulations Michigan
bull Arsenicbull Cadmiumbull Carboxyhemoglobinbull Cholinesterasebull IgE Antibodiesbull Leadbull Mercury
Occupational Illness Reporting Requirement in Michigan
bull LARA ndash MIOSHAPhysician hospital clinic or employer
having a known or suspected occupational disease or health condition aggravated by workplace exposures shall report within 10 days after discovery
Misdemeanor punishable by a fine of not more than $50
Methodology of Multi-Source Surveillance
Amputations 2006- DateHospitalsEDOutpatient ClinicsWorkersrsquo Compensation Wage Replacement
Crushing Injuries 2013- Date+ FACE Program
Skull Fractures 2012-DateBurns 2009-Date
+ Poison Control Center
bull Quarterly Reporting Specified ICD codes -134 Hospitalsbull Quarterly Reporting all Work-related Events ndash Poison Control Centerbull Electronic Data Base All Paid Claims ndash Workersrsquo Compensationbull FACE ndash Death CertificatesOSHA Hot LinePolice Reports
Work-Related Burn Reports ndash By Source Total 1461 Michigan 2009
n=1460 individuals
450
BLS
HOSPITALSEDs (1248)
4501054
BLSMIFACE 1(2) 1
16721
5 PCC (106)
1321 79
WC(306)
(Kica and Rosenman JOEM 2012)
302000 claims
260000 employer match
212000 private sector
184000 industry
Has one job73
Has employer match
9
WONK-y data match
4Did not match
14
WONK-y data match
4
Worker matches multiple employers All employers have
the same industry code One employer has
the same industry code in WCIS Only one employer is
in QCEW
Did not match14
Bad SSN or does not match on SSN Matched multiple employers gt5 employer No WONK-y data match
31 workers per 100 FTE
Rates of Injury by IndustryPrivate sectorJanuary-June 2016
Number of Claims
Rate per 100 FTE
Interurban and Rural Bus Transportation 54 150Couriers and Express Delivery Services 3084 107Building Material and Supplies Dealers 4971 106Animal Slaughtering and Processing 555 90Waste Treatment and Disposal 484 90Poultry and Egg Production 99 89Scheduled Air Transportation 1781 88Motor Vehicle Body and Trailer Manufacturing 243 85Cattle Ranching and Farming 989 81Other General Merchandise Stores 2280 80Other Ambulatory Health Care Services 850 80Foundries 250 79Sheep and Goat Farming 19 77Warehousing and Storage 1349 77Waste Collection 706 76Traveler Accommodation 6780 76Other Furniture Related Product Manufacturing 118 71Forging and Stamping 297 70Logging 58 69Sawmills and Wood Preservation 52 68
Rates of Injury by IndustryPrivate sectorJanuary-June 2016
Number of Claims
Rate per 100 FTE
Interurban and Rural Bus Transportation 54 150Couriers and Express Delivery Services 3084 107Building Material and Supplies Dealers 4971 106Animal Slaughtering and Processing 555 90Waste Treatment and Disposal 484 90Poultry and Egg Production 99 89Scheduled Air Transportation 1781 88Motor Vehicle Body and Trailer Manufacturing 243 85Cattle Ranching and Farming 989 81Other General Merchandise Stores 2280 80Other Ambulatory Health Care Services 850 80Foundries 250 79Sheep and Goat Farming 19 77Warehousing and Storage 1349 77Waste Collection 706 76Traveler Accommodation 6780 76Other Furniture Related Product Manufacturing 118 71Forging and Stamping 297 70Logging 58 69Sawmills and Wood Preservation 52 68
Rates of Injury by IndustryPrivate sectorJanuary-June 2016
Number of Claims
Rate per 100 FTE
Interurban and Rural Bus Transportation 54 150Couriers and Express Delivery Services 3084 107Building Material and Supplies Dealers 4971 106Animal Slaughtering and Processing 555 90Waste Treatment and Disposal 484 90Poultry and Egg Production 99 89Scheduled Air Transportation 1781 88Motor Vehicle Body and Trailer Manufacturing 243 85Cattle Ranching and Farming 989 81Other General Merchandise Stores 2280 80Other Ambulatory Health Care Services 850 80Foundries 250 79Sheep and Goat Farming 19 77Warehousing and Storage 1349 77Waste Collection 706 76Traveler Accommodation 6780 76Other Furniture Related Product Manufacturing 118 71Forging and Stamping 297 70Logging 58 69Sawmills and Wood Preservation 52 68
Rates of Injury by IndustryPrivate sectorJanuary-June 2016
Number of Claims
Rate per 100 FTE
Interurban and Rural Bus Transportation 54 150Couriers and Express Delivery Services 3084 107Building Material and Supplies Dealers 4971 106Animal Slaughtering and Processing 555 90Waste Treatment and Disposal 484 90Poultry and Egg Production 99 89Scheduled Air Transportation 1781 88Motor Vehicle Body and Trailer Manufacturing 243 85Cattle Ranching and Farming 989 81Other General Merchandise Stores 2280 80Other Ambulatory Health Care Services 850 80Foundries 250 79Sheep and Goat Farming 19 77Warehousing and Storage 1349 77Waste Collection 706 76Traveler Accommodation 6780 76Other Furniture Related Product Manufacturing 118 71Forging and Stamping 297 70Logging 58 69Sawmills and Wood Preservation 52 68
Rates of Injury by IndustryPrivate sectorJanuary-June 2016
Number of Claims
Rate per 100 FTE
Interurban and Rural Bus Transportation 54 150Couriers and Express Delivery Services 3084 107Building Material and Supplies Dealers 4971 106Animal Slaughtering and Processing 555 90Waste Treatment and Disposal 484 90Poultry and Egg Production 99 89Scheduled Air Transportation 1781 88Motor Vehicle Body and Trailer Manufacturing 243 85Cattle Ranching and Farming 989 81Other General Merchandise Stores 2280 80Other Ambulatory Health Care Services 850 80Foundries 250 79Sheep and Goat Farming 19 77Warehousing and Storage 1349 77Waste Collection 706 76Traveler Accommodation 6780 76Other Furniture Related Product Manufacturing 118 71Forging and Stamping 297 70Logging 58 69Sawmills and Wood Preservation 52 68
IndustryCA Rate per
100 FTENational Overall SOII
Rate per 100 FTE
Couriers and Express Delivery Services 107 74
Animal Slaughtering and Processing 90 54
Poultry and Egg Production 89 69
Scheduled Air Transportation 88 66
Cattle Ranching and Farming 81 64
Foundries 79 67
Sheep and Goat Farming 77 --
Warehousing and Storage 77 50
Traveler Accommodation 76 50
Forging and Stamping 70 53
Sawmills and Wood Preservation 68 69
IndustryCA Rate per 100
FTENational Overall SOII
Rate per 100 FTE
Interurban and Rural Bus Transportation 150 30
Building Material and Supplies Dealers 106 48
Waste Treatment and Disposal 90 33
Motor Vehicle Body and Trailer Manufacturing 85 79
Other General Merchandise Stores 80 49
Other Ambulatory Health Care Services 80 30
Waste Collection 76 46
Other Furniture Related Product Manufacturing 71 55
Logging 69 37
Collaboration
Data sharing agreements
Pilot rates
Sharable repeatable methods and code
Contribution to national discussions about
use of WC data
Workers not captured by our method
Public sector
People who do not file claims
Data analysis for 2015-2016 Data analysis report Surveillance system evaluation
Publicly available dataset Disseminate findings Sustainability
California Department of Public Health John Beckman Matt Frederick Bob Harrison
California Department of Industrial Relations Genet Daba John Gordon Liza Dizon Glenn Shor Meitong Jin
California Employment Development Department Andy Wong Spencer Wong
Terry Bunn PhDDirector Kentucky Injury Prevention and Research
Center bona fide agent for the Kentucky Department for Public Health
Associate Professor Departments of Epidemiology and Preventive Medicine and Environmental Health University of Kentucky College of Public Health
bull Occupational motor vehicle crash investigations a priority focus area since 2005
KOSHS
Case Example
Case Example
bull Substance abuse a priority focus areabull State injury prevention planbull Legislation data support (HB1)
ndash Pill millsndash Clinical prescribing regulationsndash Decedent controlled substance testing lawndash Inter-state prescription drug monitoring
program (PDMP) data sharing
bull Use of PDMP data for public health surveillance
bull Inform community interventions bull Evaluate and perform cost-benefit
analysis of drug-related laws bull Establish substance use disorder
information and referral service ndash physicians (eg prevention of needle sticks
when lancing drug abuse-related abscesses)ndash first responders (eg handling of fentanyl
analogs at drug overdose scenes) ndash law enforcement (eg naloxone
administration training)ndash general public
bull Increase timeliness of public health data sources
bull Use syndromic surveillance data for drug overdose and injury surveillance
bull Algorithm development for milligram morphine equivalent calculations in PDMP reports
bull Death certificate and PDMP data linkage to identify possible drug diversion
bull State advisory group
bull Link Ky CRASH and trauma registry data with FARS driver drug testing results from fatal crashes in 2014
bull Link 2014 trauma registry toxicology result data with inpatient hospitalization data to assess drug overdose and drug abuse coding
Primary populations
bull Opioid overdose victims
bull Pregnant and parenting women
bull Individuals re-entering society upon criminal justice release
bull Adolescents and young adults
Goals
bull Prevent opioid misuse and abuse
bull Increase access to OUD treatment services (eg MAT)
bull Increase availability of recovery support services
bull Increase availability of naloxone
bull Enhance coordination and evaluation of OUD healthcare and public safety strategies
bull KRS 217186- A person or agency including a peace officer jailer firefighter paramedic or emergency medical technician or a school employee authorized to administer medication under KRS 156502 may ndash Receive a prescription for the drug
naloxonendash Possess naloxone pursuant to this
subsection and any equipment needed for its administration
ndash Administer naloxone to an individual suffering from an apparent opiate-related overdose
bull Reduce prescriber opioid prescribing (physicians APRNs etc) to a 3-day supply for injured workers
bull First line treatment based on non-opioid therapy alternatives (physical therapy acupuncture etc)
bull Revise drug formularies for treatment of pain associated with occupational injuries
Prevention Decrease likelihood that Kentuckians develop a SUD through strategies to decrease overexposure of opioid medications and illicit opioids
bull prescriptions (dosage units) overdose deaths containing fentanyl
Harm Reduction Improve Access to Harm Reduction Services to Save Lives
bull naloxone kits dispensed to first responders and public people in syringe exchange programs who received naloxone
Treatment and Recovery Expand access to treatment and recovery supports
bull peer recovery coaches Emergency Departments with peer recovery coaches people with SUD who interact with peer recovery coaches and enter treatment Emergency Department peer follow-up individuals with SUD who receive residential services calls to SUD treatment locator and portal
bull Louisville Metro Police Department presentation
bull Breakout Session
bull First Responder Opioid Exposure Survey development
bull Focus Groups
bull Survey Administration
bull Data Analysis
bull Use of Data Results
bull UK ERC first responder overdose response exposure pilot project opportunity
bull Multistate or single state applicationsndash Use of survey
ndash development of other first responder-related pilot project
FACE case investigations
bull initiated drug overdose prevention conversations
bull enhanced collaborations
bull provided evidence of need for enhanced multidisciplinary drug overdose prevention efforts1 Interventions
2 Policies
3 Research
Ladder rap
httpswwwyoutubecomwatchv=FsW6eb3aO8gampfeature=youtube
BLS Survey of Employers vs Multi-Source Surveillance of Work-Related Injuries
Kenneth D Rosenman MDProfessor of MedicineMichigan State Universitywwwoemmsuedu
NIOSH Expanding Research Partnerships Conference Denver Colorado June 21-23 2017
Funding NIOSH U60 OH008466
Survey of Occupational Injuries and Illnesses (SOII)
bull Injuries and illnesses (based on OSHArsquos recordkeeping standards) from 230000 establishments (sample by state and NAICS code)
bull Redesigned in 1992 to collect circumstances of injuries and illnesses that lead to days away from work and characteristics of affected workers
bull Scope limitations no small farms private household or self-employed workers (lt 2008 no public sector workers)
NATIONAL ACADEMY OF SCIENCES 1987
New Jersey24 Deaths not covered by OSHA35 Deaths covered by OSHA butemployer had NOT recorded on OSHAlog or did NOT keep OSHA log
TexasNIOSH Fatal Occupational Trauma Surveillance
CENSUS OF FATAL OCCUPATIONAL INJURIES (CFOI) BEGAN IN 1992
Multiple death sourcesDeath certificatesEmployer reportingState PoliceNewspaper Clipping ServiceMedical ExaminersAgricultural Extension Service
Number of deaths doubled from previous BLS estimate
How Much Work-Related Injury and Illness is Missed By the Current National Surveillance System
Rosenman KD Kalush A Reilly MJ Gardiner JC Reeves M Luo Z JOEM 2006 48357-365Funding NIOSH 5 R01 OH004276-03
Summary of Analysis Comparing BLS and Worker Comp data Michigan 2009-2001Days away from workbull BLS estimate
37-41 BLS+ WC31-34 BLS + WC+ CaptureRecapture
1999-2001 Estimates - Michiganbull BLS -281567 vs Our Estimate - 868241
1 in 15 workers vs 1 in 5 workers
(Rosenman et al JOEM 2006)
Simplified Flowchart of Events Necessary to the Documentation of Work-Related Injuries and Illnesses
(Azaroff et al AJPH 2002)
Filters to Identifying Work-Related Injuries and Illnesses
a Filters To Reporting to Supervisorsb Filters To Losing Work Time c Filters to Obtaining Medical Cared Filters to Recognizing Work-Related by Doctore Filters to Workersrsquo Compensation being the Payerf Filters To Recording on OSHA Logg Filters to Reporting by Employers to Workersrsquo
Compensation Agencyh Filters to Reporting by Doctors
(Azaroff et al AJPH 2002)
Capture-Recapture Estimates of Workplace Injury and Illness Reporting by BLS Adjusted for Capture
Heterogeneity Lost-Time Cases 1998-2001
Percent Reported to WA WV OR WI NM MNNo Source Dependence 55 76 56 65 51 68
Source Dependence 52 71 45 53 37 53
(Adapted Boden and Ozonoff Annals Epidemiology 2008)
Workersrsquo CompensationState Specific Program
Mandatory insurance or if large enough self-insured
Michigan WC Excludesbull Federal employeesbull Interstate railroad workersbull Maritime workersbull Less than 3 employees at any one timebull All employees work less than 35 hoursweek or
if more hours less than 13 weeksbull Self-employed
Not computerizedbull Medical claims only
Proportion of Work-Injured Adults for Whom Treatment was paid by Workersrsquo Compensation by State-BRFSS 10 States 2007
State Injured with Payment by Workersrsquo Compensation
Texas 47 (95 CI 35-59)New York 50 (95 CI 39-60)Michigan 56 (95 CI 41-69)Massachusetts 60 (95 CI 45-75)California 61 (95 CI 55-66)Washington 61 (95 CI 55-67)Oregon 62 (95 CI 50-74)Connecticut 63 (95 CI 53-74)New Jersey 64 (95 CI 51-78)Kentucky 77 (95 CI 65-89)
Excludes self-employed
(Adapted Bonauto et al MMWR 2010)
Percentage Received Workersrsquo Compensation by Condition Michigan
WageReplacement
Medical Only
No CompEmployed
No Comp Self -Employed
Amputations 64 22 17 6Burns 17 48 33 2Skull Fractures 36 32 29 3
Percent Applied for Workersrsquo Comp among 2016 Cases of Work-Related Asthma Michigan
Overall 484
Still ExposedConditions Unchanged 239No Longer Exposed 575
Quit on Doctorrsquos Advice 778Sick Leave 727Fired 621New Controls 589Chemical Substitution 536Quit on Own 431Reassigned 360
Reasons Didnrsquot File a Workersrsquo Compensation Claims for a Repetitive Trauma Michigan
Only 397 (251) of 1598 Filed WC Claim
Injury Not Serious Enough 705 (591)Did Not Expect to Miss Work 694 (583)Expect to Receive Sick Leave or
Disability 337 (283) Medical Expenses Covered by
Other Insurance 427 (359)Did Not Think Injury Work Related 242 (204)
(Rosenman et al JOEM 2000)
Goals of Surveillance Population-Based
bull Assess Magnitude of Problembull NumbersRatesTrends
bull Determine Relative Importance vs Other Health Issuesbull Identify High Risk
bull IndustriesOccupationsWorker Populations
bull Prioritize Interventions bull Evaluate Interventionsbull Generate Hypotheses for Researchbull Identify Emerging Problemsbull Identify Workplaces for Intervention
Case-Based
Reportable Conditions in Michigan
Local Health DepartmentsCommunicable Diseases (83)
ldquoUnusual occurrence outbreak or epidemic of any disease or conditionsrdquoMDHHS
AbortionsBirth DefectsCancerChemical Poisonings including Carbon MonoxideInjuries Nursing Home Abuse
LARAOccupational Illnesses
County Department of Social ServicesChild AbuseAdult Abuse
PoliceInjury from Knife Gun or Deadly WeaponMental Health Patient Abuse
On Request Only
Laboratory Reporting Regulations Michigan
bull Arsenicbull Cadmiumbull Carboxyhemoglobinbull Cholinesterasebull IgE Antibodiesbull Leadbull Mercury
Occupational Illness Reporting Requirement in Michigan
bull LARA ndash MIOSHAPhysician hospital clinic or employer
having a known or suspected occupational disease or health condition aggravated by workplace exposures shall report within 10 days after discovery
Misdemeanor punishable by a fine of not more than $50
Methodology of Multi-Source Surveillance
Amputations 2006- DateHospitalsEDOutpatient ClinicsWorkersrsquo Compensation Wage Replacement
Crushing Injuries 2013- Date+ FACE Program
Skull Fractures 2012-DateBurns 2009-Date
+ Poison Control Center
bull Quarterly Reporting Specified ICD codes -134 Hospitalsbull Quarterly Reporting all Work-related Events ndash Poison Control Centerbull Electronic Data Base All Paid Claims ndash Workersrsquo Compensationbull FACE ndash Death CertificatesOSHA Hot LinePolice Reports
Work-Related Burn Reports ndash By Source Total 1461 Michigan 2009
n=1460 individuals
450
BLS
HOSPITALSEDs (1248)
4501054
BLSMIFACE 1(2) 1
16721
5 PCC (106)
1321 79
WC(306)
(Kica and Rosenman JOEM 2012)
Has one job73
Has employer match
9
WONK-y data match
4Did not match
14
WONK-y data match
4
Worker matches multiple employers All employers have
the same industry code One employer has
the same industry code in WCIS Only one employer is
in QCEW
Did not match14
Bad SSN or does not match on SSN Matched multiple employers gt5 employer No WONK-y data match
31 workers per 100 FTE
Rates of Injury by IndustryPrivate sectorJanuary-June 2016
Number of Claims
Rate per 100 FTE
Interurban and Rural Bus Transportation 54 150Couriers and Express Delivery Services 3084 107Building Material and Supplies Dealers 4971 106Animal Slaughtering and Processing 555 90Waste Treatment and Disposal 484 90Poultry and Egg Production 99 89Scheduled Air Transportation 1781 88Motor Vehicle Body and Trailer Manufacturing 243 85Cattle Ranching and Farming 989 81Other General Merchandise Stores 2280 80Other Ambulatory Health Care Services 850 80Foundries 250 79Sheep and Goat Farming 19 77Warehousing and Storage 1349 77Waste Collection 706 76Traveler Accommodation 6780 76Other Furniture Related Product Manufacturing 118 71Forging and Stamping 297 70Logging 58 69Sawmills and Wood Preservation 52 68
Rates of Injury by IndustryPrivate sectorJanuary-June 2016
Number of Claims
Rate per 100 FTE
Interurban and Rural Bus Transportation 54 150Couriers and Express Delivery Services 3084 107Building Material and Supplies Dealers 4971 106Animal Slaughtering and Processing 555 90Waste Treatment and Disposal 484 90Poultry and Egg Production 99 89Scheduled Air Transportation 1781 88Motor Vehicle Body and Trailer Manufacturing 243 85Cattle Ranching and Farming 989 81Other General Merchandise Stores 2280 80Other Ambulatory Health Care Services 850 80Foundries 250 79Sheep and Goat Farming 19 77Warehousing and Storage 1349 77Waste Collection 706 76Traveler Accommodation 6780 76Other Furniture Related Product Manufacturing 118 71Forging and Stamping 297 70Logging 58 69Sawmills and Wood Preservation 52 68
Rates of Injury by IndustryPrivate sectorJanuary-June 2016
Number of Claims
Rate per 100 FTE
Interurban and Rural Bus Transportation 54 150Couriers and Express Delivery Services 3084 107Building Material and Supplies Dealers 4971 106Animal Slaughtering and Processing 555 90Waste Treatment and Disposal 484 90Poultry and Egg Production 99 89Scheduled Air Transportation 1781 88Motor Vehicle Body and Trailer Manufacturing 243 85Cattle Ranching and Farming 989 81Other General Merchandise Stores 2280 80Other Ambulatory Health Care Services 850 80Foundries 250 79Sheep and Goat Farming 19 77Warehousing and Storage 1349 77Waste Collection 706 76Traveler Accommodation 6780 76Other Furniture Related Product Manufacturing 118 71Forging and Stamping 297 70Logging 58 69Sawmills and Wood Preservation 52 68
Rates of Injury by IndustryPrivate sectorJanuary-June 2016
Number of Claims
Rate per 100 FTE
Interurban and Rural Bus Transportation 54 150Couriers and Express Delivery Services 3084 107Building Material and Supplies Dealers 4971 106Animal Slaughtering and Processing 555 90Waste Treatment and Disposal 484 90Poultry and Egg Production 99 89Scheduled Air Transportation 1781 88Motor Vehicle Body and Trailer Manufacturing 243 85Cattle Ranching and Farming 989 81Other General Merchandise Stores 2280 80Other Ambulatory Health Care Services 850 80Foundries 250 79Sheep and Goat Farming 19 77Warehousing and Storage 1349 77Waste Collection 706 76Traveler Accommodation 6780 76Other Furniture Related Product Manufacturing 118 71Forging and Stamping 297 70Logging 58 69Sawmills and Wood Preservation 52 68
Rates of Injury by IndustryPrivate sectorJanuary-June 2016
Number of Claims
Rate per 100 FTE
Interurban and Rural Bus Transportation 54 150Couriers and Express Delivery Services 3084 107Building Material and Supplies Dealers 4971 106Animal Slaughtering and Processing 555 90Waste Treatment and Disposal 484 90Poultry and Egg Production 99 89Scheduled Air Transportation 1781 88Motor Vehicle Body and Trailer Manufacturing 243 85Cattle Ranching and Farming 989 81Other General Merchandise Stores 2280 80Other Ambulatory Health Care Services 850 80Foundries 250 79Sheep and Goat Farming 19 77Warehousing and Storage 1349 77Waste Collection 706 76Traveler Accommodation 6780 76Other Furniture Related Product Manufacturing 118 71Forging and Stamping 297 70Logging 58 69Sawmills and Wood Preservation 52 68
IndustryCA Rate per
100 FTENational Overall SOII
Rate per 100 FTE
Couriers and Express Delivery Services 107 74
Animal Slaughtering and Processing 90 54
Poultry and Egg Production 89 69
Scheduled Air Transportation 88 66
Cattle Ranching and Farming 81 64
Foundries 79 67
Sheep and Goat Farming 77 --
Warehousing and Storage 77 50
Traveler Accommodation 76 50
Forging and Stamping 70 53
Sawmills and Wood Preservation 68 69
IndustryCA Rate per 100
FTENational Overall SOII
Rate per 100 FTE
Interurban and Rural Bus Transportation 150 30
Building Material and Supplies Dealers 106 48
Waste Treatment and Disposal 90 33
Motor Vehicle Body and Trailer Manufacturing 85 79
Other General Merchandise Stores 80 49
Other Ambulatory Health Care Services 80 30
Waste Collection 76 46
Other Furniture Related Product Manufacturing 71 55
Logging 69 37
Collaboration
Data sharing agreements
Pilot rates
Sharable repeatable methods and code
Contribution to national discussions about
use of WC data
Workers not captured by our method
Public sector
People who do not file claims
Data analysis for 2015-2016 Data analysis report Surveillance system evaluation
Publicly available dataset Disseminate findings Sustainability
California Department of Public Health John Beckman Matt Frederick Bob Harrison
California Department of Industrial Relations Genet Daba John Gordon Liza Dizon Glenn Shor Meitong Jin
California Employment Development Department Andy Wong Spencer Wong
Terry Bunn PhDDirector Kentucky Injury Prevention and Research
Center bona fide agent for the Kentucky Department for Public Health
Associate Professor Departments of Epidemiology and Preventive Medicine and Environmental Health University of Kentucky College of Public Health
bull Occupational motor vehicle crash investigations a priority focus area since 2005
KOSHS
Case Example
Case Example
bull Substance abuse a priority focus areabull State injury prevention planbull Legislation data support (HB1)
ndash Pill millsndash Clinical prescribing regulationsndash Decedent controlled substance testing lawndash Inter-state prescription drug monitoring
program (PDMP) data sharing
bull Use of PDMP data for public health surveillance
bull Inform community interventions bull Evaluate and perform cost-benefit
analysis of drug-related laws bull Establish substance use disorder
information and referral service ndash physicians (eg prevention of needle sticks
when lancing drug abuse-related abscesses)ndash first responders (eg handling of fentanyl
analogs at drug overdose scenes) ndash law enforcement (eg naloxone
administration training)ndash general public
bull Increase timeliness of public health data sources
bull Use syndromic surveillance data for drug overdose and injury surveillance
bull Algorithm development for milligram morphine equivalent calculations in PDMP reports
bull Death certificate and PDMP data linkage to identify possible drug diversion
bull State advisory group
bull Link Ky CRASH and trauma registry data with FARS driver drug testing results from fatal crashes in 2014
bull Link 2014 trauma registry toxicology result data with inpatient hospitalization data to assess drug overdose and drug abuse coding
Primary populations
bull Opioid overdose victims
bull Pregnant and parenting women
bull Individuals re-entering society upon criminal justice release
bull Adolescents and young adults
Goals
bull Prevent opioid misuse and abuse
bull Increase access to OUD treatment services (eg MAT)
bull Increase availability of recovery support services
bull Increase availability of naloxone
bull Enhance coordination and evaluation of OUD healthcare and public safety strategies
bull KRS 217186- A person or agency including a peace officer jailer firefighter paramedic or emergency medical technician or a school employee authorized to administer medication under KRS 156502 may ndash Receive a prescription for the drug
naloxonendash Possess naloxone pursuant to this
subsection and any equipment needed for its administration
ndash Administer naloxone to an individual suffering from an apparent opiate-related overdose
bull Reduce prescriber opioid prescribing (physicians APRNs etc) to a 3-day supply for injured workers
bull First line treatment based on non-opioid therapy alternatives (physical therapy acupuncture etc)
bull Revise drug formularies for treatment of pain associated with occupational injuries
Prevention Decrease likelihood that Kentuckians develop a SUD through strategies to decrease overexposure of opioid medications and illicit opioids
bull prescriptions (dosage units) overdose deaths containing fentanyl
Harm Reduction Improve Access to Harm Reduction Services to Save Lives
bull naloxone kits dispensed to first responders and public people in syringe exchange programs who received naloxone
Treatment and Recovery Expand access to treatment and recovery supports
bull peer recovery coaches Emergency Departments with peer recovery coaches people with SUD who interact with peer recovery coaches and enter treatment Emergency Department peer follow-up individuals with SUD who receive residential services calls to SUD treatment locator and portal
bull Louisville Metro Police Department presentation
bull Breakout Session
bull First Responder Opioid Exposure Survey development
bull Focus Groups
bull Survey Administration
bull Data Analysis
bull Use of Data Results
bull UK ERC first responder overdose response exposure pilot project opportunity
bull Multistate or single state applicationsndash Use of survey
ndash development of other first responder-related pilot project
FACE case investigations
bull initiated drug overdose prevention conversations
bull enhanced collaborations
bull provided evidence of need for enhanced multidisciplinary drug overdose prevention efforts1 Interventions
2 Policies
3 Research
Ladder rap
httpswwwyoutubecomwatchv=FsW6eb3aO8gampfeature=youtube
BLS Survey of Employers vs Multi-Source Surveillance of Work-Related Injuries
Kenneth D Rosenman MDProfessor of MedicineMichigan State Universitywwwoemmsuedu
NIOSH Expanding Research Partnerships Conference Denver Colorado June 21-23 2017
Funding NIOSH U60 OH008466
Survey of Occupational Injuries and Illnesses (SOII)
bull Injuries and illnesses (based on OSHArsquos recordkeeping standards) from 230000 establishments (sample by state and NAICS code)
bull Redesigned in 1992 to collect circumstances of injuries and illnesses that lead to days away from work and characteristics of affected workers
bull Scope limitations no small farms private household or self-employed workers (lt 2008 no public sector workers)
NATIONAL ACADEMY OF SCIENCES 1987
New Jersey24 Deaths not covered by OSHA35 Deaths covered by OSHA butemployer had NOT recorded on OSHAlog or did NOT keep OSHA log
TexasNIOSH Fatal Occupational Trauma Surveillance
CENSUS OF FATAL OCCUPATIONAL INJURIES (CFOI) BEGAN IN 1992
Multiple death sourcesDeath certificatesEmployer reportingState PoliceNewspaper Clipping ServiceMedical ExaminersAgricultural Extension Service
Number of deaths doubled from previous BLS estimate
How Much Work-Related Injury and Illness is Missed By the Current National Surveillance System
Rosenman KD Kalush A Reilly MJ Gardiner JC Reeves M Luo Z JOEM 2006 48357-365Funding NIOSH 5 R01 OH004276-03
Summary of Analysis Comparing BLS and Worker Comp data Michigan 2009-2001Days away from workbull BLS estimate
37-41 BLS+ WC31-34 BLS + WC+ CaptureRecapture
1999-2001 Estimates - Michiganbull BLS -281567 vs Our Estimate - 868241
1 in 15 workers vs 1 in 5 workers
(Rosenman et al JOEM 2006)
Simplified Flowchart of Events Necessary to the Documentation of Work-Related Injuries and Illnesses
(Azaroff et al AJPH 2002)
Filters to Identifying Work-Related Injuries and Illnesses
a Filters To Reporting to Supervisorsb Filters To Losing Work Time c Filters to Obtaining Medical Cared Filters to Recognizing Work-Related by Doctore Filters to Workersrsquo Compensation being the Payerf Filters To Recording on OSHA Logg Filters to Reporting by Employers to Workersrsquo
Compensation Agencyh Filters to Reporting by Doctors
(Azaroff et al AJPH 2002)
Capture-Recapture Estimates of Workplace Injury and Illness Reporting by BLS Adjusted for Capture
Heterogeneity Lost-Time Cases 1998-2001
Percent Reported to WA WV OR WI NM MNNo Source Dependence 55 76 56 65 51 68
Source Dependence 52 71 45 53 37 53
(Adapted Boden and Ozonoff Annals Epidemiology 2008)
Workersrsquo CompensationState Specific Program
Mandatory insurance or if large enough self-insured
Michigan WC Excludesbull Federal employeesbull Interstate railroad workersbull Maritime workersbull Less than 3 employees at any one timebull All employees work less than 35 hoursweek or
if more hours less than 13 weeksbull Self-employed
Not computerizedbull Medical claims only
Proportion of Work-Injured Adults for Whom Treatment was paid by Workersrsquo Compensation by State-BRFSS 10 States 2007
State Injured with Payment by Workersrsquo Compensation
Texas 47 (95 CI 35-59)New York 50 (95 CI 39-60)Michigan 56 (95 CI 41-69)Massachusetts 60 (95 CI 45-75)California 61 (95 CI 55-66)Washington 61 (95 CI 55-67)Oregon 62 (95 CI 50-74)Connecticut 63 (95 CI 53-74)New Jersey 64 (95 CI 51-78)Kentucky 77 (95 CI 65-89)
Excludes self-employed
(Adapted Bonauto et al MMWR 2010)
Percentage Received Workersrsquo Compensation by Condition Michigan
WageReplacement
Medical Only
No CompEmployed
No Comp Self -Employed
Amputations 64 22 17 6Burns 17 48 33 2Skull Fractures 36 32 29 3
Percent Applied for Workersrsquo Comp among 2016 Cases of Work-Related Asthma Michigan
Overall 484
Still ExposedConditions Unchanged 239No Longer Exposed 575
Quit on Doctorrsquos Advice 778Sick Leave 727Fired 621New Controls 589Chemical Substitution 536Quit on Own 431Reassigned 360
Reasons Didnrsquot File a Workersrsquo Compensation Claims for a Repetitive Trauma Michigan
Only 397 (251) of 1598 Filed WC Claim
Injury Not Serious Enough 705 (591)Did Not Expect to Miss Work 694 (583)Expect to Receive Sick Leave or
Disability 337 (283) Medical Expenses Covered by
Other Insurance 427 (359)Did Not Think Injury Work Related 242 (204)
(Rosenman et al JOEM 2000)
Goals of Surveillance Population-Based
bull Assess Magnitude of Problembull NumbersRatesTrends
bull Determine Relative Importance vs Other Health Issuesbull Identify High Risk
bull IndustriesOccupationsWorker Populations
bull Prioritize Interventions bull Evaluate Interventionsbull Generate Hypotheses for Researchbull Identify Emerging Problemsbull Identify Workplaces for Intervention
Case-Based
Reportable Conditions in Michigan
Local Health DepartmentsCommunicable Diseases (83)
ldquoUnusual occurrence outbreak or epidemic of any disease or conditionsrdquoMDHHS
AbortionsBirth DefectsCancerChemical Poisonings including Carbon MonoxideInjuries Nursing Home Abuse
LARAOccupational Illnesses
County Department of Social ServicesChild AbuseAdult Abuse
PoliceInjury from Knife Gun or Deadly WeaponMental Health Patient Abuse
On Request Only
Laboratory Reporting Regulations Michigan
bull Arsenicbull Cadmiumbull Carboxyhemoglobinbull Cholinesterasebull IgE Antibodiesbull Leadbull Mercury
Occupational Illness Reporting Requirement in Michigan
bull LARA ndash MIOSHAPhysician hospital clinic or employer
having a known or suspected occupational disease or health condition aggravated by workplace exposures shall report within 10 days after discovery
Misdemeanor punishable by a fine of not more than $50
Methodology of Multi-Source Surveillance
Amputations 2006- DateHospitalsEDOutpatient ClinicsWorkersrsquo Compensation Wage Replacement
Crushing Injuries 2013- Date+ FACE Program
Skull Fractures 2012-DateBurns 2009-Date
+ Poison Control Center
bull Quarterly Reporting Specified ICD codes -134 Hospitalsbull Quarterly Reporting all Work-related Events ndash Poison Control Centerbull Electronic Data Base All Paid Claims ndash Workersrsquo Compensationbull FACE ndash Death CertificatesOSHA Hot LinePolice Reports
Work-Related Burn Reports ndash By Source Total 1461 Michigan 2009
n=1460 individuals
450
BLS
HOSPITALSEDs (1248)
4501054
BLSMIFACE 1(2) 1
16721
5 PCC (106)
1321 79
WC(306)
(Kica and Rosenman JOEM 2012)
WONK-y data match
4
Worker matches multiple employers All employers have
the same industry code One employer has
the same industry code in WCIS Only one employer is
in QCEW
Did not match14
Bad SSN or does not match on SSN Matched multiple employers gt5 employer No WONK-y data match
31 workers per 100 FTE
Rates of Injury by IndustryPrivate sectorJanuary-June 2016
Number of Claims
Rate per 100 FTE
Interurban and Rural Bus Transportation 54 150Couriers and Express Delivery Services 3084 107Building Material and Supplies Dealers 4971 106Animal Slaughtering and Processing 555 90Waste Treatment and Disposal 484 90Poultry and Egg Production 99 89Scheduled Air Transportation 1781 88Motor Vehicle Body and Trailer Manufacturing 243 85Cattle Ranching and Farming 989 81Other General Merchandise Stores 2280 80Other Ambulatory Health Care Services 850 80Foundries 250 79Sheep and Goat Farming 19 77Warehousing and Storage 1349 77Waste Collection 706 76Traveler Accommodation 6780 76Other Furniture Related Product Manufacturing 118 71Forging and Stamping 297 70Logging 58 69Sawmills and Wood Preservation 52 68
Rates of Injury by IndustryPrivate sectorJanuary-June 2016
Number of Claims
Rate per 100 FTE
Interurban and Rural Bus Transportation 54 150Couriers and Express Delivery Services 3084 107Building Material and Supplies Dealers 4971 106Animal Slaughtering and Processing 555 90Waste Treatment and Disposal 484 90Poultry and Egg Production 99 89Scheduled Air Transportation 1781 88Motor Vehicle Body and Trailer Manufacturing 243 85Cattle Ranching and Farming 989 81Other General Merchandise Stores 2280 80Other Ambulatory Health Care Services 850 80Foundries 250 79Sheep and Goat Farming 19 77Warehousing and Storage 1349 77Waste Collection 706 76Traveler Accommodation 6780 76Other Furniture Related Product Manufacturing 118 71Forging and Stamping 297 70Logging 58 69Sawmills and Wood Preservation 52 68
Rates of Injury by IndustryPrivate sectorJanuary-June 2016
Number of Claims
Rate per 100 FTE
Interurban and Rural Bus Transportation 54 150Couriers and Express Delivery Services 3084 107Building Material and Supplies Dealers 4971 106Animal Slaughtering and Processing 555 90Waste Treatment and Disposal 484 90Poultry and Egg Production 99 89Scheduled Air Transportation 1781 88Motor Vehicle Body and Trailer Manufacturing 243 85Cattle Ranching and Farming 989 81Other General Merchandise Stores 2280 80Other Ambulatory Health Care Services 850 80Foundries 250 79Sheep and Goat Farming 19 77Warehousing and Storage 1349 77Waste Collection 706 76Traveler Accommodation 6780 76Other Furniture Related Product Manufacturing 118 71Forging and Stamping 297 70Logging 58 69Sawmills and Wood Preservation 52 68
Rates of Injury by IndustryPrivate sectorJanuary-June 2016
Number of Claims
Rate per 100 FTE
Interurban and Rural Bus Transportation 54 150Couriers and Express Delivery Services 3084 107Building Material and Supplies Dealers 4971 106Animal Slaughtering and Processing 555 90Waste Treatment and Disposal 484 90Poultry and Egg Production 99 89Scheduled Air Transportation 1781 88Motor Vehicle Body and Trailer Manufacturing 243 85Cattle Ranching and Farming 989 81Other General Merchandise Stores 2280 80Other Ambulatory Health Care Services 850 80Foundries 250 79Sheep and Goat Farming 19 77Warehousing and Storage 1349 77Waste Collection 706 76Traveler Accommodation 6780 76Other Furniture Related Product Manufacturing 118 71Forging and Stamping 297 70Logging 58 69Sawmills and Wood Preservation 52 68
Rates of Injury by IndustryPrivate sectorJanuary-June 2016
Number of Claims
Rate per 100 FTE
Interurban and Rural Bus Transportation 54 150Couriers and Express Delivery Services 3084 107Building Material and Supplies Dealers 4971 106Animal Slaughtering and Processing 555 90Waste Treatment and Disposal 484 90Poultry and Egg Production 99 89Scheduled Air Transportation 1781 88Motor Vehicle Body and Trailer Manufacturing 243 85Cattle Ranching and Farming 989 81Other General Merchandise Stores 2280 80Other Ambulatory Health Care Services 850 80Foundries 250 79Sheep and Goat Farming 19 77Warehousing and Storage 1349 77Waste Collection 706 76Traveler Accommodation 6780 76Other Furniture Related Product Manufacturing 118 71Forging and Stamping 297 70Logging 58 69Sawmills and Wood Preservation 52 68
IndustryCA Rate per
100 FTENational Overall SOII
Rate per 100 FTE
Couriers and Express Delivery Services 107 74
Animal Slaughtering and Processing 90 54
Poultry and Egg Production 89 69
Scheduled Air Transportation 88 66
Cattle Ranching and Farming 81 64
Foundries 79 67
Sheep and Goat Farming 77 --
Warehousing and Storage 77 50
Traveler Accommodation 76 50
Forging and Stamping 70 53
Sawmills and Wood Preservation 68 69
IndustryCA Rate per 100
FTENational Overall SOII
Rate per 100 FTE
Interurban and Rural Bus Transportation 150 30
Building Material and Supplies Dealers 106 48
Waste Treatment and Disposal 90 33
Motor Vehicle Body and Trailer Manufacturing 85 79
Other General Merchandise Stores 80 49
Other Ambulatory Health Care Services 80 30
Waste Collection 76 46
Other Furniture Related Product Manufacturing 71 55
Logging 69 37
Collaboration
Data sharing agreements
Pilot rates
Sharable repeatable methods and code
Contribution to national discussions about
use of WC data
Workers not captured by our method
Public sector
People who do not file claims
Data analysis for 2015-2016 Data analysis report Surveillance system evaluation
Publicly available dataset Disseminate findings Sustainability
California Department of Public Health John Beckman Matt Frederick Bob Harrison
California Department of Industrial Relations Genet Daba John Gordon Liza Dizon Glenn Shor Meitong Jin
California Employment Development Department Andy Wong Spencer Wong
Terry Bunn PhDDirector Kentucky Injury Prevention and Research
Center bona fide agent for the Kentucky Department for Public Health
Associate Professor Departments of Epidemiology and Preventive Medicine and Environmental Health University of Kentucky College of Public Health
bull Occupational motor vehicle crash investigations a priority focus area since 2005
KOSHS
Case Example
Case Example
bull Substance abuse a priority focus areabull State injury prevention planbull Legislation data support (HB1)
ndash Pill millsndash Clinical prescribing regulationsndash Decedent controlled substance testing lawndash Inter-state prescription drug monitoring
program (PDMP) data sharing
bull Use of PDMP data for public health surveillance
bull Inform community interventions bull Evaluate and perform cost-benefit
analysis of drug-related laws bull Establish substance use disorder
information and referral service ndash physicians (eg prevention of needle sticks
when lancing drug abuse-related abscesses)ndash first responders (eg handling of fentanyl
analogs at drug overdose scenes) ndash law enforcement (eg naloxone
administration training)ndash general public
bull Increase timeliness of public health data sources
bull Use syndromic surveillance data for drug overdose and injury surveillance
bull Algorithm development for milligram morphine equivalent calculations in PDMP reports
bull Death certificate and PDMP data linkage to identify possible drug diversion
bull State advisory group
bull Link Ky CRASH and trauma registry data with FARS driver drug testing results from fatal crashes in 2014
bull Link 2014 trauma registry toxicology result data with inpatient hospitalization data to assess drug overdose and drug abuse coding
Primary populations
bull Opioid overdose victims
bull Pregnant and parenting women
bull Individuals re-entering society upon criminal justice release
bull Adolescents and young adults
Goals
bull Prevent opioid misuse and abuse
bull Increase access to OUD treatment services (eg MAT)
bull Increase availability of recovery support services
bull Increase availability of naloxone
bull Enhance coordination and evaluation of OUD healthcare and public safety strategies
bull KRS 217186- A person or agency including a peace officer jailer firefighter paramedic or emergency medical technician or a school employee authorized to administer medication under KRS 156502 may ndash Receive a prescription for the drug
naloxonendash Possess naloxone pursuant to this
subsection and any equipment needed for its administration
ndash Administer naloxone to an individual suffering from an apparent opiate-related overdose
bull Reduce prescriber opioid prescribing (physicians APRNs etc) to a 3-day supply for injured workers
bull First line treatment based on non-opioid therapy alternatives (physical therapy acupuncture etc)
bull Revise drug formularies for treatment of pain associated with occupational injuries
Prevention Decrease likelihood that Kentuckians develop a SUD through strategies to decrease overexposure of opioid medications and illicit opioids
bull prescriptions (dosage units) overdose deaths containing fentanyl
Harm Reduction Improve Access to Harm Reduction Services to Save Lives
bull naloxone kits dispensed to first responders and public people in syringe exchange programs who received naloxone
Treatment and Recovery Expand access to treatment and recovery supports
bull peer recovery coaches Emergency Departments with peer recovery coaches people with SUD who interact with peer recovery coaches and enter treatment Emergency Department peer follow-up individuals with SUD who receive residential services calls to SUD treatment locator and portal
bull Louisville Metro Police Department presentation
bull Breakout Session
bull First Responder Opioid Exposure Survey development
bull Focus Groups
bull Survey Administration
bull Data Analysis
bull Use of Data Results
bull UK ERC first responder overdose response exposure pilot project opportunity
bull Multistate or single state applicationsndash Use of survey
ndash development of other first responder-related pilot project
FACE case investigations
bull initiated drug overdose prevention conversations
bull enhanced collaborations
bull provided evidence of need for enhanced multidisciplinary drug overdose prevention efforts1 Interventions
2 Policies
3 Research
Ladder rap
httpswwwyoutubecomwatchv=FsW6eb3aO8gampfeature=youtube
BLS Survey of Employers vs Multi-Source Surveillance of Work-Related Injuries
Kenneth D Rosenman MDProfessor of MedicineMichigan State Universitywwwoemmsuedu
NIOSH Expanding Research Partnerships Conference Denver Colorado June 21-23 2017
Funding NIOSH U60 OH008466
Survey of Occupational Injuries and Illnesses (SOII)
bull Injuries and illnesses (based on OSHArsquos recordkeeping standards) from 230000 establishments (sample by state and NAICS code)
bull Redesigned in 1992 to collect circumstances of injuries and illnesses that lead to days away from work and characteristics of affected workers
bull Scope limitations no small farms private household or self-employed workers (lt 2008 no public sector workers)
NATIONAL ACADEMY OF SCIENCES 1987
New Jersey24 Deaths not covered by OSHA35 Deaths covered by OSHA butemployer had NOT recorded on OSHAlog or did NOT keep OSHA log
TexasNIOSH Fatal Occupational Trauma Surveillance
CENSUS OF FATAL OCCUPATIONAL INJURIES (CFOI) BEGAN IN 1992
Multiple death sourcesDeath certificatesEmployer reportingState PoliceNewspaper Clipping ServiceMedical ExaminersAgricultural Extension Service
Number of deaths doubled from previous BLS estimate
How Much Work-Related Injury and Illness is Missed By the Current National Surveillance System
Rosenman KD Kalush A Reilly MJ Gardiner JC Reeves M Luo Z JOEM 2006 48357-365Funding NIOSH 5 R01 OH004276-03
Summary of Analysis Comparing BLS and Worker Comp data Michigan 2009-2001Days away from workbull BLS estimate
37-41 BLS+ WC31-34 BLS + WC+ CaptureRecapture
1999-2001 Estimates - Michiganbull BLS -281567 vs Our Estimate - 868241
1 in 15 workers vs 1 in 5 workers
(Rosenman et al JOEM 2006)
Simplified Flowchart of Events Necessary to the Documentation of Work-Related Injuries and Illnesses
(Azaroff et al AJPH 2002)
Filters to Identifying Work-Related Injuries and Illnesses
a Filters To Reporting to Supervisorsb Filters To Losing Work Time c Filters to Obtaining Medical Cared Filters to Recognizing Work-Related by Doctore Filters to Workersrsquo Compensation being the Payerf Filters To Recording on OSHA Logg Filters to Reporting by Employers to Workersrsquo
Compensation Agencyh Filters to Reporting by Doctors
(Azaroff et al AJPH 2002)
Capture-Recapture Estimates of Workplace Injury and Illness Reporting by BLS Adjusted for Capture
Heterogeneity Lost-Time Cases 1998-2001
Percent Reported to WA WV OR WI NM MNNo Source Dependence 55 76 56 65 51 68
Source Dependence 52 71 45 53 37 53
(Adapted Boden and Ozonoff Annals Epidemiology 2008)
Workersrsquo CompensationState Specific Program
Mandatory insurance or if large enough self-insured
Michigan WC Excludesbull Federal employeesbull Interstate railroad workersbull Maritime workersbull Less than 3 employees at any one timebull All employees work less than 35 hoursweek or
if more hours less than 13 weeksbull Self-employed
Not computerizedbull Medical claims only
Proportion of Work-Injured Adults for Whom Treatment was paid by Workersrsquo Compensation by State-BRFSS 10 States 2007
State Injured with Payment by Workersrsquo Compensation
Texas 47 (95 CI 35-59)New York 50 (95 CI 39-60)Michigan 56 (95 CI 41-69)Massachusetts 60 (95 CI 45-75)California 61 (95 CI 55-66)Washington 61 (95 CI 55-67)Oregon 62 (95 CI 50-74)Connecticut 63 (95 CI 53-74)New Jersey 64 (95 CI 51-78)Kentucky 77 (95 CI 65-89)
Excludes self-employed
(Adapted Bonauto et al MMWR 2010)
Percentage Received Workersrsquo Compensation by Condition Michigan
WageReplacement
Medical Only
No CompEmployed
No Comp Self -Employed
Amputations 64 22 17 6Burns 17 48 33 2Skull Fractures 36 32 29 3
Percent Applied for Workersrsquo Comp among 2016 Cases of Work-Related Asthma Michigan
Overall 484
Still ExposedConditions Unchanged 239No Longer Exposed 575
Quit on Doctorrsquos Advice 778Sick Leave 727Fired 621New Controls 589Chemical Substitution 536Quit on Own 431Reassigned 360
Reasons Didnrsquot File a Workersrsquo Compensation Claims for a Repetitive Trauma Michigan
Only 397 (251) of 1598 Filed WC Claim
Injury Not Serious Enough 705 (591)Did Not Expect to Miss Work 694 (583)Expect to Receive Sick Leave or
Disability 337 (283) Medical Expenses Covered by
Other Insurance 427 (359)Did Not Think Injury Work Related 242 (204)
(Rosenman et al JOEM 2000)
Goals of Surveillance Population-Based
bull Assess Magnitude of Problembull NumbersRatesTrends
bull Determine Relative Importance vs Other Health Issuesbull Identify High Risk
bull IndustriesOccupationsWorker Populations
bull Prioritize Interventions bull Evaluate Interventionsbull Generate Hypotheses for Researchbull Identify Emerging Problemsbull Identify Workplaces for Intervention
Case-Based
Reportable Conditions in Michigan
Local Health DepartmentsCommunicable Diseases (83)
ldquoUnusual occurrence outbreak or epidemic of any disease or conditionsrdquoMDHHS
AbortionsBirth DefectsCancerChemical Poisonings including Carbon MonoxideInjuries Nursing Home Abuse
LARAOccupational Illnesses
County Department of Social ServicesChild AbuseAdult Abuse
PoliceInjury from Knife Gun or Deadly WeaponMental Health Patient Abuse
On Request Only
Laboratory Reporting Regulations Michigan
bull Arsenicbull Cadmiumbull Carboxyhemoglobinbull Cholinesterasebull IgE Antibodiesbull Leadbull Mercury
Occupational Illness Reporting Requirement in Michigan
bull LARA ndash MIOSHAPhysician hospital clinic or employer
having a known or suspected occupational disease or health condition aggravated by workplace exposures shall report within 10 days after discovery
Misdemeanor punishable by a fine of not more than $50
Methodology of Multi-Source Surveillance
Amputations 2006- DateHospitalsEDOutpatient ClinicsWorkersrsquo Compensation Wage Replacement
Crushing Injuries 2013- Date+ FACE Program
Skull Fractures 2012-DateBurns 2009-Date
+ Poison Control Center
bull Quarterly Reporting Specified ICD codes -134 Hospitalsbull Quarterly Reporting all Work-related Events ndash Poison Control Centerbull Electronic Data Base All Paid Claims ndash Workersrsquo Compensationbull FACE ndash Death CertificatesOSHA Hot LinePolice Reports
Work-Related Burn Reports ndash By Source Total 1461 Michigan 2009
n=1460 individuals
450
BLS
HOSPITALSEDs (1248)
4501054
BLSMIFACE 1(2) 1
16721
5 PCC (106)
1321 79
WC(306)
(Kica and Rosenman JOEM 2012)
Did not match14
Bad SSN or does not match on SSN Matched multiple employers gt5 employer No WONK-y data match
31 workers per 100 FTE
Rates of Injury by IndustryPrivate sectorJanuary-June 2016
Number of Claims
Rate per 100 FTE
Interurban and Rural Bus Transportation 54 150Couriers and Express Delivery Services 3084 107Building Material and Supplies Dealers 4971 106Animal Slaughtering and Processing 555 90Waste Treatment and Disposal 484 90Poultry and Egg Production 99 89Scheduled Air Transportation 1781 88Motor Vehicle Body and Trailer Manufacturing 243 85Cattle Ranching and Farming 989 81Other General Merchandise Stores 2280 80Other Ambulatory Health Care Services 850 80Foundries 250 79Sheep and Goat Farming 19 77Warehousing and Storage 1349 77Waste Collection 706 76Traveler Accommodation 6780 76Other Furniture Related Product Manufacturing 118 71Forging and Stamping 297 70Logging 58 69Sawmills and Wood Preservation 52 68
Rates of Injury by IndustryPrivate sectorJanuary-June 2016
Number of Claims
Rate per 100 FTE
Interurban and Rural Bus Transportation 54 150Couriers and Express Delivery Services 3084 107Building Material and Supplies Dealers 4971 106Animal Slaughtering and Processing 555 90Waste Treatment and Disposal 484 90Poultry and Egg Production 99 89Scheduled Air Transportation 1781 88Motor Vehicle Body and Trailer Manufacturing 243 85Cattle Ranching and Farming 989 81Other General Merchandise Stores 2280 80Other Ambulatory Health Care Services 850 80Foundries 250 79Sheep and Goat Farming 19 77Warehousing and Storage 1349 77Waste Collection 706 76Traveler Accommodation 6780 76Other Furniture Related Product Manufacturing 118 71Forging and Stamping 297 70Logging 58 69Sawmills and Wood Preservation 52 68
Rates of Injury by IndustryPrivate sectorJanuary-June 2016
Number of Claims
Rate per 100 FTE
Interurban and Rural Bus Transportation 54 150Couriers and Express Delivery Services 3084 107Building Material and Supplies Dealers 4971 106Animal Slaughtering and Processing 555 90Waste Treatment and Disposal 484 90Poultry and Egg Production 99 89Scheduled Air Transportation 1781 88Motor Vehicle Body and Trailer Manufacturing 243 85Cattle Ranching and Farming 989 81Other General Merchandise Stores 2280 80Other Ambulatory Health Care Services 850 80Foundries 250 79Sheep and Goat Farming 19 77Warehousing and Storage 1349 77Waste Collection 706 76Traveler Accommodation 6780 76Other Furniture Related Product Manufacturing 118 71Forging and Stamping 297 70Logging 58 69Sawmills and Wood Preservation 52 68
Rates of Injury by IndustryPrivate sectorJanuary-June 2016
Number of Claims
Rate per 100 FTE
Interurban and Rural Bus Transportation 54 150Couriers and Express Delivery Services 3084 107Building Material and Supplies Dealers 4971 106Animal Slaughtering and Processing 555 90Waste Treatment and Disposal 484 90Poultry and Egg Production 99 89Scheduled Air Transportation 1781 88Motor Vehicle Body and Trailer Manufacturing 243 85Cattle Ranching and Farming 989 81Other General Merchandise Stores 2280 80Other Ambulatory Health Care Services 850 80Foundries 250 79Sheep and Goat Farming 19 77Warehousing and Storage 1349 77Waste Collection 706 76Traveler Accommodation 6780 76Other Furniture Related Product Manufacturing 118 71Forging and Stamping 297 70Logging 58 69Sawmills and Wood Preservation 52 68
Rates of Injury by IndustryPrivate sectorJanuary-June 2016
Number of Claims
Rate per 100 FTE
Interurban and Rural Bus Transportation 54 150Couriers and Express Delivery Services 3084 107Building Material and Supplies Dealers 4971 106Animal Slaughtering and Processing 555 90Waste Treatment and Disposal 484 90Poultry and Egg Production 99 89Scheduled Air Transportation 1781 88Motor Vehicle Body and Trailer Manufacturing 243 85Cattle Ranching and Farming 989 81Other General Merchandise Stores 2280 80Other Ambulatory Health Care Services 850 80Foundries 250 79Sheep and Goat Farming 19 77Warehousing and Storage 1349 77Waste Collection 706 76Traveler Accommodation 6780 76Other Furniture Related Product Manufacturing 118 71Forging and Stamping 297 70Logging 58 69Sawmills and Wood Preservation 52 68
IndustryCA Rate per
100 FTENational Overall SOII
Rate per 100 FTE
Couriers and Express Delivery Services 107 74
Animal Slaughtering and Processing 90 54
Poultry and Egg Production 89 69
Scheduled Air Transportation 88 66
Cattle Ranching and Farming 81 64
Foundries 79 67
Sheep and Goat Farming 77 --
Warehousing and Storage 77 50
Traveler Accommodation 76 50
Forging and Stamping 70 53
Sawmills and Wood Preservation 68 69
IndustryCA Rate per 100
FTENational Overall SOII
Rate per 100 FTE
Interurban and Rural Bus Transportation 150 30
Building Material and Supplies Dealers 106 48
Waste Treatment and Disposal 90 33
Motor Vehicle Body and Trailer Manufacturing 85 79
Other General Merchandise Stores 80 49
Other Ambulatory Health Care Services 80 30
Waste Collection 76 46
Other Furniture Related Product Manufacturing 71 55
Logging 69 37
Collaboration
Data sharing agreements
Pilot rates
Sharable repeatable methods and code
Contribution to national discussions about
use of WC data
Workers not captured by our method
Public sector
People who do not file claims
Data analysis for 2015-2016 Data analysis report Surveillance system evaluation
Publicly available dataset Disseminate findings Sustainability
California Department of Public Health John Beckman Matt Frederick Bob Harrison
California Department of Industrial Relations Genet Daba John Gordon Liza Dizon Glenn Shor Meitong Jin
California Employment Development Department Andy Wong Spencer Wong
Terry Bunn PhDDirector Kentucky Injury Prevention and Research
Center bona fide agent for the Kentucky Department for Public Health
Associate Professor Departments of Epidemiology and Preventive Medicine and Environmental Health University of Kentucky College of Public Health
bull Occupational motor vehicle crash investigations a priority focus area since 2005
KOSHS
Case Example
Case Example
bull Substance abuse a priority focus areabull State injury prevention planbull Legislation data support (HB1)
ndash Pill millsndash Clinical prescribing regulationsndash Decedent controlled substance testing lawndash Inter-state prescription drug monitoring
program (PDMP) data sharing
bull Use of PDMP data for public health surveillance
bull Inform community interventions bull Evaluate and perform cost-benefit
analysis of drug-related laws bull Establish substance use disorder
information and referral service ndash physicians (eg prevention of needle sticks
when lancing drug abuse-related abscesses)ndash first responders (eg handling of fentanyl
analogs at drug overdose scenes) ndash law enforcement (eg naloxone
administration training)ndash general public
bull Increase timeliness of public health data sources
bull Use syndromic surveillance data for drug overdose and injury surveillance
bull Algorithm development for milligram morphine equivalent calculations in PDMP reports
bull Death certificate and PDMP data linkage to identify possible drug diversion
bull State advisory group
bull Link Ky CRASH and trauma registry data with FARS driver drug testing results from fatal crashes in 2014
bull Link 2014 trauma registry toxicology result data with inpatient hospitalization data to assess drug overdose and drug abuse coding
Primary populations
bull Opioid overdose victims
bull Pregnant and parenting women
bull Individuals re-entering society upon criminal justice release
bull Adolescents and young adults
Goals
bull Prevent opioid misuse and abuse
bull Increase access to OUD treatment services (eg MAT)
bull Increase availability of recovery support services
bull Increase availability of naloxone
bull Enhance coordination and evaluation of OUD healthcare and public safety strategies
bull KRS 217186- A person or agency including a peace officer jailer firefighter paramedic or emergency medical technician or a school employee authorized to administer medication under KRS 156502 may ndash Receive a prescription for the drug
naloxonendash Possess naloxone pursuant to this
subsection and any equipment needed for its administration
ndash Administer naloxone to an individual suffering from an apparent opiate-related overdose
bull Reduce prescriber opioid prescribing (physicians APRNs etc) to a 3-day supply for injured workers
bull First line treatment based on non-opioid therapy alternatives (physical therapy acupuncture etc)
bull Revise drug formularies for treatment of pain associated with occupational injuries
Prevention Decrease likelihood that Kentuckians develop a SUD through strategies to decrease overexposure of opioid medications and illicit opioids
bull prescriptions (dosage units) overdose deaths containing fentanyl
Harm Reduction Improve Access to Harm Reduction Services to Save Lives
bull naloxone kits dispensed to first responders and public people in syringe exchange programs who received naloxone
Treatment and Recovery Expand access to treatment and recovery supports
bull peer recovery coaches Emergency Departments with peer recovery coaches people with SUD who interact with peer recovery coaches and enter treatment Emergency Department peer follow-up individuals with SUD who receive residential services calls to SUD treatment locator and portal
bull Louisville Metro Police Department presentation
bull Breakout Session
bull First Responder Opioid Exposure Survey development
bull Focus Groups
bull Survey Administration
bull Data Analysis
bull Use of Data Results
bull UK ERC first responder overdose response exposure pilot project opportunity
bull Multistate or single state applicationsndash Use of survey
ndash development of other first responder-related pilot project
FACE case investigations
bull initiated drug overdose prevention conversations
bull enhanced collaborations
bull provided evidence of need for enhanced multidisciplinary drug overdose prevention efforts1 Interventions
2 Policies
3 Research
Ladder rap
httpswwwyoutubecomwatchv=FsW6eb3aO8gampfeature=youtube
BLS Survey of Employers vs Multi-Source Surveillance of Work-Related Injuries
Kenneth D Rosenman MDProfessor of MedicineMichigan State Universitywwwoemmsuedu
NIOSH Expanding Research Partnerships Conference Denver Colorado June 21-23 2017
Funding NIOSH U60 OH008466
Survey of Occupational Injuries and Illnesses (SOII)
bull Injuries and illnesses (based on OSHArsquos recordkeeping standards) from 230000 establishments (sample by state and NAICS code)
bull Redesigned in 1992 to collect circumstances of injuries and illnesses that lead to days away from work and characteristics of affected workers
bull Scope limitations no small farms private household or self-employed workers (lt 2008 no public sector workers)
NATIONAL ACADEMY OF SCIENCES 1987
New Jersey24 Deaths not covered by OSHA35 Deaths covered by OSHA butemployer had NOT recorded on OSHAlog or did NOT keep OSHA log
TexasNIOSH Fatal Occupational Trauma Surveillance
CENSUS OF FATAL OCCUPATIONAL INJURIES (CFOI) BEGAN IN 1992
Multiple death sourcesDeath certificatesEmployer reportingState PoliceNewspaper Clipping ServiceMedical ExaminersAgricultural Extension Service
Number of deaths doubled from previous BLS estimate
How Much Work-Related Injury and Illness is Missed By the Current National Surveillance System
Rosenman KD Kalush A Reilly MJ Gardiner JC Reeves M Luo Z JOEM 2006 48357-365Funding NIOSH 5 R01 OH004276-03
Summary of Analysis Comparing BLS and Worker Comp data Michigan 2009-2001Days away from workbull BLS estimate
37-41 BLS+ WC31-34 BLS + WC+ CaptureRecapture
1999-2001 Estimates - Michiganbull BLS -281567 vs Our Estimate - 868241
1 in 15 workers vs 1 in 5 workers
(Rosenman et al JOEM 2006)
Simplified Flowchart of Events Necessary to the Documentation of Work-Related Injuries and Illnesses
(Azaroff et al AJPH 2002)
Filters to Identifying Work-Related Injuries and Illnesses
a Filters To Reporting to Supervisorsb Filters To Losing Work Time c Filters to Obtaining Medical Cared Filters to Recognizing Work-Related by Doctore Filters to Workersrsquo Compensation being the Payerf Filters To Recording on OSHA Logg Filters to Reporting by Employers to Workersrsquo
Compensation Agencyh Filters to Reporting by Doctors
(Azaroff et al AJPH 2002)
Capture-Recapture Estimates of Workplace Injury and Illness Reporting by BLS Adjusted for Capture
Heterogeneity Lost-Time Cases 1998-2001
Percent Reported to WA WV OR WI NM MNNo Source Dependence 55 76 56 65 51 68
Source Dependence 52 71 45 53 37 53
(Adapted Boden and Ozonoff Annals Epidemiology 2008)
Workersrsquo CompensationState Specific Program
Mandatory insurance or if large enough self-insured
Michigan WC Excludesbull Federal employeesbull Interstate railroad workersbull Maritime workersbull Less than 3 employees at any one timebull All employees work less than 35 hoursweek or
if more hours less than 13 weeksbull Self-employed
Not computerizedbull Medical claims only
Proportion of Work-Injured Adults for Whom Treatment was paid by Workersrsquo Compensation by State-BRFSS 10 States 2007
State Injured with Payment by Workersrsquo Compensation
Texas 47 (95 CI 35-59)New York 50 (95 CI 39-60)Michigan 56 (95 CI 41-69)Massachusetts 60 (95 CI 45-75)California 61 (95 CI 55-66)Washington 61 (95 CI 55-67)Oregon 62 (95 CI 50-74)Connecticut 63 (95 CI 53-74)New Jersey 64 (95 CI 51-78)Kentucky 77 (95 CI 65-89)
Excludes self-employed
(Adapted Bonauto et al MMWR 2010)
Percentage Received Workersrsquo Compensation by Condition Michigan
WageReplacement
Medical Only
No CompEmployed
No Comp Self -Employed
Amputations 64 22 17 6Burns 17 48 33 2Skull Fractures 36 32 29 3
Percent Applied for Workersrsquo Comp among 2016 Cases of Work-Related Asthma Michigan
Overall 484
Still ExposedConditions Unchanged 239No Longer Exposed 575
Quit on Doctorrsquos Advice 778Sick Leave 727Fired 621New Controls 589Chemical Substitution 536Quit on Own 431Reassigned 360
Reasons Didnrsquot File a Workersrsquo Compensation Claims for a Repetitive Trauma Michigan
Only 397 (251) of 1598 Filed WC Claim
Injury Not Serious Enough 705 (591)Did Not Expect to Miss Work 694 (583)Expect to Receive Sick Leave or
Disability 337 (283) Medical Expenses Covered by
Other Insurance 427 (359)Did Not Think Injury Work Related 242 (204)
(Rosenman et al JOEM 2000)
Goals of Surveillance Population-Based
bull Assess Magnitude of Problembull NumbersRatesTrends
bull Determine Relative Importance vs Other Health Issuesbull Identify High Risk
bull IndustriesOccupationsWorker Populations
bull Prioritize Interventions bull Evaluate Interventionsbull Generate Hypotheses for Researchbull Identify Emerging Problemsbull Identify Workplaces for Intervention
Case-Based
Reportable Conditions in Michigan
Local Health DepartmentsCommunicable Diseases (83)
ldquoUnusual occurrence outbreak or epidemic of any disease or conditionsrdquoMDHHS
AbortionsBirth DefectsCancerChemical Poisonings including Carbon MonoxideInjuries Nursing Home Abuse
LARAOccupational Illnesses
County Department of Social ServicesChild AbuseAdult Abuse
PoliceInjury from Knife Gun or Deadly WeaponMental Health Patient Abuse
On Request Only
Laboratory Reporting Regulations Michigan
bull Arsenicbull Cadmiumbull Carboxyhemoglobinbull Cholinesterasebull IgE Antibodiesbull Leadbull Mercury
Occupational Illness Reporting Requirement in Michigan
bull LARA ndash MIOSHAPhysician hospital clinic or employer
having a known or suspected occupational disease or health condition aggravated by workplace exposures shall report within 10 days after discovery
Misdemeanor punishable by a fine of not more than $50
Methodology of Multi-Source Surveillance
Amputations 2006- DateHospitalsEDOutpatient ClinicsWorkersrsquo Compensation Wage Replacement
Crushing Injuries 2013- Date+ FACE Program
Skull Fractures 2012-DateBurns 2009-Date
+ Poison Control Center
bull Quarterly Reporting Specified ICD codes -134 Hospitalsbull Quarterly Reporting all Work-related Events ndash Poison Control Centerbull Electronic Data Base All Paid Claims ndash Workersrsquo Compensationbull FACE ndash Death CertificatesOSHA Hot LinePolice Reports
Work-Related Burn Reports ndash By Source Total 1461 Michigan 2009
n=1460 individuals
450
BLS
HOSPITALSEDs (1248)
4501054
BLSMIFACE 1(2) 1
16721
5 PCC (106)
1321 79
WC(306)
(Kica and Rosenman JOEM 2012)
31 workers per 100 FTE
Rates of Injury by IndustryPrivate sectorJanuary-June 2016
Number of Claims
Rate per 100 FTE
Interurban and Rural Bus Transportation 54 150Couriers and Express Delivery Services 3084 107Building Material and Supplies Dealers 4971 106Animal Slaughtering and Processing 555 90Waste Treatment and Disposal 484 90Poultry and Egg Production 99 89Scheduled Air Transportation 1781 88Motor Vehicle Body and Trailer Manufacturing 243 85Cattle Ranching and Farming 989 81Other General Merchandise Stores 2280 80Other Ambulatory Health Care Services 850 80Foundries 250 79Sheep and Goat Farming 19 77Warehousing and Storage 1349 77Waste Collection 706 76Traveler Accommodation 6780 76Other Furniture Related Product Manufacturing 118 71Forging and Stamping 297 70Logging 58 69Sawmills and Wood Preservation 52 68
Rates of Injury by IndustryPrivate sectorJanuary-June 2016
Number of Claims
Rate per 100 FTE
Interurban and Rural Bus Transportation 54 150Couriers and Express Delivery Services 3084 107Building Material and Supplies Dealers 4971 106Animal Slaughtering and Processing 555 90Waste Treatment and Disposal 484 90Poultry and Egg Production 99 89Scheduled Air Transportation 1781 88Motor Vehicle Body and Trailer Manufacturing 243 85Cattle Ranching and Farming 989 81Other General Merchandise Stores 2280 80Other Ambulatory Health Care Services 850 80Foundries 250 79Sheep and Goat Farming 19 77Warehousing and Storage 1349 77Waste Collection 706 76Traveler Accommodation 6780 76Other Furniture Related Product Manufacturing 118 71Forging and Stamping 297 70Logging 58 69Sawmills and Wood Preservation 52 68
Rates of Injury by IndustryPrivate sectorJanuary-June 2016
Number of Claims
Rate per 100 FTE
Interurban and Rural Bus Transportation 54 150Couriers and Express Delivery Services 3084 107Building Material and Supplies Dealers 4971 106Animal Slaughtering and Processing 555 90Waste Treatment and Disposal 484 90Poultry and Egg Production 99 89Scheduled Air Transportation 1781 88Motor Vehicle Body and Trailer Manufacturing 243 85Cattle Ranching and Farming 989 81Other General Merchandise Stores 2280 80Other Ambulatory Health Care Services 850 80Foundries 250 79Sheep and Goat Farming 19 77Warehousing and Storage 1349 77Waste Collection 706 76Traveler Accommodation 6780 76Other Furniture Related Product Manufacturing 118 71Forging and Stamping 297 70Logging 58 69Sawmills and Wood Preservation 52 68
Rates of Injury by IndustryPrivate sectorJanuary-June 2016
Number of Claims
Rate per 100 FTE
Interurban and Rural Bus Transportation 54 150Couriers and Express Delivery Services 3084 107Building Material and Supplies Dealers 4971 106Animal Slaughtering and Processing 555 90Waste Treatment and Disposal 484 90Poultry and Egg Production 99 89Scheduled Air Transportation 1781 88Motor Vehicle Body and Trailer Manufacturing 243 85Cattle Ranching and Farming 989 81Other General Merchandise Stores 2280 80Other Ambulatory Health Care Services 850 80Foundries 250 79Sheep and Goat Farming 19 77Warehousing and Storage 1349 77Waste Collection 706 76Traveler Accommodation 6780 76Other Furniture Related Product Manufacturing 118 71Forging and Stamping 297 70Logging 58 69Sawmills and Wood Preservation 52 68
Rates of Injury by IndustryPrivate sectorJanuary-June 2016
Number of Claims
Rate per 100 FTE
Interurban and Rural Bus Transportation 54 150Couriers and Express Delivery Services 3084 107Building Material and Supplies Dealers 4971 106Animal Slaughtering and Processing 555 90Waste Treatment and Disposal 484 90Poultry and Egg Production 99 89Scheduled Air Transportation 1781 88Motor Vehicle Body and Trailer Manufacturing 243 85Cattle Ranching and Farming 989 81Other General Merchandise Stores 2280 80Other Ambulatory Health Care Services 850 80Foundries 250 79Sheep and Goat Farming 19 77Warehousing and Storage 1349 77Waste Collection 706 76Traveler Accommodation 6780 76Other Furniture Related Product Manufacturing 118 71Forging and Stamping 297 70Logging 58 69Sawmills and Wood Preservation 52 68
IndustryCA Rate per
100 FTENational Overall SOII
Rate per 100 FTE
Couriers and Express Delivery Services 107 74
Animal Slaughtering and Processing 90 54
Poultry and Egg Production 89 69
Scheduled Air Transportation 88 66
Cattle Ranching and Farming 81 64
Foundries 79 67
Sheep and Goat Farming 77 --
Warehousing and Storage 77 50
Traveler Accommodation 76 50
Forging and Stamping 70 53
Sawmills and Wood Preservation 68 69
IndustryCA Rate per 100
FTENational Overall SOII
Rate per 100 FTE
Interurban and Rural Bus Transportation 150 30
Building Material and Supplies Dealers 106 48
Waste Treatment and Disposal 90 33
Motor Vehicle Body and Trailer Manufacturing 85 79
Other General Merchandise Stores 80 49
Other Ambulatory Health Care Services 80 30
Waste Collection 76 46
Other Furniture Related Product Manufacturing 71 55
Logging 69 37
Collaboration
Data sharing agreements
Pilot rates
Sharable repeatable methods and code
Contribution to national discussions about
use of WC data
Workers not captured by our method
Public sector
People who do not file claims
Data analysis for 2015-2016 Data analysis report Surveillance system evaluation
Publicly available dataset Disseminate findings Sustainability
California Department of Public Health John Beckman Matt Frederick Bob Harrison
California Department of Industrial Relations Genet Daba John Gordon Liza Dizon Glenn Shor Meitong Jin
California Employment Development Department Andy Wong Spencer Wong
Terry Bunn PhDDirector Kentucky Injury Prevention and Research
Center bona fide agent for the Kentucky Department for Public Health
Associate Professor Departments of Epidemiology and Preventive Medicine and Environmental Health University of Kentucky College of Public Health
bull Occupational motor vehicle crash investigations a priority focus area since 2005
KOSHS
Case Example
Case Example
bull Substance abuse a priority focus areabull State injury prevention planbull Legislation data support (HB1)
ndash Pill millsndash Clinical prescribing regulationsndash Decedent controlled substance testing lawndash Inter-state prescription drug monitoring
program (PDMP) data sharing
bull Use of PDMP data for public health surveillance
bull Inform community interventions bull Evaluate and perform cost-benefit
analysis of drug-related laws bull Establish substance use disorder
information and referral service ndash physicians (eg prevention of needle sticks
when lancing drug abuse-related abscesses)ndash first responders (eg handling of fentanyl
analogs at drug overdose scenes) ndash law enforcement (eg naloxone
administration training)ndash general public
bull Increase timeliness of public health data sources
bull Use syndromic surveillance data for drug overdose and injury surveillance
bull Algorithm development for milligram morphine equivalent calculations in PDMP reports
bull Death certificate and PDMP data linkage to identify possible drug diversion
bull State advisory group
bull Link Ky CRASH and trauma registry data with FARS driver drug testing results from fatal crashes in 2014
bull Link 2014 trauma registry toxicology result data with inpatient hospitalization data to assess drug overdose and drug abuse coding
Primary populations
bull Opioid overdose victims
bull Pregnant and parenting women
bull Individuals re-entering society upon criminal justice release
bull Adolescents and young adults
Goals
bull Prevent opioid misuse and abuse
bull Increase access to OUD treatment services (eg MAT)
bull Increase availability of recovery support services
bull Increase availability of naloxone
bull Enhance coordination and evaluation of OUD healthcare and public safety strategies
bull KRS 217186- A person or agency including a peace officer jailer firefighter paramedic or emergency medical technician or a school employee authorized to administer medication under KRS 156502 may ndash Receive a prescription for the drug
naloxonendash Possess naloxone pursuant to this
subsection and any equipment needed for its administration
ndash Administer naloxone to an individual suffering from an apparent opiate-related overdose
bull Reduce prescriber opioid prescribing (physicians APRNs etc) to a 3-day supply for injured workers
bull First line treatment based on non-opioid therapy alternatives (physical therapy acupuncture etc)
bull Revise drug formularies for treatment of pain associated with occupational injuries
Prevention Decrease likelihood that Kentuckians develop a SUD through strategies to decrease overexposure of opioid medications and illicit opioids
bull prescriptions (dosage units) overdose deaths containing fentanyl
Harm Reduction Improve Access to Harm Reduction Services to Save Lives
bull naloxone kits dispensed to first responders and public people in syringe exchange programs who received naloxone
Treatment and Recovery Expand access to treatment and recovery supports
bull peer recovery coaches Emergency Departments with peer recovery coaches people with SUD who interact with peer recovery coaches and enter treatment Emergency Department peer follow-up individuals with SUD who receive residential services calls to SUD treatment locator and portal
bull Louisville Metro Police Department presentation
bull Breakout Session
bull First Responder Opioid Exposure Survey development
bull Focus Groups
bull Survey Administration
bull Data Analysis
bull Use of Data Results
bull UK ERC first responder overdose response exposure pilot project opportunity
bull Multistate or single state applicationsndash Use of survey
ndash development of other first responder-related pilot project
FACE case investigations
bull initiated drug overdose prevention conversations
bull enhanced collaborations
bull provided evidence of need for enhanced multidisciplinary drug overdose prevention efforts1 Interventions
2 Policies
3 Research
Ladder rap
httpswwwyoutubecomwatchv=FsW6eb3aO8gampfeature=youtube
BLS Survey of Employers vs Multi-Source Surveillance of Work-Related Injuries
Kenneth D Rosenman MDProfessor of MedicineMichigan State Universitywwwoemmsuedu
NIOSH Expanding Research Partnerships Conference Denver Colorado June 21-23 2017
Funding NIOSH U60 OH008466
Survey of Occupational Injuries and Illnesses (SOII)
bull Injuries and illnesses (based on OSHArsquos recordkeeping standards) from 230000 establishments (sample by state and NAICS code)
bull Redesigned in 1992 to collect circumstances of injuries and illnesses that lead to days away from work and characteristics of affected workers
bull Scope limitations no small farms private household or self-employed workers (lt 2008 no public sector workers)
NATIONAL ACADEMY OF SCIENCES 1987
New Jersey24 Deaths not covered by OSHA35 Deaths covered by OSHA butemployer had NOT recorded on OSHAlog or did NOT keep OSHA log
TexasNIOSH Fatal Occupational Trauma Surveillance
CENSUS OF FATAL OCCUPATIONAL INJURIES (CFOI) BEGAN IN 1992
Multiple death sourcesDeath certificatesEmployer reportingState PoliceNewspaper Clipping ServiceMedical ExaminersAgricultural Extension Service
Number of deaths doubled from previous BLS estimate
How Much Work-Related Injury and Illness is Missed By the Current National Surveillance System
Rosenman KD Kalush A Reilly MJ Gardiner JC Reeves M Luo Z JOEM 2006 48357-365Funding NIOSH 5 R01 OH004276-03
Summary of Analysis Comparing BLS and Worker Comp data Michigan 2009-2001Days away from workbull BLS estimate
37-41 BLS+ WC31-34 BLS + WC+ CaptureRecapture
1999-2001 Estimates - Michiganbull BLS -281567 vs Our Estimate - 868241
1 in 15 workers vs 1 in 5 workers
(Rosenman et al JOEM 2006)
Simplified Flowchart of Events Necessary to the Documentation of Work-Related Injuries and Illnesses
(Azaroff et al AJPH 2002)
Filters to Identifying Work-Related Injuries and Illnesses
a Filters To Reporting to Supervisorsb Filters To Losing Work Time c Filters to Obtaining Medical Cared Filters to Recognizing Work-Related by Doctore Filters to Workersrsquo Compensation being the Payerf Filters To Recording on OSHA Logg Filters to Reporting by Employers to Workersrsquo
Compensation Agencyh Filters to Reporting by Doctors
(Azaroff et al AJPH 2002)
Capture-Recapture Estimates of Workplace Injury and Illness Reporting by BLS Adjusted for Capture
Heterogeneity Lost-Time Cases 1998-2001
Percent Reported to WA WV OR WI NM MNNo Source Dependence 55 76 56 65 51 68
Source Dependence 52 71 45 53 37 53
(Adapted Boden and Ozonoff Annals Epidemiology 2008)
Workersrsquo CompensationState Specific Program
Mandatory insurance or if large enough self-insured
Michigan WC Excludesbull Federal employeesbull Interstate railroad workersbull Maritime workersbull Less than 3 employees at any one timebull All employees work less than 35 hoursweek or
if more hours less than 13 weeksbull Self-employed
Not computerizedbull Medical claims only
Proportion of Work-Injured Adults for Whom Treatment was paid by Workersrsquo Compensation by State-BRFSS 10 States 2007
State Injured with Payment by Workersrsquo Compensation
Texas 47 (95 CI 35-59)New York 50 (95 CI 39-60)Michigan 56 (95 CI 41-69)Massachusetts 60 (95 CI 45-75)California 61 (95 CI 55-66)Washington 61 (95 CI 55-67)Oregon 62 (95 CI 50-74)Connecticut 63 (95 CI 53-74)New Jersey 64 (95 CI 51-78)Kentucky 77 (95 CI 65-89)
Excludes self-employed
(Adapted Bonauto et al MMWR 2010)
Percentage Received Workersrsquo Compensation by Condition Michigan
WageReplacement
Medical Only
No CompEmployed
No Comp Self -Employed
Amputations 64 22 17 6Burns 17 48 33 2Skull Fractures 36 32 29 3
Percent Applied for Workersrsquo Comp among 2016 Cases of Work-Related Asthma Michigan
Overall 484
Still ExposedConditions Unchanged 239No Longer Exposed 575
Quit on Doctorrsquos Advice 778Sick Leave 727Fired 621New Controls 589Chemical Substitution 536Quit on Own 431Reassigned 360
Reasons Didnrsquot File a Workersrsquo Compensation Claims for a Repetitive Trauma Michigan
Only 397 (251) of 1598 Filed WC Claim
Injury Not Serious Enough 705 (591)Did Not Expect to Miss Work 694 (583)Expect to Receive Sick Leave or
Disability 337 (283) Medical Expenses Covered by
Other Insurance 427 (359)Did Not Think Injury Work Related 242 (204)
(Rosenman et al JOEM 2000)
Goals of Surveillance Population-Based
bull Assess Magnitude of Problembull NumbersRatesTrends
bull Determine Relative Importance vs Other Health Issuesbull Identify High Risk
bull IndustriesOccupationsWorker Populations
bull Prioritize Interventions bull Evaluate Interventionsbull Generate Hypotheses for Researchbull Identify Emerging Problemsbull Identify Workplaces for Intervention
Case-Based
Reportable Conditions in Michigan
Local Health DepartmentsCommunicable Diseases (83)
ldquoUnusual occurrence outbreak or epidemic of any disease or conditionsrdquoMDHHS
AbortionsBirth DefectsCancerChemical Poisonings including Carbon MonoxideInjuries Nursing Home Abuse
LARAOccupational Illnesses
County Department of Social ServicesChild AbuseAdult Abuse
PoliceInjury from Knife Gun or Deadly WeaponMental Health Patient Abuse
On Request Only
Laboratory Reporting Regulations Michigan
bull Arsenicbull Cadmiumbull Carboxyhemoglobinbull Cholinesterasebull IgE Antibodiesbull Leadbull Mercury
Occupational Illness Reporting Requirement in Michigan
bull LARA ndash MIOSHAPhysician hospital clinic or employer
having a known or suspected occupational disease or health condition aggravated by workplace exposures shall report within 10 days after discovery
Misdemeanor punishable by a fine of not more than $50
Methodology of Multi-Source Surveillance
Amputations 2006- DateHospitalsEDOutpatient ClinicsWorkersrsquo Compensation Wage Replacement
Crushing Injuries 2013- Date+ FACE Program
Skull Fractures 2012-DateBurns 2009-Date
+ Poison Control Center
bull Quarterly Reporting Specified ICD codes -134 Hospitalsbull Quarterly Reporting all Work-related Events ndash Poison Control Centerbull Electronic Data Base All Paid Claims ndash Workersrsquo Compensationbull FACE ndash Death CertificatesOSHA Hot LinePolice Reports
Work-Related Burn Reports ndash By Source Total 1461 Michigan 2009
n=1460 individuals
450
BLS
HOSPITALSEDs (1248)
4501054
BLSMIFACE 1(2) 1
16721
5 PCC (106)
1321 79
WC(306)
(Kica and Rosenman JOEM 2012)
Rates of Injury by IndustryPrivate sectorJanuary-June 2016
Number of Claims
Rate per 100 FTE
Interurban and Rural Bus Transportation 54 150Couriers and Express Delivery Services 3084 107Building Material and Supplies Dealers 4971 106Animal Slaughtering and Processing 555 90Waste Treatment and Disposal 484 90Poultry and Egg Production 99 89Scheduled Air Transportation 1781 88Motor Vehicle Body and Trailer Manufacturing 243 85Cattle Ranching and Farming 989 81Other General Merchandise Stores 2280 80Other Ambulatory Health Care Services 850 80Foundries 250 79Sheep and Goat Farming 19 77Warehousing and Storage 1349 77Waste Collection 706 76Traveler Accommodation 6780 76Other Furniture Related Product Manufacturing 118 71Forging and Stamping 297 70Logging 58 69Sawmills and Wood Preservation 52 68
Rates of Injury by IndustryPrivate sectorJanuary-June 2016
Number of Claims
Rate per 100 FTE
Interurban and Rural Bus Transportation 54 150Couriers and Express Delivery Services 3084 107Building Material and Supplies Dealers 4971 106Animal Slaughtering and Processing 555 90Waste Treatment and Disposal 484 90Poultry and Egg Production 99 89Scheduled Air Transportation 1781 88Motor Vehicle Body and Trailer Manufacturing 243 85Cattle Ranching and Farming 989 81Other General Merchandise Stores 2280 80Other Ambulatory Health Care Services 850 80Foundries 250 79Sheep and Goat Farming 19 77Warehousing and Storage 1349 77Waste Collection 706 76Traveler Accommodation 6780 76Other Furniture Related Product Manufacturing 118 71Forging and Stamping 297 70Logging 58 69Sawmills and Wood Preservation 52 68
Rates of Injury by IndustryPrivate sectorJanuary-June 2016
Number of Claims
Rate per 100 FTE
Interurban and Rural Bus Transportation 54 150Couriers and Express Delivery Services 3084 107Building Material and Supplies Dealers 4971 106Animal Slaughtering and Processing 555 90Waste Treatment and Disposal 484 90Poultry and Egg Production 99 89Scheduled Air Transportation 1781 88Motor Vehicle Body and Trailer Manufacturing 243 85Cattle Ranching and Farming 989 81Other General Merchandise Stores 2280 80Other Ambulatory Health Care Services 850 80Foundries 250 79Sheep and Goat Farming 19 77Warehousing and Storage 1349 77Waste Collection 706 76Traveler Accommodation 6780 76Other Furniture Related Product Manufacturing 118 71Forging and Stamping 297 70Logging 58 69Sawmills and Wood Preservation 52 68
Rates of Injury by IndustryPrivate sectorJanuary-June 2016
Number of Claims
Rate per 100 FTE
Interurban and Rural Bus Transportation 54 150Couriers and Express Delivery Services 3084 107Building Material and Supplies Dealers 4971 106Animal Slaughtering and Processing 555 90Waste Treatment and Disposal 484 90Poultry and Egg Production 99 89Scheduled Air Transportation 1781 88Motor Vehicle Body and Trailer Manufacturing 243 85Cattle Ranching and Farming 989 81Other General Merchandise Stores 2280 80Other Ambulatory Health Care Services 850 80Foundries 250 79Sheep and Goat Farming 19 77Warehousing and Storage 1349 77Waste Collection 706 76Traveler Accommodation 6780 76Other Furniture Related Product Manufacturing 118 71Forging and Stamping 297 70Logging 58 69Sawmills and Wood Preservation 52 68
Rates of Injury by IndustryPrivate sectorJanuary-June 2016
Number of Claims
Rate per 100 FTE
Interurban and Rural Bus Transportation 54 150Couriers and Express Delivery Services 3084 107Building Material and Supplies Dealers 4971 106Animal Slaughtering and Processing 555 90Waste Treatment and Disposal 484 90Poultry and Egg Production 99 89Scheduled Air Transportation 1781 88Motor Vehicle Body and Trailer Manufacturing 243 85Cattle Ranching and Farming 989 81Other General Merchandise Stores 2280 80Other Ambulatory Health Care Services 850 80Foundries 250 79Sheep and Goat Farming 19 77Warehousing and Storage 1349 77Waste Collection 706 76Traveler Accommodation 6780 76Other Furniture Related Product Manufacturing 118 71Forging and Stamping 297 70Logging 58 69Sawmills and Wood Preservation 52 68
IndustryCA Rate per
100 FTENational Overall SOII
Rate per 100 FTE
Couriers and Express Delivery Services 107 74
Animal Slaughtering and Processing 90 54
Poultry and Egg Production 89 69
Scheduled Air Transportation 88 66
Cattle Ranching and Farming 81 64
Foundries 79 67
Sheep and Goat Farming 77 --
Warehousing and Storage 77 50
Traveler Accommodation 76 50
Forging and Stamping 70 53
Sawmills and Wood Preservation 68 69
IndustryCA Rate per 100
FTENational Overall SOII
Rate per 100 FTE
Interurban and Rural Bus Transportation 150 30
Building Material and Supplies Dealers 106 48
Waste Treatment and Disposal 90 33
Motor Vehicle Body and Trailer Manufacturing 85 79
Other General Merchandise Stores 80 49
Other Ambulatory Health Care Services 80 30
Waste Collection 76 46
Other Furniture Related Product Manufacturing 71 55
Logging 69 37
Collaboration
Data sharing agreements
Pilot rates
Sharable repeatable methods and code
Contribution to national discussions about
use of WC data
Workers not captured by our method
Public sector
People who do not file claims
Data analysis for 2015-2016 Data analysis report Surveillance system evaluation
Publicly available dataset Disseminate findings Sustainability
California Department of Public Health John Beckman Matt Frederick Bob Harrison
California Department of Industrial Relations Genet Daba John Gordon Liza Dizon Glenn Shor Meitong Jin
California Employment Development Department Andy Wong Spencer Wong
Terry Bunn PhDDirector Kentucky Injury Prevention and Research
Center bona fide agent for the Kentucky Department for Public Health
Associate Professor Departments of Epidemiology and Preventive Medicine and Environmental Health University of Kentucky College of Public Health
bull Occupational motor vehicle crash investigations a priority focus area since 2005
KOSHS
Case Example
Case Example
bull Substance abuse a priority focus areabull State injury prevention planbull Legislation data support (HB1)
ndash Pill millsndash Clinical prescribing regulationsndash Decedent controlled substance testing lawndash Inter-state prescription drug monitoring
program (PDMP) data sharing
bull Use of PDMP data for public health surveillance
bull Inform community interventions bull Evaluate and perform cost-benefit
analysis of drug-related laws bull Establish substance use disorder
information and referral service ndash physicians (eg prevention of needle sticks
when lancing drug abuse-related abscesses)ndash first responders (eg handling of fentanyl
analogs at drug overdose scenes) ndash law enforcement (eg naloxone
administration training)ndash general public
bull Increase timeliness of public health data sources
bull Use syndromic surveillance data for drug overdose and injury surveillance
bull Algorithm development for milligram morphine equivalent calculations in PDMP reports
bull Death certificate and PDMP data linkage to identify possible drug diversion
bull State advisory group
bull Link Ky CRASH and trauma registry data with FARS driver drug testing results from fatal crashes in 2014
bull Link 2014 trauma registry toxicology result data with inpatient hospitalization data to assess drug overdose and drug abuse coding
Primary populations
bull Opioid overdose victims
bull Pregnant and parenting women
bull Individuals re-entering society upon criminal justice release
bull Adolescents and young adults
Goals
bull Prevent opioid misuse and abuse
bull Increase access to OUD treatment services (eg MAT)
bull Increase availability of recovery support services
bull Increase availability of naloxone
bull Enhance coordination and evaluation of OUD healthcare and public safety strategies
bull KRS 217186- A person or agency including a peace officer jailer firefighter paramedic or emergency medical technician or a school employee authorized to administer medication under KRS 156502 may ndash Receive a prescription for the drug
naloxonendash Possess naloxone pursuant to this
subsection and any equipment needed for its administration
ndash Administer naloxone to an individual suffering from an apparent opiate-related overdose
bull Reduce prescriber opioid prescribing (physicians APRNs etc) to a 3-day supply for injured workers
bull First line treatment based on non-opioid therapy alternatives (physical therapy acupuncture etc)
bull Revise drug formularies for treatment of pain associated with occupational injuries
Prevention Decrease likelihood that Kentuckians develop a SUD through strategies to decrease overexposure of opioid medications and illicit opioids
bull prescriptions (dosage units) overdose deaths containing fentanyl
Harm Reduction Improve Access to Harm Reduction Services to Save Lives
bull naloxone kits dispensed to first responders and public people in syringe exchange programs who received naloxone
Treatment and Recovery Expand access to treatment and recovery supports
bull peer recovery coaches Emergency Departments with peer recovery coaches people with SUD who interact with peer recovery coaches and enter treatment Emergency Department peer follow-up individuals with SUD who receive residential services calls to SUD treatment locator and portal
bull Louisville Metro Police Department presentation
bull Breakout Session
bull First Responder Opioid Exposure Survey development
bull Focus Groups
bull Survey Administration
bull Data Analysis
bull Use of Data Results
bull UK ERC first responder overdose response exposure pilot project opportunity
bull Multistate or single state applicationsndash Use of survey
ndash development of other first responder-related pilot project
FACE case investigations
bull initiated drug overdose prevention conversations
bull enhanced collaborations
bull provided evidence of need for enhanced multidisciplinary drug overdose prevention efforts1 Interventions
2 Policies
3 Research
Ladder rap
httpswwwyoutubecomwatchv=FsW6eb3aO8gampfeature=youtube
BLS Survey of Employers vs Multi-Source Surveillance of Work-Related Injuries
Kenneth D Rosenman MDProfessor of MedicineMichigan State Universitywwwoemmsuedu
NIOSH Expanding Research Partnerships Conference Denver Colorado June 21-23 2017
Funding NIOSH U60 OH008466
Survey of Occupational Injuries and Illnesses (SOII)
bull Injuries and illnesses (based on OSHArsquos recordkeeping standards) from 230000 establishments (sample by state and NAICS code)
bull Redesigned in 1992 to collect circumstances of injuries and illnesses that lead to days away from work and characteristics of affected workers
bull Scope limitations no small farms private household or self-employed workers (lt 2008 no public sector workers)
NATIONAL ACADEMY OF SCIENCES 1987
New Jersey24 Deaths not covered by OSHA35 Deaths covered by OSHA butemployer had NOT recorded on OSHAlog or did NOT keep OSHA log
TexasNIOSH Fatal Occupational Trauma Surveillance
CENSUS OF FATAL OCCUPATIONAL INJURIES (CFOI) BEGAN IN 1992
Multiple death sourcesDeath certificatesEmployer reportingState PoliceNewspaper Clipping ServiceMedical ExaminersAgricultural Extension Service
Number of deaths doubled from previous BLS estimate
How Much Work-Related Injury and Illness is Missed By the Current National Surveillance System
Rosenman KD Kalush A Reilly MJ Gardiner JC Reeves M Luo Z JOEM 2006 48357-365Funding NIOSH 5 R01 OH004276-03
Summary of Analysis Comparing BLS and Worker Comp data Michigan 2009-2001Days away from workbull BLS estimate
37-41 BLS+ WC31-34 BLS + WC+ CaptureRecapture
1999-2001 Estimates - Michiganbull BLS -281567 vs Our Estimate - 868241
1 in 15 workers vs 1 in 5 workers
(Rosenman et al JOEM 2006)
Simplified Flowchart of Events Necessary to the Documentation of Work-Related Injuries and Illnesses
(Azaroff et al AJPH 2002)
Filters to Identifying Work-Related Injuries and Illnesses
a Filters To Reporting to Supervisorsb Filters To Losing Work Time c Filters to Obtaining Medical Cared Filters to Recognizing Work-Related by Doctore Filters to Workersrsquo Compensation being the Payerf Filters To Recording on OSHA Logg Filters to Reporting by Employers to Workersrsquo
Compensation Agencyh Filters to Reporting by Doctors
(Azaroff et al AJPH 2002)
Capture-Recapture Estimates of Workplace Injury and Illness Reporting by BLS Adjusted for Capture
Heterogeneity Lost-Time Cases 1998-2001
Percent Reported to WA WV OR WI NM MNNo Source Dependence 55 76 56 65 51 68
Source Dependence 52 71 45 53 37 53
(Adapted Boden and Ozonoff Annals Epidemiology 2008)
Workersrsquo CompensationState Specific Program
Mandatory insurance or if large enough self-insured
Michigan WC Excludesbull Federal employeesbull Interstate railroad workersbull Maritime workersbull Less than 3 employees at any one timebull All employees work less than 35 hoursweek or
if more hours less than 13 weeksbull Self-employed
Not computerizedbull Medical claims only
Proportion of Work-Injured Adults for Whom Treatment was paid by Workersrsquo Compensation by State-BRFSS 10 States 2007
State Injured with Payment by Workersrsquo Compensation
Texas 47 (95 CI 35-59)New York 50 (95 CI 39-60)Michigan 56 (95 CI 41-69)Massachusetts 60 (95 CI 45-75)California 61 (95 CI 55-66)Washington 61 (95 CI 55-67)Oregon 62 (95 CI 50-74)Connecticut 63 (95 CI 53-74)New Jersey 64 (95 CI 51-78)Kentucky 77 (95 CI 65-89)
Excludes self-employed
(Adapted Bonauto et al MMWR 2010)
Percentage Received Workersrsquo Compensation by Condition Michigan
WageReplacement
Medical Only
No CompEmployed
No Comp Self -Employed
Amputations 64 22 17 6Burns 17 48 33 2Skull Fractures 36 32 29 3
Percent Applied for Workersrsquo Comp among 2016 Cases of Work-Related Asthma Michigan
Overall 484
Still ExposedConditions Unchanged 239No Longer Exposed 575
Quit on Doctorrsquos Advice 778Sick Leave 727Fired 621New Controls 589Chemical Substitution 536Quit on Own 431Reassigned 360
Reasons Didnrsquot File a Workersrsquo Compensation Claims for a Repetitive Trauma Michigan
Only 397 (251) of 1598 Filed WC Claim
Injury Not Serious Enough 705 (591)Did Not Expect to Miss Work 694 (583)Expect to Receive Sick Leave or
Disability 337 (283) Medical Expenses Covered by
Other Insurance 427 (359)Did Not Think Injury Work Related 242 (204)
(Rosenman et al JOEM 2000)
Goals of Surveillance Population-Based
bull Assess Magnitude of Problembull NumbersRatesTrends
bull Determine Relative Importance vs Other Health Issuesbull Identify High Risk
bull IndustriesOccupationsWorker Populations
bull Prioritize Interventions bull Evaluate Interventionsbull Generate Hypotheses for Researchbull Identify Emerging Problemsbull Identify Workplaces for Intervention
Case-Based
Reportable Conditions in Michigan
Local Health DepartmentsCommunicable Diseases (83)
ldquoUnusual occurrence outbreak or epidemic of any disease or conditionsrdquoMDHHS
AbortionsBirth DefectsCancerChemical Poisonings including Carbon MonoxideInjuries Nursing Home Abuse
LARAOccupational Illnesses
County Department of Social ServicesChild AbuseAdult Abuse
PoliceInjury from Knife Gun or Deadly WeaponMental Health Patient Abuse
On Request Only
Laboratory Reporting Regulations Michigan
bull Arsenicbull Cadmiumbull Carboxyhemoglobinbull Cholinesterasebull IgE Antibodiesbull Leadbull Mercury
Occupational Illness Reporting Requirement in Michigan
bull LARA ndash MIOSHAPhysician hospital clinic or employer
having a known or suspected occupational disease or health condition aggravated by workplace exposures shall report within 10 days after discovery
Misdemeanor punishable by a fine of not more than $50
Methodology of Multi-Source Surveillance
Amputations 2006- DateHospitalsEDOutpatient ClinicsWorkersrsquo Compensation Wage Replacement
Crushing Injuries 2013- Date+ FACE Program
Skull Fractures 2012-DateBurns 2009-Date
+ Poison Control Center
bull Quarterly Reporting Specified ICD codes -134 Hospitalsbull Quarterly Reporting all Work-related Events ndash Poison Control Centerbull Electronic Data Base All Paid Claims ndash Workersrsquo Compensationbull FACE ndash Death CertificatesOSHA Hot LinePolice Reports
Work-Related Burn Reports ndash By Source Total 1461 Michigan 2009
n=1460 individuals
450
BLS
HOSPITALSEDs (1248)
4501054
BLSMIFACE 1(2) 1
16721
5 PCC (106)
1321 79
WC(306)
(Kica and Rosenman JOEM 2012)
Rates of Injury by IndustryPrivate sectorJanuary-June 2016
Number of Claims
Rate per 100 FTE
Interurban and Rural Bus Transportation 54 150Couriers and Express Delivery Services 3084 107Building Material and Supplies Dealers 4971 106Animal Slaughtering and Processing 555 90Waste Treatment and Disposal 484 90Poultry and Egg Production 99 89Scheduled Air Transportation 1781 88Motor Vehicle Body and Trailer Manufacturing 243 85Cattle Ranching and Farming 989 81Other General Merchandise Stores 2280 80Other Ambulatory Health Care Services 850 80Foundries 250 79Sheep and Goat Farming 19 77Warehousing and Storage 1349 77Waste Collection 706 76Traveler Accommodation 6780 76Other Furniture Related Product Manufacturing 118 71Forging and Stamping 297 70Logging 58 69Sawmills and Wood Preservation 52 68
Rates of Injury by IndustryPrivate sectorJanuary-June 2016
Number of Claims
Rate per 100 FTE
Interurban and Rural Bus Transportation 54 150Couriers and Express Delivery Services 3084 107Building Material and Supplies Dealers 4971 106Animal Slaughtering and Processing 555 90Waste Treatment and Disposal 484 90Poultry and Egg Production 99 89Scheduled Air Transportation 1781 88Motor Vehicle Body and Trailer Manufacturing 243 85Cattle Ranching and Farming 989 81Other General Merchandise Stores 2280 80Other Ambulatory Health Care Services 850 80Foundries 250 79Sheep and Goat Farming 19 77Warehousing and Storage 1349 77Waste Collection 706 76Traveler Accommodation 6780 76Other Furniture Related Product Manufacturing 118 71Forging and Stamping 297 70Logging 58 69Sawmills and Wood Preservation 52 68
Rates of Injury by IndustryPrivate sectorJanuary-June 2016
Number of Claims
Rate per 100 FTE
Interurban and Rural Bus Transportation 54 150Couriers and Express Delivery Services 3084 107Building Material and Supplies Dealers 4971 106Animal Slaughtering and Processing 555 90Waste Treatment and Disposal 484 90Poultry and Egg Production 99 89Scheduled Air Transportation 1781 88Motor Vehicle Body and Trailer Manufacturing 243 85Cattle Ranching and Farming 989 81Other General Merchandise Stores 2280 80Other Ambulatory Health Care Services 850 80Foundries 250 79Sheep and Goat Farming 19 77Warehousing and Storage 1349 77Waste Collection 706 76Traveler Accommodation 6780 76Other Furniture Related Product Manufacturing 118 71Forging and Stamping 297 70Logging 58 69Sawmills and Wood Preservation 52 68
Rates of Injury by IndustryPrivate sectorJanuary-June 2016
Number of Claims
Rate per 100 FTE
Interurban and Rural Bus Transportation 54 150Couriers and Express Delivery Services 3084 107Building Material and Supplies Dealers 4971 106Animal Slaughtering and Processing 555 90Waste Treatment and Disposal 484 90Poultry and Egg Production 99 89Scheduled Air Transportation 1781 88Motor Vehicle Body and Trailer Manufacturing 243 85Cattle Ranching and Farming 989 81Other General Merchandise Stores 2280 80Other Ambulatory Health Care Services 850 80Foundries 250 79Sheep and Goat Farming 19 77Warehousing and Storage 1349 77Waste Collection 706 76Traveler Accommodation 6780 76Other Furniture Related Product Manufacturing 118 71Forging and Stamping 297 70Logging 58 69Sawmills and Wood Preservation 52 68
IndustryCA Rate per
100 FTENational Overall SOII
Rate per 100 FTE
Couriers and Express Delivery Services 107 74
Animal Slaughtering and Processing 90 54
Poultry and Egg Production 89 69
Scheduled Air Transportation 88 66
Cattle Ranching and Farming 81 64
Foundries 79 67
Sheep and Goat Farming 77 --
Warehousing and Storage 77 50
Traveler Accommodation 76 50
Forging and Stamping 70 53
Sawmills and Wood Preservation 68 69
IndustryCA Rate per 100
FTENational Overall SOII
Rate per 100 FTE
Interurban and Rural Bus Transportation 150 30
Building Material and Supplies Dealers 106 48
Waste Treatment and Disposal 90 33
Motor Vehicle Body and Trailer Manufacturing 85 79
Other General Merchandise Stores 80 49
Other Ambulatory Health Care Services 80 30
Waste Collection 76 46
Other Furniture Related Product Manufacturing 71 55
Logging 69 37
Collaboration
Data sharing agreements
Pilot rates
Sharable repeatable methods and code
Contribution to national discussions about
use of WC data
Workers not captured by our method
Public sector
People who do not file claims
Data analysis for 2015-2016 Data analysis report Surveillance system evaluation
Publicly available dataset Disseminate findings Sustainability
California Department of Public Health John Beckman Matt Frederick Bob Harrison
California Department of Industrial Relations Genet Daba John Gordon Liza Dizon Glenn Shor Meitong Jin
California Employment Development Department Andy Wong Spencer Wong
Terry Bunn PhDDirector Kentucky Injury Prevention and Research
Center bona fide agent for the Kentucky Department for Public Health
Associate Professor Departments of Epidemiology and Preventive Medicine and Environmental Health University of Kentucky College of Public Health
bull Occupational motor vehicle crash investigations a priority focus area since 2005
KOSHS
Case Example
Case Example
bull Substance abuse a priority focus areabull State injury prevention planbull Legislation data support (HB1)
ndash Pill millsndash Clinical prescribing regulationsndash Decedent controlled substance testing lawndash Inter-state prescription drug monitoring
program (PDMP) data sharing
bull Use of PDMP data for public health surveillance
bull Inform community interventions bull Evaluate and perform cost-benefit
analysis of drug-related laws bull Establish substance use disorder
information and referral service ndash physicians (eg prevention of needle sticks
when lancing drug abuse-related abscesses)ndash first responders (eg handling of fentanyl
analogs at drug overdose scenes) ndash law enforcement (eg naloxone
administration training)ndash general public
bull Increase timeliness of public health data sources
bull Use syndromic surveillance data for drug overdose and injury surveillance
bull Algorithm development for milligram morphine equivalent calculations in PDMP reports
bull Death certificate and PDMP data linkage to identify possible drug diversion
bull State advisory group
bull Link Ky CRASH and trauma registry data with FARS driver drug testing results from fatal crashes in 2014
bull Link 2014 trauma registry toxicology result data with inpatient hospitalization data to assess drug overdose and drug abuse coding
Primary populations
bull Opioid overdose victims
bull Pregnant and parenting women
bull Individuals re-entering society upon criminal justice release
bull Adolescents and young adults
Goals
bull Prevent opioid misuse and abuse
bull Increase access to OUD treatment services (eg MAT)
bull Increase availability of recovery support services
bull Increase availability of naloxone
bull Enhance coordination and evaluation of OUD healthcare and public safety strategies
bull KRS 217186- A person or agency including a peace officer jailer firefighter paramedic or emergency medical technician or a school employee authorized to administer medication under KRS 156502 may ndash Receive a prescription for the drug
naloxonendash Possess naloxone pursuant to this
subsection and any equipment needed for its administration
ndash Administer naloxone to an individual suffering from an apparent opiate-related overdose
bull Reduce prescriber opioid prescribing (physicians APRNs etc) to a 3-day supply for injured workers
bull First line treatment based on non-opioid therapy alternatives (physical therapy acupuncture etc)
bull Revise drug formularies for treatment of pain associated with occupational injuries
Prevention Decrease likelihood that Kentuckians develop a SUD through strategies to decrease overexposure of opioid medications and illicit opioids
bull prescriptions (dosage units) overdose deaths containing fentanyl
Harm Reduction Improve Access to Harm Reduction Services to Save Lives
bull naloxone kits dispensed to first responders and public people in syringe exchange programs who received naloxone
Treatment and Recovery Expand access to treatment and recovery supports
bull peer recovery coaches Emergency Departments with peer recovery coaches people with SUD who interact with peer recovery coaches and enter treatment Emergency Department peer follow-up individuals with SUD who receive residential services calls to SUD treatment locator and portal
bull Louisville Metro Police Department presentation
bull Breakout Session
bull First Responder Opioid Exposure Survey development
bull Focus Groups
bull Survey Administration
bull Data Analysis
bull Use of Data Results
bull UK ERC first responder overdose response exposure pilot project opportunity
bull Multistate or single state applicationsndash Use of survey
ndash development of other first responder-related pilot project
FACE case investigations
bull initiated drug overdose prevention conversations
bull enhanced collaborations
bull provided evidence of need for enhanced multidisciplinary drug overdose prevention efforts1 Interventions
2 Policies
3 Research
Ladder rap
httpswwwyoutubecomwatchv=FsW6eb3aO8gampfeature=youtube
BLS Survey of Employers vs Multi-Source Surveillance of Work-Related Injuries
Kenneth D Rosenman MDProfessor of MedicineMichigan State Universitywwwoemmsuedu
NIOSH Expanding Research Partnerships Conference Denver Colorado June 21-23 2017
Funding NIOSH U60 OH008466
Survey of Occupational Injuries and Illnesses (SOII)
bull Injuries and illnesses (based on OSHArsquos recordkeeping standards) from 230000 establishments (sample by state and NAICS code)
bull Redesigned in 1992 to collect circumstances of injuries and illnesses that lead to days away from work and characteristics of affected workers
bull Scope limitations no small farms private household or self-employed workers (lt 2008 no public sector workers)
NATIONAL ACADEMY OF SCIENCES 1987
New Jersey24 Deaths not covered by OSHA35 Deaths covered by OSHA butemployer had NOT recorded on OSHAlog or did NOT keep OSHA log
TexasNIOSH Fatal Occupational Trauma Surveillance
CENSUS OF FATAL OCCUPATIONAL INJURIES (CFOI) BEGAN IN 1992
Multiple death sourcesDeath certificatesEmployer reportingState PoliceNewspaper Clipping ServiceMedical ExaminersAgricultural Extension Service
Number of deaths doubled from previous BLS estimate
How Much Work-Related Injury and Illness is Missed By the Current National Surveillance System
Rosenman KD Kalush A Reilly MJ Gardiner JC Reeves M Luo Z JOEM 2006 48357-365Funding NIOSH 5 R01 OH004276-03
Summary of Analysis Comparing BLS and Worker Comp data Michigan 2009-2001Days away from workbull BLS estimate
37-41 BLS+ WC31-34 BLS + WC+ CaptureRecapture
1999-2001 Estimates - Michiganbull BLS -281567 vs Our Estimate - 868241
1 in 15 workers vs 1 in 5 workers
(Rosenman et al JOEM 2006)
Simplified Flowchart of Events Necessary to the Documentation of Work-Related Injuries and Illnesses
(Azaroff et al AJPH 2002)
Filters to Identifying Work-Related Injuries and Illnesses
a Filters To Reporting to Supervisorsb Filters To Losing Work Time c Filters to Obtaining Medical Cared Filters to Recognizing Work-Related by Doctore Filters to Workersrsquo Compensation being the Payerf Filters To Recording on OSHA Logg Filters to Reporting by Employers to Workersrsquo
Compensation Agencyh Filters to Reporting by Doctors
(Azaroff et al AJPH 2002)
Capture-Recapture Estimates of Workplace Injury and Illness Reporting by BLS Adjusted for Capture
Heterogeneity Lost-Time Cases 1998-2001
Percent Reported to WA WV OR WI NM MNNo Source Dependence 55 76 56 65 51 68
Source Dependence 52 71 45 53 37 53
(Adapted Boden and Ozonoff Annals Epidemiology 2008)
Workersrsquo CompensationState Specific Program
Mandatory insurance or if large enough self-insured
Michigan WC Excludesbull Federal employeesbull Interstate railroad workersbull Maritime workersbull Less than 3 employees at any one timebull All employees work less than 35 hoursweek or
if more hours less than 13 weeksbull Self-employed
Not computerizedbull Medical claims only
Proportion of Work-Injured Adults for Whom Treatment was paid by Workersrsquo Compensation by State-BRFSS 10 States 2007
State Injured with Payment by Workersrsquo Compensation
Texas 47 (95 CI 35-59)New York 50 (95 CI 39-60)Michigan 56 (95 CI 41-69)Massachusetts 60 (95 CI 45-75)California 61 (95 CI 55-66)Washington 61 (95 CI 55-67)Oregon 62 (95 CI 50-74)Connecticut 63 (95 CI 53-74)New Jersey 64 (95 CI 51-78)Kentucky 77 (95 CI 65-89)
Excludes self-employed
(Adapted Bonauto et al MMWR 2010)
Percentage Received Workersrsquo Compensation by Condition Michigan
WageReplacement
Medical Only
No CompEmployed
No Comp Self -Employed
Amputations 64 22 17 6Burns 17 48 33 2Skull Fractures 36 32 29 3
Percent Applied for Workersrsquo Comp among 2016 Cases of Work-Related Asthma Michigan
Overall 484
Still ExposedConditions Unchanged 239No Longer Exposed 575
Quit on Doctorrsquos Advice 778Sick Leave 727Fired 621New Controls 589Chemical Substitution 536Quit on Own 431Reassigned 360
Reasons Didnrsquot File a Workersrsquo Compensation Claims for a Repetitive Trauma Michigan
Only 397 (251) of 1598 Filed WC Claim
Injury Not Serious Enough 705 (591)Did Not Expect to Miss Work 694 (583)Expect to Receive Sick Leave or
Disability 337 (283) Medical Expenses Covered by
Other Insurance 427 (359)Did Not Think Injury Work Related 242 (204)
(Rosenman et al JOEM 2000)
Goals of Surveillance Population-Based
bull Assess Magnitude of Problembull NumbersRatesTrends
bull Determine Relative Importance vs Other Health Issuesbull Identify High Risk
bull IndustriesOccupationsWorker Populations
bull Prioritize Interventions bull Evaluate Interventionsbull Generate Hypotheses for Researchbull Identify Emerging Problemsbull Identify Workplaces for Intervention
Case-Based
Reportable Conditions in Michigan
Local Health DepartmentsCommunicable Diseases (83)
ldquoUnusual occurrence outbreak or epidemic of any disease or conditionsrdquoMDHHS
AbortionsBirth DefectsCancerChemical Poisonings including Carbon MonoxideInjuries Nursing Home Abuse
LARAOccupational Illnesses
County Department of Social ServicesChild AbuseAdult Abuse
PoliceInjury from Knife Gun or Deadly WeaponMental Health Patient Abuse
On Request Only
Laboratory Reporting Regulations Michigan
bull Arsenicbull Cadmiumbull Carboxyhemoglobinbull Cholinesterasebull IgE Antibodiesbull Leadbull Mercury
Occupational Illness Reporting Requirement in Michigan
bull LARA ndash MIOSHAPhysician hospital clinic or employer
having a known or suspected occupational disease or health condition aggravated by workplace exposures shall report within 10 days after discovery
Misdemeanor punishable by a fine of not more than $50
Methodology of Multi-Source Surveillance
Amputations 2006- DateHospitalsEDOutpatient ClinicsWorkersrsquo Compensation Wage Replacement
Crushing Injuries 2013- Date+ FACE Program
Skull Fractures 2012-DateBurns 2009-Date
+ Poison Control Center
bull Quarterly Reporting Specified ICD codes -134 Hospitalsbull Quarterly Reporting all Work-related Events ndash Poison Control Centerbull Electronic Data Base All Paid Claims ndash Workersrsquo Compensationbull FACE ndash Death CertificatesOSHA Hot LinePolice Reports
Work-Related Burn Reports ndash By Source Total 1461 Michigan 2009
n=1460 individuals
450
BLS
HOSPITALSEDs (1248)
4501054
BLSMIFACE 1(2) 1
16721
5 PCC (106)
1321 79
WC(306)
(Kica and Rosenman JOEM 2012)
Rates of Injury by IndustryPrivate sectorJanuary-June 2016
Number of Claims
Rate per 100 FTE
Interurban and Rural Bus Transportation 54 150Couriers and Express Delivery Services 3084 107Building Material and Supplies Dealers 4971 106Animal Slaughtering and Processing 555 90Waste Treatment and Disposal 484 90Poultry and Egg Production 99 89Scheduled Air Transportation 1781 88Motor Vehicle Body and Trailer Manufacturing 243 85Cattle Ranching and Farming 989 81Other General Merchandise Stores 2280 80Other Ambulatory Health Care Services 850 80Foundries 250 79Sheep and Goat Farming 19 77Warehousing and Storage 1349 77Waste Collection 706 76Traveler Accommodation 6780 76Other Furniture Related Product Manufacturing 118 71Forging and Stamping 297 70Logging 58 69Sawmills and Wood Preservation 52 68
Rates of Injury by IndustryPrivate sectorJanuary-June 2016
Number of Claims
Rate per 100 FTE
Interurban and Rural Bus Transportation 54 150Couriers and Express Delivery Services 3084 107Building Material and Supplies Dealers 4971 106Animal Slaughtering and Processing 555 90Waste Treatment and Disposal 484 90Poultry and Egg Production 99 89Scheduled Air Transportation 1781 88Motor Vehicle Body and Trailer Manufacturing 243 85Cattle Ranching and Farming 989 81Other General Merchandise Stores 2280 80Other Ambulatory Health Care Services 850 80Foundries 250 79Sheep and Goat Farming 19 77Warehousing and Storage 1349 77Waste Collection 706 76Traveler Accommodation 6780 76Other Furniture Related Product Manufacturing 118 71Forging and Stamping 297 70Logging 58 69Sawmills and Wood Preservation 52 68
Rates of Injury by IndustryPrivate sectorJanuary-June 2016
Number of Claims
Rate per 100 FTE
Interurban and Rural Bus Transportation 54 150Couriers and Express Delivery Services 3084 107Building Material and Supplies Dealers 4971 106Animal Slaughtering and Processing 555 90Waste Treatment and Disposal 484 90Poultry and Egg Production 99 89Scheduled Air Transportation 1781 88Motor Vehicle Body and Trailer Manufacturing 243 85Cattle Ranching and Farming 989 81Other General Merchandise Stores 2280 80Other Ambulatory Health Care Services 850 80Foundries 250 79Sheep and Goat Farming 19 77Warehousing and Storage 1349 77Waste Collection 706 76Traveler Accommodation 6780 76Other Furniture Related Product Manufacturing 118 71Forging and Stamping 297 70Logging 58 69Sawmills and Wood Preservation 52 68
IndustryCA Rate per
100 FTENational Overall SOII
Rate per 100 FTE
Couriers and Express Delivery Services 107 74
Animal Slaughtering and Processing 90 54
Poultry and Egg Production 89 69
Scheduled Air Transportation 88 66
Cattle Ranching and Farming 81 64
Foundries 79 67
Sheep and Goat Farming 77 --
Warehousing and Storage 77 50
Traveler Accommodation 76 50
Forging and Stamping 70 53
Sawmills and Wood Preservation 68 69
IndustryCA Rate per 100
FTENational Overall SOII
Rate per 100 FTE
Interurban and Rural Bus Transportation 150 30
Building Material and Supplies Dealers 106 48
Waste Treatment and Disposal 90 33
Motor Vehicle Body and Trailer Manufacturing 85 79
Other General Merchandise Stores 80 49
Other Ambulatory Health Care Services 80 30
Waste Collection 76 46
Other Furniture Related Product Manufacturing 71 55
Logging 69 37
Collaboration
Data sharing agreements
Pilot rates
Sharable repeatable methods and code
Contribution to national discussions about
use of WC data
Workers not captured by our method
Public sector
People who do not file claims
Data analysis for 2015-2016 Data analysis report Surveillance system evaluation
Publicly available dataset Disseminate findings Sustainability
California Department of Public Health John Beckman Matt Frederick Bob Harrison
California Department of Industrial Relations Genet Daba John Gordon Liza Dizon Glenn Shor Meitong Jin
California Employment Development Department Andy Wong Spencer Wong
Terry Bunn PhDDirector Kentucky Injury Prevention and Research
Center bona fide agent for the Kentucky Department for Public Health
Associate Professor Departments of Epidemiology and Preventive Medicine and Environmental Health University of Kentucky College of Public Health
bull Occupational motor vehicle crash investigations a priority focus area since 2005
KOSHS
Case Example
Case Example
bull Substance abuse a priority focus areabull State injury prevention planbull Legislation data support (HB1)
ndash Pill millsndash Clinical prescribing regulationsndash Decedent controlled substance testing lawndash Inter-state prescription drug monitoring
program (PDMP) data sharing
bull Use of PDMP data for public health surveillance
bull Inform community interventions bull Evaluate and perform cost-benefit
analysis of drug-related laws bull Establish substance use disorder
information and referral service ndash physicians (eg prevention of needle sticks
when lancing drug abuse-related abscesses)ndash first responders (eg handling of fentanyl
analogs at drug overdose scenes) ndash law enforcement (eg naloxone
administration training)ndash general public
bull Increase timeliness of public health data sources
bull Use syndromic surveillance data for drug overdose and injury surveillance
bull Algorithm development for milligram morphine equivalent calculations in PDMP reports
bull Death certificate and PDMP data linkage to identify possible drug diversion
bull State advisory group
bull Link Ky CRASH and trauma registry data with FARS driver drug testing results from fatal crashes in 2014
bull Link 2014 trauma registry toxicology result data with inpatient hospitalization data to assess drug overdose and drug abuse coding
Primary populations
bull Opioid overdose victims
bull Pregnant and parenting women
bull Individuals re-entering society upon criminal justice release
bull Adolescents and young adults
Goals
bull Prevent opioid misuse and abuse
bull Increase access to OUD treatment services (eg MAT)
bull Increase availability of recovery support services
bull Increase availability of naloxone
bull Enhance coordination and evaluation of OUD healthcare and public safety strategies
bull KRS 217186- A person or agency including a peace officer jailer firefighter paramedic or emergency medical technician or a school employee authorized to administer medication under KRS 156502 may ndash Receive a prescription for the drug
naloxonendash Possess naloxone pursuant to this
subsection and any equipment needed for its administration
ndash Administer naloxone to an individual suffering from an apparent opiate-related overdose
bull Reduce prescriber opioid prescribing (physicians APRNs etc) to a 3-day supply for injured workers
bull First line treatment based on non-opioid therapy alternatives (physical therapy acupuncture etc)
bull Revise drug formularies for treatment of pain associated with occupational injuries
Prevention Decrease likelihood that Kentuckians develop a SUD through strategies to decrease overexposure of opioid medications and illicit opioids
bull prescriptions (dosage units) overdose deaths containing fentanyl
Harm Reduction Improve Access to Harm Reduction Services to Save Lives
bull naloxone kits dispensed to first responders and public people in syringe exchange programs who received naloxone
Treatment and Recovery Expand access to treatment and recovery supports
bull peer recovery coaches Emergency Departments with peer recovery coaches people with SUD who interact with peer recovery coaches and enter treatment Emergency Department peer follow-up individuals with SUD who receive residential services calls to SUD treatment locator and portal
bull Louisville Metro Police Department presentation
bull Breakout Session
bull First Responder Opioid Exposure Survey development
bull Focus Groups
bull Survey Administration
bull Data Analysis
bull Use of Data Results
bull UK ERC first responder overdose response exposure pilot project opportunity
bull Multistate or single state applicationsndash Use of survey
ndash development of other first responder-related pilot project
FACE case investigations
bull initiated drug overdose prevention conversations
bull enhanced collaborations
bull provided evidence of need for enhanced multidisciplinary drug overdose prevention efforts1 Interventions
2 Policies
3 Research
Ladder rap
httpswwwyoutubecomwatchv=FsW6eb3aO8gampfeature=youtube
BLS Survey of Employers vs Multi-Source Surveillance of Work-Related Injuries
Kenneth D Rosenman MDProfessor of MedicineMichigan State Universitywwwoemmsuedu
NIOSH Expanding Research Partnerships Conference Denver Colorado June 21-23 2017
Funding NIOSH U60 OH008466
Survey of Occupational Injuries and Illnesses (SOII)
bull Injuries and illnesses (based on OSHArsquos recordkeeping standards) from 230000 establishments (sample by state and NAICS code)
bull Redesigned in 1992 to collect circumstances of injuries and illnesses that lead to days away from work and characteristics of affected workers
bull Scope limitations no small farms private household or self-employed workers (lt 2008 no public sector workers)
NATIONAL ACADEMY OF SCIENCES 1987
New Jersey24 Deaths not covered by OSHA35 Deaths covered by OSHA butemployer had NOT recorded on OSHAlog or did NOT keep OSHA log
TexasNIOSH Fatal Occupational Trauma Surveillance
CENSUS OF FATAL OCCUPATIONAL INJURIES (CFOI) BEGAN IN 1992
Multiple death sourcesDeath certificatesEmployer reportingState PoliceNewspaper Clipping ServiceMedical ExaminersAgricultural Extension Service
Number of deaths doubled from previous BLS estimate
How Much Work-Related Injury and Illness is Missed By the Current National Surveillance System
Rosenman KD Kalush A Reilly MJ Gardiner JC Reeves M Luo Z JOEM 2006 48357-365Funding NIOSH 5 R01 OH004276-03
Summary of Analysis Comparing BLS and Worker Comp data Michigan 2009-2001Days away from workbull BLS estimate
37-41 BLS+ WC31-34 BLS + WC+ CaptureRecapture
1999-2001 Estimates - Michiganbull BLS -281567 vs Our Estimate - 868241
1 in 15 workers vs 1 in 5 workers
(Rosenman et al JOEM 2006)
Simplified Flowchart of Events Necessary to the Documentation of Work-Related Injuries and Illnesses
(Azaroff et al AJPH 2002)
Filters to Identifying Work-Related Injuries and Illnesses
a Filters To Reporting to Supervisorsb Filters To Losing Work Time c Filters to Obtaining Medical Cared Filters to Recognizing Work-Related by Doctore Filters to Workersrsquo Compensation being the Payerf Filters To Recording on OSHA Logg Filters to Reporting by Employers to Workersrsquo
Compensation Agencyh Filters to Reporting by Doctors
(Azaroff et al AJPH 2002)
Capture-Recapture Estimates of Workplace Injury and Illness Reporting by BLS Adjusted for Capture
Heterogeneity Lost-Time Cases 1998-2001
Percent Reported to WA WV OR WI NM MNNo Source Dependence 55 76 56 65 51 68
Source Dependence 52 71 45 53 37 53
(Adapted Boden and Ozonoff Annals Epidemiology 2008)
Workersrsquo CompensationState Specific Program
Mandatory insurance or if large enough self-insured
Michigan WC Excludesbull Federal employeesbull Interstate railroad workersbull Maritime workersbull Less than 3 employees at any one timebull All employees work less than 35 hoursweek or
if more hours less than 13 weeksbull Self-employed
Not computerizedbull Medical claims only
Proportion of Work-Injured Adults for Whom Treatment was paid by Workersrsquo Compensation by State-BRFSS 10 States 2007
State Injured with Payment by Workersrsquo Compensation
Texas 47 (95 CI 35-59)New York 50 (95 CI 39-60)Michigan 56 (95 CI 41-69)Massachusetts 60 (95 CI 45-75)California 61 (95 CI 55-66)Washington 61 (95 CI 55-67)Oregon 62 (95 CI 50-74)Connecticut 63 (95 CI 53-74)New Jersey 64 (95 CI 51-78)Kentucky 77 (95 CI 65-89)
Excludes self-employed
(Adapted Bonauto et al MMWR 2010)
Percentage Received Workersrsquo Compensation by Condition Michigan
WageReplacement
Medical Only
No CompEmployed
No Comp Self -Employed
Amputations 64 22 17 6Burns 17 48 33 2Skull Fractures 36 32 29 3
Percent Applied for Workersrsquo Comp among 2016 Cases of Work-Related Asthma Michigan
Overall 484
Still ExposedConditions Unchanged 239No Longer Exposed 575
Quit on Doctorrsquos Advice 778Sick Leave 727Fired 621New Controls 589Chemical Substitution 536Quit on Own 431Reassigned 360
Reasons Didnrsquot File a Workersrsquo Compensation Claims for a Repetitive Trauma Michigan
Only 397 (251) of 1598 Filed WC Claim
Injury Not Serious Enough 705 (591)Did Not Expect to Miss Work 694 (583)Expect to Receive Sick Leave or
Disability 337 (283) Medical Expenses Covered by
Other Insurance 427 (359)Did Not Think Injury Work Related 242 (204)
(Rosenman et al JOEM 2000)
Goals of Surveillance Population-Based
bull Assess Magnitude of Problembull NumbersRatesTrends
bull Determine Relative Importance vs Other Health Issuesbull Identify High Risk
bull IndustriesOccupationsWorker Populations
bull Prioritize Interventions bull Evaluate Interventionsbull Generate Hypotheses for Researchbull Identify Emerging Problemsbull Identify Workplaces for Intervention
Case-Based
Reportable Conditions in Michigan
Local Health DepartmentsCommunicable Diseases (83)
ldquoUnusual occurrence outbreak or epidemic of any disease or conditionsrdquoMDHHS
AbortionsBirth DefectsCancerChemical Poisonings including Carbon MonoxideInjuries Nursing Home Abuse
LARAOccupational Illnesses
County Department of Social ServicesChild AbuseAdult Abuse
PoliceInjury from Knife Gun or Deadly WeaponMental Health Patient Abuse
On Request Only
Laboratory Reporting Regulations Michigan
bull Arsenicbull Cadmiumbull Carboxyhemoglobinbull Cholinesterasebull IgE Antibodiesbull Leadbull Mercury
Occupational Illness Reporting Requirement in Michigan
bull LARA ndash MIOSHAPhysician hospital clinic or employer
having a known or suspected occupational disease or health condition aggravated by workplace exposures shall report within 10 days after discovery
Misdemeanor punishable by a fine of not more than $50
Methodology of Multi-Source Surveillance
Amputations 2006- DateHospitalsEDOutpatient ClinicsWorkersrsquo Compensation Wage Replacement
Crushing Injuries 2013- Date+ FACE Program
Skull Fractures 2012-DateBurns 2009-Date
+ Poison Control Center
bull Quarterly Reporting Specified ICD codes -134 Hospitalsbull Quarterly Reporting all Work-related Events ndash Poison Control Centerbull Electronic Data Base All Paid Claims ndash Workersrsquo Compensationbull FACE ndash Death CertificatesOSHA Hot LinePolice Reports
Work-Related Burn Reports ndash By Source Total 1461 Michigan 2009
n=1460 individuals
450
BLS
HOSPITALSEDs (1248)
4501054
BLSMIFACE 1(2) 1
16721
5 PCC (106)
1321 79
WC(306)
(Kica and Rosenman JOEM 2012)
Rates of Injury by IndustryPrivate sectorJanuary-June 2016
Number of Claims
Rate per 100 FTE
Interurban and Rural Bus Transportation 54 150Couriers and Express Delivery Services 3084 107Building Material and Supplies Dealers 4971 106Animal Slaughtering and Processing 555 90Waste Treatment and Disposal 484 90Poultry and Egg Production 99 89Scheduled Air Transportation 1781 88Motor Vehicle Body and Trailer Manufacturing 243 85Cattle Ranching and Farming 989 81Other General Merchandise Stores 2280 80Other Ambulatory Health Care Services 850 80Foundries 250 79Sheep and Goat Farming 19 77Warehousing and Storage 1349 77Waste Collection 706 76Traveler Accommodation 6780 76Other Furniture Related Product Manufacturing 118 71Forging and Stamping 297 70Logging 58 69Sawmills and Wood Preservation 52 68
Rates of Injury by IndustryPrivate sectorJanuary-June 2016
Number of Claims
Rate per 100 FTE
Interurban and Rural Bus Transportation 54 150Couriers and Express Delivery Services 3084 107Building Material and Supplies Dealers 4971 106Animal Slaughtering and Processing 555 90Waste Treatment and Disposal 484 90Poultry and Egg Production 99 89Scheduled Air Transportation 1781 88Motor Vehicle Body and Trailer Manufacturing 243 85Cattle Ranching and Farming 989 81Other General Merchandise Stores 2280 80Other Ambulatory Health Care Services 850 80Foundries 250 79Sheep and Goat Farming 19 77Warehousing and Storage 1349 77Waste Collection 706 76Traveler Accommodation 6780 76Other Furniture Related Product Manufacturing 118 71Forging and Stamping 297 70Logging 58 69Sawmills and Wood Preservation 52 68
IndustryCA Rate per
100 FTENational Overall SOII
Rate per 100 FTE
Couriers and Express Delivery Services 107 74
Animal Slaughtering and Processing 90 54
Poultry and Egg Production 89 69
Scheduled Air Transportation 88 66
Cattle Ranching and Farming 81 64
Foundries 79 67
Sheep and Goat Farming 77 --
Warehousing and Storage 77 50
Traveler Accommodation 76 50
Forging and Stamping 70 53
Sawmills and Wood Preservation 68 69
IndustryCA Rate per 100
FTENational Overall SOII
Rate per 100 FTE
Interurban and Rural Bus Transportation 150 30
Building Material and Supplies Dealers 106 48
Waste Treatment and Disposal 90 33
Motor Vehicle Body and Trailer Manufacturing 85 79
Other General Merchandise Stores 80 49
Other Ambulatory Health Care Services 80 30
Waste Collection 76 46
Other Furniture Related Product Manufacturing 71 55
Logging 69 37
Collaboration
Data sharing agreements
Pilot rates
Sharable repeatable methods and code
Contribution to national discussions about
use of WC data
Workers not captured by our method
Public sector
People who do not file claims
Data analysis for 2015-2016 Data analysis report Surveillance system evaluation
Publicly available dataset Disseminate findings Sustainability
California Department of Public Health John Beckman Matt Frederick Bob Harrison
California Department of Industrial Relations Genet Daba John Gordon Liza Dizon Glenn Shor Meitong Jin
California Employment Development Department Andy Wong Spencer Wong
Terry Bunn PhDDirector Kentucky Injury Prevention and Research
Center bona fide agent for the Kentucky Department for Public Health
Associate Professor Departments of Epidemiology and Preventive Medicine and Environmental Health University of Kentucky College of Public Health
bull Occupational motor vehicle crash investigations a priority focus area since 2005
KOSHS
Case Example
Case Example
bull Substance abuse a priority focus areabull State injury prevention planbull Legislation data support (HB1)
ndash Pill millsndash Clinical prescribing regulationsndash Decedent controlled substance testing lawndash Inter-state prescription drug monitoring
program (PDMP) data sharing
bull Use of PDMP data for public health surveillance
bull Inform community interventions bull Evaluate and perform cost-benefit
analysis of drug-related laws bull Establish substance use disorder
information and referral service ndash physicians (eg prevention of needle sticks
when lancing drug abuse-related abscesses)ndash first responders (eg handling of fentanyl
analogs at drug overdose scenes) ndash law enforcement (eg naloxone
administration training)ndash general public
bull Increase timeliness of public health data sources
bull Use syndromic surveillance data for drug overdose and injury surveillance
bull Algorithm development for milligram morphine equivalent calculations in PDMP reports
bull Death certificate and PDMP data linkage to identify possible drug diversion
bull State advisory group
bull Link Ky CRASH and trauma registry data with FARS driver drug testing results from fatal crashes in 2014
bull Link 2014 trauma registry toxicology result data with inpatient hospitalization data to assess drug overdose and drug abuse coding
Primary populations
bull Opioid overdose victims
bull Pregnant and parenting women
bull Individuals re-entering society upon criminal justice release
bull Adolescents and young adults
Goals
bull Prevent opioid misuse and abuse
bull Increase access to OUD treatment services (eg MAT)
bull Increase availability of recovery support services
bull Increase availability of naloxone
bull Enhance coordination and evaluation of OUD healthcare and public safety strategies
bull KRS 217186- A person or agency including a peace officer jailer firefighter paramedic or emergency medical technician or a school employee authorized to administer medication under KRS 156502 may ndash Receive a prescription for the drug
naloxonendash Possess naloxone pursuant to this
subsection and any equipment needed for its administration
ndash Administer naloxone to an individual suffering from an apparent opiate-related overdose
bull Reduce prescriber opioid prescribing (physicians APRNs etc) to a 3-day supply for injured workers
bull First line treatment based on non-opioid therapy alternatives (physical therapy acupuncture etc)
bull Revise drug formularies for treatment of pain associated with occupational injuries
Prevention Decrease likelihood that Kentuckians develop a SUD through strategies to decrease overexposure of opioid medications and illicit opioids
bull prescriptions (dosage units) overdose deaths containing fentanyl
Harm Reduction Improve Access to Harm Reduction Services to Save Lives
bull naloxone kits dispensed to first responders and public people in syringe exchange programs who received naloxone
Treatment and Recovery Expand access to treatment and recovery supports
bull peer recovery coaches Emergency Departments with peer recovery coaches people with SUD who interact with peer recovery coaches and enter treatment Emergency Department peer follow-up individuals with SUD who receive residential services calls to SUD treatment locator and portal
bull Louisville Metro Police Department presentation
bull Breakout Session
bull First Responder Opioid Exposure Survey development
bull Focus Groups
bull Survey Administration
bull Data Analysis
bull Use of Data Results
bull UK ERC first responder overdose response exposure pilot project opportunity
bull Multistate or single state applicationsndash Use of survey
ndash development of other first responder-related pilot project
FACE case investigations
bull initiated drug overdose prevention conversations
bull enhanced collaborations
bull provided evidence of need for enhanced multidisciplinary drug overdose prevention efforts1 Interventions
2 Policies
3 Research
Ladder rap
httpswwwyoutubecomwatchv=FsW6eb3aO8gampfeature=youtube
BLS Survey of Employers vs Multi-Source Surveillance of Work-Related Injuries
Kenneth D Rosenman MDProfessor of MedicineMichigan State Universitywwwoemmsuedu
NIOSH Expanding Research Partnerships Conference Denver Colorado June 21-23 2017
Funding NIOSH U60 OH008466
Survey of Occupational Injuries and Illnesses (SOII)
bull Injuries and illnesses (based on OSHArsquos recordkeeping standards) from 230000 establishments (sample by state and NAICS code)
bull Redesigned in 1992 to collect circumstances of injuries and illnesses that lead to days away from work and characteristics of affected workers
bull Scope limitations no small farms private household or self-employed workers (lt 2008 no public sector workers)
NATIONAL ACADEMY OF SCIENCES 1987
New Jersey24 Deaths not covered by OSHA35 Deaths covered by OSHA butemployer had NOT recorded on OSHAlog or did NOT keep OSHA log
TexasNIOSH Fatal Occupational Trauma Surveillance
CENSUS OF FATAL OCCUPATIONAL INJURIES (CFOI) BEGAN IN 1992
Multiple death sourcesDeath certificatesEmployer reportingState PoliceNewspaper Clipping ServiceMedical ExaminersAgricultural Extension Service
Number of deaths doubled from previous BLS estimate
How Much Work-Related Injury and Illness is Missed By the Current National Surveillance System
Rosenman KD Kalush A Reilly MJ Gardiner JC Reeves M Luo Z JOEM 2006 48357-365Funding NIOSH 5 R01 OH004276-03
Summary of Analysis Comparing BLS and Worker Comp data Michigan 2009-2001Days away from workbull BLS estimate
37-41 BLS+ WC31-34 BLS + WC+ CaptureRecapture
1999-2001 Estimates - Michiganbull BLS -281567 vs Our Estimate - 868241
1 in 15 workers vs 1 in 5 workers
(Rosenman et al JOEM 2006)
Simplified Flowchart of Events Necessary to the Documentation of Work-Related Injuries and Illnesses
(Azaroff et al AJPH 2002)
Filters to Identifying Work-Related Injuries and Illnesses
a Filters To Reporting to Supervisorsb Filters To Losing Work Time c Filters to Obtaining Medical Cared Filters to Recognizing Work-Related by Doctore Filters to Workersrsquo Compensation being the Payerf Filters To Recording on OSHA Logg Filters to Reporting by Employers to Workersrsquo
Compensation Agencyh Filters to Reporting by Doctors
(Azaroff et al AJPH 2002)
Capture-Recapture Estimates of Workplace Injury and Illness Reporting by BLS Adjusted for Capture
Heterogeneity Lost-Time Cases 1998-2001
Percent Reported to WA WV OR WI NM MNNo Source Dependence 55 76 56 65 51 68
Source Dependence 52 71 45 53 37 53
(Adapted Boden and Ozonoff Annals Epidemiology 2008)
Workersrsquo CompensationState Specific Program
Mandatory insurance or if large enough self-insured
Michigan WC Excludesbull Federal employeesbull Interstate railroad workersbull Maritime workersbull Less than 3 employees at any one timebull All employees work less than 35 hoursweek or
if more hours less than 13 weeksbull Self-employed
Not computerizedbull Medical claims only
Proportion of Work-Injured Adults for Whom Treatment was paid by Workersrsquo Compensation by State-BRFSS 10 States 2007
State Injured with Payment by Workersrsquo Compensation
Texas 47 (95 CI 35-59)New York 50 (95 CI 39-60)Michigan 56 (95 CI 41-69)Massachusetts 60 (95 CI 45-75)California 61 (95 CI 55-66)Washington 61 (95 CI 55-67)Oregon 62 (95 CI 50-74)Connecticut 63 (95 CI 53-74)New Jersey 64 (95 CI 51-78)Kentucky 77 (95 CI 65-89)
Excludes self-employed
(Adapted Bonauto et al MMWR 2010)
Percentage Received Workersrsquo Compensation by Condition Michigan
WageReplacement
Medical Only
No CompEmployed
No Comp Self -Employed
Amputations 64 22 17 6Burns 17 48 33 2Skull Fractures 36 32 29 3
Percent Applied for Workersrsquo Comp among 2016 Cases of Work-Related Asthma Michigan
Overall 484
Still ExposedConditions Unchanged 239No Longer Exposed 575
Quit on Doctorrsquos Advice 778Sick Leave 727Fired 621New Controls 589Chemical Substitution 536Quit on Own 431Reassigned 360
Reasons Didnrsquot File a Workersrsquo Compensation Claims for a Repetitive Trauma Michigan
Only 397 (251) of 1598 Filed WC Claim
Injury Not Serious Enough 705 (591)Did Not Expect to Miss Work 694 (583)Expect to Receive Sick Leave or
Disability 337 (283) Medical Expenses Covered by
Other Insurance 427 (359)Did Not Think Injury Work Related 242 (204)
(Rosenman et al JOEM 2000)
Goals of Surveillance Population-Based
bull Assess Magnitude of Problembull NumbersRatesTrends
bull Determine Relative Importance vs Other Health Issuesbull Identify High Risk
bull IndustriesOccupationsWorker Populations
bull Prioritize Interventions bull Evaluate Interventionsbull Generate Hypotheses for Researchbull Identify Emerging Problemsbull Identify Workplaces for Intervention
Case-Based
Reportable Conditions in Michigan
Local Health DepartmentsCommunicable Diseases (83)
ldquoUnusual occurrence outbreak or epidemic of any disease or conditionsrdquoMDHHS
AbortionsBirth DefectsCancerChemical Poisonings including Carbon MonoxideInjuries Nursing Home Abuse
LARAOccupational Illnesses
County Department of Social ServicesChild AbuseAdult Abuse
PoliceInjury from Knife Gun or Deadly WeaponMental Health Patient Abuse
On Request Only
Laboratory Reporting Regulations Michigan
bull Arsenicbull Cadmiumbull Carboxyhemoglobinbull Cholinesterasebull IgE Antibodiesbull Leadbull Mercury
Occupational Illness Reporting Requirement in Michigan
bull LARA ndash MIOSHAPhysician hospital clinic or employer
having a known or suspected occupational disease or health condition aggravated by workplace exposures shall report within 10 days after discovery
Misdemeanor punishable by a fine of not more than $50
Methodology of Multi-Source Surveillance
Amputations 2006- DateHospitalsEDOutpatient ClinicsWorkersrsquo Compensation Wage Replacement
Crushing Injuries 2013- Date+ FACE Program
Skull Fractures 2012-DateBurns 2009-Date
+ Poison Control Center
bull Quarterly Reporting Specified ICD codes -134 Hospitalsbull Quarterly Reporting all Work-related Events ndash Poison Control Centerbull Electronic Data Base All Paid Claims ndash Workersrsquo Compensationbull FACE ndash Death CertificatesOSHA Hot LinePolice Reports
Work-Related Burn Reports ndash By Source Total 1461 Michigan 2009
n=1460 individuals
450
BLS
HOSPITALSEDs (1248)
4501054
BLSMIFACE 1(2) 1
16721
5 PCC (106)
1321 79
WC(306)
(Kica and Rosenman JOEM 2012)
Rates of Injury by IndustryPrivate sectorJanuary-June 2016
Number of Claims
Rate per 100 FTE
Interurban and Rural Bus Transportation 54 150Couriers and Express Delivery Services 3084 107Building Material and Supplies Dealers 4971 106Animal Slaughtering and Processing 555 90Waste Treatment and Disposal 484 90Poultry and Egg Production 99 89Scheduled Air Transportation 1781 88Motor Vehicle Body and Trailer Manufacturing 243 85Cattle Ranching and Farming 989 81Other General Merchandise Stores 2280 80Other Ambulatory Health Care Services 850 80Foundries 250 79Sheep and Goat Farming 19 77Warehousing and Storage 1349 77Waste Collection 706 76Traveler Accommodation 6780 76Other Furniture Related Product Manufacturing 118 71Forging and Stamping 297 70Logging 58 69Sawmills and Wood Preservation 52 68
IndustryCA Rate per
100 FTENational Overall SOII
Rate per 100 FTE
Couriers and Express Delivery Services 107 74
Animal Slaughtering and Processing 90 54
Poultry and Egg Production 89 69
Scheduled Air Transportation 88 66
Cattle Ranching and Farming 81 64
Foundries 79 67
Sheep and Goat Farming 77 --
Warehousing and Storage 77 50
Traveler Accommodation 76 50
Forging and Stamping 70 53
Sawmills and Wood Preservation 68 69
IndustryCA Rate per 100
FTENational Overall SOII
Rate per 100 FTE
Interurban and Rural Bus Transportation 150 30
Building Material and Supplies Dealers 106 48
Waste Treatment and Disposal 90 33
Motor Vehicle Body and Trailer Manufacturing 85 79
Other General Merchandise Stores 80 49
Other Ambulatory Health Care Services 80 30
Waste Collection 76 46
Other Furniture Related Product Manufacturing 71 55
Logging 69 37
Collaboration
Data sharing agreements
Pilot rates
Sharable repeatable methods and code
Contribution to national discussions about
use of WC data
Workers not captured by our method
Public sector
People who do not file claims
Data analysis for 2015-2016 Data analysis report Surveillance system evaluation
Publicly available dataset Disseminate findings Sustainability
California Department of Public Health John Beckman Matt Frederick Bob Harrison
California Department of Industrial Relations Genet Daba John Gordon Liza Dizon Glenn Shor Meitong Jin
California Employment Development Department Andy Wong Spencer Wong
Terry Bunn PhDDirector Kentucky Injury Prevention and Research
Center bona fide agent for the Kentucky Department for Public Health
Associate Professor Departments of Epidemiology and Preventive Medicine and Environmental Health University of Kentucky College of Public Health
bull Occupational motor vehicle crash investigations a priority focus area since 2005
KOSHS
Case Example
Case Example
bull Substance abuse a priority focus areabull State injury prevention planbull Legislation data support (HB1)
ndash Pill millsndash Clinical prescribing regulationsndash Decedent controlled substance testing lawndash Inter-state prescription drug monitoring
program (PDMP) data sharing
bull Use of PDMP data for public health surveillance
bull Inform community interventions bull Evaluate and perform cost-benefit
analysis of drug-related laws bull Establish substance use disorder
information and referral service ndash physicians (eg prevention of needle sticks
when lancing drug abuse-related abscesses)ndash first responders (eg handling of fentanyl
analogs at drug overdose scenes) ndash law enforcement (eg naloxone
administration training)ndash general public
bull Increase timeliness of public health data sources
bull Use syndromic surveillance data for drug overdose and injury surveillance
bull Algorithm development for milligram morphine equivalent calculations in PDMP reports
bull Death certificate and PDMP data linkage to identify possible drug diversion
bull State advisory group
bull Link Ky CRASH and trauma registry data with FARS driver drug testing results from fatal crashes in 2014
bull Link 2014 trauma registry toxicology result data with inpatient hospitalization data to assess drug overdose and drug abuse coding
Primary populations
bull Opioid overdose victims
bull Pregnant and parenting women
bull Individuals re-entering society upon criminal justice release
bull Adolescents and young adults
Goals
bull Prevent opioid misuse and abuse
bull Increase access to OUD treatment services (eg MAT)
bull Increase availability of recovery support services
bull Increase availability of naloxone
bull Enhance coordination and evaluation of OUD healthcare and public safety strategies
bull KRS 217186- A person or agency including a peace officer jailer firefighter paramedic or emergency medical technician or a school employee authorized to administer medication under KRS 156502 may ndash Receive a prescription for the drug
naloxonendash Possess naloxone pursuant to this
subsection and any equipment needed for its administration
ndash Administer naloxone to an individual suffering from an apparent opiate-related overdose
bull Reduce prescriber opioid prescribing (physicians APRNs etc) to a 3-day supply for injured workers
bull First line treatment based on non-opioid therapy alternatives (physical therapy acupuncture etc)
bull Revise drug formularies for treatment of pain associated with occupational injuries
Prevention Decrease likelihood that Kentuckians develop a SUD through strategies to decrease overexposure of opioid medications and illicit opioids
bull prescriptions (dosage units) overdose deaths containing fentanyl
Harm Reduction Improve Access to Harm Reduction Services to Save Lives
bull naloxone kits dispensed to first responders and public people in syringe exchange programs who received naloxone
Treatment and Recovery Expand access to treatment and recovery supports
bull peer recovery coaches Emergency Departments with peer recovery coaches people with SUD who interact with peer recovery coaches and enter treatment Emergency Department peer follow-up individuals with SUD who receive residential services calls to SUD treatment locator and portal
bull Louisville Metro Police Department presentation
bull Breakout Session
bull First Responder Opioid Exposure Survey development
bull Focus Groups
bull Survey Administration
bull Data Analysis
bull Use of Data Results
bull UK ERC first responder overdose response exposure pilot project opportunity
bull Multistate or single state applicationsndash Use of survey
ndash development of other first responder-related pilot project
FACE case investigations
bull initiated drug overdose prevention conversations
bull enhanced collaborations
bull provided evidence of need for enhanced multidisciplinary drug overdose prevention efforts1 Interventions
2 Policies
3 Research
Ladder rap
httpswwwyoutubecomwatchv=FsW6eb3aO8gampfeature=youtube
BLS Survey of Employers vs Multi-Source Surveillance of Work-Related Injuries
Kenneth D Rosenman MDProfessor of MedicineMichigan State Universitywwwoemmsuedu
NIOSH Expanding Research Partnerships Conference Denver Colorado June 21-23 2017
Funding NIOSH U60 OH008466
Survey of Occupational Injuries and Illnesses (SOII)
bull Injuries and illnesses (based on OSHArsquos recordkeeping standards) from 230000 establishments (sample by state and NAICS code)
bull Redesigned in 1992 to collect circumstances of injuries and illnesses that lead to days away from work and characteristics of affected workers
bull Scope limitations no small farms private household or self-employed workers (lt 2008 no public sector workers)
NATIONAL ACADEMY OF SCIENCES 1987
New Jersey24 Deaths not covered by OSHA35 Deaths covered by OSHA butemployer had NOT recorded on OSHAlog or did NOT keep OSHA log
TexasNIOSH Fatal Occupational Trauma Surveillance
CENSUS OF FATAL OCCUPATIONAL INJURIES (CFOI) BEGAN IN 1992
Multiple death sourcesDeath certificatesEmployer reportingState PoliceNewspaper Clipping ServiceMedical ExaminersAgricultural Extension Service
Number of deaths doubled from previous BLS estimate
How Much Work-Related Injury and Illness is Missed By the Current National Surveillance System
Rosenman KD Kalush A Reilly MJ Gardiner JC Reeves M Luo Z JOEM 2006 48357-365Funding NIOSH 5 R01 OH004276-03
Summary of Analysis Comparing BLS and Worker Comp data Michigan 2009-2001Days away from workbull BLS estimate
37-41 BLS+ WC31-34 BLS + WC+ CaptureRecapture
1999-2001 Estimates - Michiganbull BLS -281567 vs Our Estimate - 868241
1 in 15 workers vs 1 in 5 workers
(Rosenman et al JOEM 2006)
Simplified Flowchart of Events Necessary to the Documentation of Work-Related Injuries and Illnesses
(Azaroff et al AJPH 2002)
Filters to Identifying Work-Related Injuries and Illnesses
a Filters To Reporting to Supervisorsb Filters To Losing Work Time c Filters to Obtaining Medical Cared Filters to Recognizing Work-Related by Doctore Filters to Workersrsquo Compensation being the Payerf Filters To Recording on OSHA Logg Filters to Reporting by Employers to Workersrsquo
Compensation Agencyh Filters to Reporting by Doctors
(Azaroff et al AJPH 2002)
Capture-Recapture Estimates of Workplace Injury and Illness Reporting by BLS Adjusted for Capture
Heterogeneity Lost-Time Cases 1998-2001
Percent Reported to WA WV OR WI NM MNNo Source Dependence 55 76 56 65 51 68
Source Dependence 52 71 45 53 37 53
(Adapted Boden and Ozonoff Annals Epidemiology 2008)
Workersrsquo CompensationState Specific Program
Mandatory insurance or if large enough self-insured
Michigan WC Excludesbull Federal employeesbull Interstate railroad workersbull Maritime workersbull Less than 3 employees at any one timebull All employees work less than 35 hoursweek or
if more hours less than 13 weeksbull Self-employed
Not computerizedbull Medical claims only
Proportion of Work-Injured Adults for Whom Treatment was paid by Workersrsquo Compensation by State-BRFSS 10 States 2007
State Injured with Payment by Workersrsquo Compensation
Texas 47 (95 CI 35-59)New York 50 (95 CI 39-60)Michigan 56 (95 CI 41-69)Massachusetts 60 (95 CI 45-75)California 61 (95 CI 55-66)Washington 61 (95 CI 55-67)Oregon 62 (95 CI 50-74)Connecticut 63 (95 CI 53-74)New Jersey 64 (95 CI 51-78)Kentucky 77 (95 CI 65-89)
Excludes self-employed
(Adapted Bonauto et al MMWR 2010)
Percentage Received Workersrsquo Compensation by Condition Michigan
WageReplacement
Medical Only
No CompEmployed
No Comp Self -Employed
Amputations 64 22 17 6Burns 17 48 33 2Skull Fractures 36 32 29 3
Percent Applied for Workersrsquo Comp among 2016 Cases of Work-Related Asthma Michigan
Overall 484
Still ExposedConditions Unchanged 239No Longer Exposed 575
Quit on Doctorrsquos Advice 778Sick Leave 727Fired 621New Controls 589Chemical Substitution 536Quit on Own 431Reassigned 360
Reasons Didnrsquot File a Workersrsquo Compensation Claims for a Repetitive Trauma Michigan
Only 397 (251) of 1598 Filed WC Claim
Injury Not Serious Enough 705 (591)Did Not Expect to Miss Work 694 (583)Expect to Receive Sick Leave or
Disability 337 (283) Medical Expenses Covered by
Other Insurance 427 (359)Did Not Think Injury Work Related 242 (204)
(Rosenman et al JOEM 2000)
Goals of Surveillance Population-Based
bull Assess Magnitude of Problembull NumbersRatesTrends
bull Determine Relative Importance vs Other Health Issuesbull Identify High Risk
bull IndustriesOccupationsWorker Populations
bull Prioritize Interventions bull Evaluate Interventionsbull Generate Hypotheses for Researchbull Identify Emerging Problemsbull Identify Workplaces for Intervention
Case-Based
Reportable Conditions in Michigan
Local Health DepartmentsCommunicable Diseases (83)
ldquoUnusual occurrence outbreak or epidemic of any disease or conditionsrdquoMDHHS
AbortionsBirth DefectsCancerChemical Poisonings including Carbon MonoxideInjuries Nursing Home Abuse
LARAOccupational Illnesses
County Department of Social ServicesChild AbuseAdult Abuse
PoliceInjury from Knife Gun or Deadly WeaponMental Health Patient Abuse
On Request Only
Laboratory Reporting Regulations Michigan
bull Arsenicbull Cadmiumbull Carboxyhemoglobinbull Cholinesterasebull IgE Antibodiesbull Leadbull Mercury
Occupational Illness Reporting Requirement in Michigan
bull LARA ndash MIOSHAPhysician hospital clinic or employer
having a known or suspected occupational disease or health condition aggravated by workplace exposures shall report within 10 days after discovery
Misdemeanor punishable by a fine of not more than $50
Methodology of Multi-Source Surveillance
Amputations 2006- DateHospitalsEDOutpatient ClinicsWorkersrsquo Compensation Wage Replacement
Crushing Injuries 2013- Date+ FACE Program
Skull Fractures 2012-DateBurns 2009-Date
+ Poison Control Center
bull Quarterly Reporting Specified ICD codes -134 Hospitalsbull Quarterly Reporting all Work-related Events ndash Poison Control Centerbull Electronic Data Base All Paid Claims ndash Workersrsquo Compensationbull FACE ndash Death CertificatesOSHA Hot LinePolice Reports
Work-Related Burn Reports ndash By Source Total 1461 Michigan 2009
n=1460 individuals
450
BLS
HOSPITALSEDs (1248)
4501054
BLSMIFACE 1(2) 1
16721
5 PCC (106)
1321 79
WC(306)
(Kica and Rosenman JOEM 2012)
IndustryCA Rate per
100 FTENational Overall SOII
Rate per 100 FTE
Couriers and Express Delivery Services 107 74
Animal Slaughtering and Processing 90 54
Poultry and Egg Production 89 69
Scheduled Air Transportation 88 66
Cattle Ranching and Farming 81 64
Foundries 79 67
Sheep and Goat Farming 77 --
Warehousing and Storage 77 50
Traveler Accommodation 76 50
Forging and Stamping 70 53
Sawmills and Wood Preservation 68 69
IndustryCA Rate per 100
FTENational Overall SOII
Rate per 100 FTE
Interurban and Rural Bus Transportation 150 30
Building Material and Supplies Dealers 106 48
Waste Treatment and Disposal 90 33
Motor Vehicle Body and Trailer Manufacturing 85 79
Other General Merchandise Stores 80 49
Other Ambulatory Health Care Services 80 30
Waste Collection 76 46
Other Furniture Related Product Manufacturing 71 55
Logging 69 37
Collaboration
Data sharing agreements
Pilot rates
Sharable repeatable methods and code
Contribution to national discussions about
use of WC data
Workers not captured by our method
Public sector
People who do not file claims
Data analysis for 2015-2016 Data analysis report Surveillance system evaluation
Publicly available dataset Disseminate findings Sustainability
California Department of Public Health John Beckman Matt Frederick Bob Harrison
California Department of Industrial Relations Genet Daba John Gordon Liza Dizon Glenn Shor Meitong Jin
California Employment Development Department Andy Wong Spencer Wong
Terry Bunn PhDDirector Kentucky Injury Prevention and Research
Center bona fide agent for the Kentucky Department for Public Health
Associate Professor Departments of Epidemiology and Preventive Medicine and Environmental Health University of Kentucky College of Public Health
bull Occupational motor vehicle crash investigations a priority focus area since 2005
KOSHS
Case Example
Case Example
bull Substance abuse a priority focus areabull State injury prevention planbull Legislation data support (HB1)
ndash Pill millsndash Clinical prescribing regulationsndash Decedent controlled substance testing lawndash Inter-state prescription drug monitoring
program (PDMP) data sharing
bull Use of PDMP data for public health surveillance
bull Inform community interventions bull Evaluate and perform cost-benefit
analysis of drug-related laws bull Establish substance use disorder
information and referral service ndash physicians (eg prevention of needle sticks
when lancing drug abuse-related abscesses)ndash first responders (eg handling of fentanyl
analogs at drug overdose scenes) ndash law enforcement (eg naloxone
administration training)ndash general public
bull Increase timeliness of public health data sources
bull Use syndromic surveillance data for drug overdose and injury surveillance
bull Algorithm development for milligram morphine equivalent calculations in PDMP reports
bull Death certificate and PDMP data linkage to identify possible drug diversion
bull State advisory group
bull Link Ky CRASH and trauma registry data with FARS driver drug testing results from fatal crashes in 2014
bull Link 2014 trauma registry toxicology result data with inpatient hospitalization data to assess drug overdose and drug abuse coding
Primary populations
bull Opioid overdose victims
bull Pregnant and parenting women
bull Individuals re-entering society upon criminal justice release
bull Adolescents and young adults
Goals
bull Prevent opioid misuse and abuse
bull Increase access to OUD treatment services (eg MAT)
bull Increase availability of recovery support services
bull Increase availability of naloxone
bull Enhance coordination and evaluation of OUD healthcare and public safety strategies
bull KRS 217186- A person or agency including a peace officer jailer firefighter paramedic or emergency medical technician or a school employee authorized to administer medication under KRS 156502 may ndash Receive a prescription for the drug
naloxonendash Possess naloxone pursuant to this
subsection and any equipment needed for its administration
ndash Administer naloxone to an individual suffering from an apparent opiate-related overdose
bull Reduce prescriber opioid prescribing (physicians APRNs etc) to a 3-day supply for injured workers
bull First line treatment based on non-opioid therapy alternatives (physical therapy acupuncture etc)
bull Revise drug formularies for treatment of pain associated with occupational injuries
Prevention Decrease likelihood that Kentuckians develop a SUD through strategies to decrease overexposure of opioid medications and illicit opioids
bull prescriptions (dosage units) overdose deaths containing fentanyl
Harm Reduction Improve Access to Harm Reduction Services to Save Lives
bull naloxone kits dispensed to first responders and public people in syringe exchange programs who received naloxone
Treatment and Recovery Expand access to treatment and recovery supports
bull peer recovery coaches Emergency Departments with peer recovery coaches people with SUD who interact with peer recovery coaches and enter treatment Emergency Department peer follow-up individuals with SUD who receive residential services calls to SUD treatment locator and portal
bull Louisville Metro Police Department presentation
bull Breakout Session
bull First Responder Opioid Exposure Survey development
bull Focus Groups
bull Survey Administration
bull Data Analysis
bull Use of Data Results
bull UK ERC first responder overdose response exposure pilot project opportunity
bull Multistate or single state applicationsndash Use of survey
ndash development of other first responder-related pilot project
FACE case investigations
bull initiated drug overdose prevention conversations
bull enhanced collaborations
bull provided evidence of need for enhanced multidisciplinary drug overdose prevention efforts1 Interventions
2 Policies
3 Research
Ladder rap
httpswwwyoutubecomwatchv=FsW6eb3aO8gampfeature=youtube
BLS Survey of Employers vs Multi-Source Surveillance of Work-Related Injuries
Kenneth D Rosenman MDProfessor of MedicineMichigan State Universitywwwoemmsuedu
NIOSH Expanding Research Partnerships Conference Denver Colorado June 21-23 2017
Funding NIOSH U60 OH008466
Survey of Occupational Injuries and Illnesses (SOII)
bull Injuries and illnesses (based on OSHArsquos recordkeeping standards) from 230000 establishments (sample by state and NAICS code)
bull Redesigned in 1992 to collect circumstances of injuries and illnesses that lead to days away from work and characteristics of affected workers
bull Scope limitations no small farms private household or self-employed workers (lt 2008 no public sector workers)
NATIONAL ACADEMY OF SCIENCES 1987
New Jersey24 Deaths not covered by OSHA35 Deaths covered by OSHA butemployer had NOT recorded on OSHAlog or did NOT keep OSHA log
TexasNIOSH Fatal Occupational Trauma Surveillance
CENSUS OF FATAL OCCUPATIONAL INJURIES (CFOI) BEGAN IN 1992
Multiple death sourcesDeath certificatesEmployer reportingState PoliceNewspaper Clipping ServiceMedical ExaminersAgricultural Extension Service
Number of deaths doubled from previous BLS estimate
How Much Work-Related Injury and Illness is Missed By the Current National Surveillance System
Rosenman KD Kalush A Reilly MJ Gardiner JC Reeves M Luo Z JOEM 2006 48357-365Funding NIOSH 5 R01 OH004276-03
Summary of Analysis Comparing BLS and Worker Comp data Michigan 2009-2001Days away from workbull BLS estimate
37-41 BLS+ WC31-34 BLS + WC+ CaptureRecapture
1999-2001 Estimates - Michiganbull BLS -281567 vs Our Estimate - 868241
1 in 15 workers vs 1 in 5 workers
(Rosenman et al JOEM 2006)
Simplified Flowchart of Events Necessary to the Documentation of Work-Related Injuries and Illnesses
(Azaroff et al AJPH 2002)
Filters to Identifying Work-Related Injuries and Illnesses
a Filters To Reporting to Supervisorsb Filters To Losing Work Time c Filters to Obtaining Medical Cared Filters to Recognizing Work-Related by Doctore Filters to Workersrsquo Compensation being the Payerf Filters To Recording on OSHA Logg Filters to Reporting by Employers to Workersrsquo
Compensation Agencyh Filters to Reporting by Doctors
(Azaroff et al AJPH 2002)
Capture-Recapture Estimates of Workplace Injury and Illness Reporting by BLS Adjusted for Capture
Heterogeneity Lost-Time Cases 1998-2001
Percent Reported to WA WV OR WI NM MNNo Source Dependence 55 76 56 65 51 68
Source Dependence 52 71 45 53 37 53
(Adapted Boden and Ozonoff Annals Epidemiology 2008)
Workersrsquo CompensationState Specific Program
Mandatory insurance or if large enough self-insured
Michigan WC Excludesbull Federal employeesbull Interstate railroad workersbull Maritime workersbull Less than 3 employees at any one timebull All employees work less than 35 hoursweek or
if more hours less than 13 weeksbull Self-employed
Not computerizedbull Medical claims only
Proportion of Work-Injured Adults for Whom Treatment was paid by Workersrsquo Compensation by State-BRFSS 10 States 2007
State Injured with Payment by Workersrsquo Compensation
Texas 47 (95 CI 35-59)New York 50 (95 CI 39-60)Michigan 56 (95 CI 41-69)Massachusetts 60 (95 CI 45-75)California 61 (95 CI 55-66)Washington 61 (95 CI 55-67)Oregon 62 (95 CI 50-74)Connecticut 63 (95 CI 53-74)New Jersey 64 (95 CI 51-78)Kentucky 77 (95 CI 65-89)
Excludes self-employed
(Adapted Bonauto et al MMWR 2010)
Percentage Received Workersrsquo Compensation by Condition Michigan
WageReplacement
Medical Only
No CompEmployed
No Comp Self -Employed
Amputations 64 22 17 6Burns 17 48 33 2Skull Fractures 36 32 29 3
Percent Applied for Workersrsquo Comp among 2016 Cases of Work-Related Asthma Michigan
Overall 484
Still ExposedConditions Unchanged 239No Longer Exposed 575
Quit on Doctorrsquos Advice 778Sick Leave 727Fired 621New Controls 589Chemical Substitution 536Quit on Own 431Reassigned 360
Reasons Didnrsquot File a Workersrsquo Compensation Claims for a Repetitive Trauma Michigan
Only 397 (251) of 1598 Filed WC Claim
Injury Not Serious Enough 705 (591)Did Not Expect to Miss Work 694 (583)Expect to Receive Sick Leave or
Disability 337 (283) Medical Expenses Covered by
Other Insurance 427 (359)Did Not Think Injury Work Related 242 (204)
(Rosenman et al JOEM 2000)
Goals of Surveillance Population-Based
bull Assess Magnitude of Problembull NumbersRatesTrends
bull Determine Relative Importance vs Other Health Issuesbull Identify High Risk
bull IndustriesOccupationsWorker Populations
bull Prioritize Interventions bull Evaluate Interventionsbull Generate Hypotheses for Researchbull Identify Emerging Problemsbull Identify Workplaces for Intervention
Case-Based
Reportable Conditions in Michigan
Local Health DepartmentsCommunicable Diseases (83)
ldquoUnusual occurrence outbreak or epidemic of any disease or conditionsrdquoMDHHS
AbortionsBirth DefectsCancerChemical Poisonings including Carbon MonoxideInjuries Nursing Home Abuse
LARAOccupational Illnesses
County Department of Social ServicesChild AbuseAdult Abuse
PoliceInjury from Knife Gun or Deadly WeaponMental Health Patient Abuse
On Request Only
Laboratory Reporting Regulations Michigan
bull Arsenicbull Cadmiumbull Carboxyhemoglobinbull Cholinesterasebull IgE Antibodiesbull Leadbull Mercury
Occupational Illness Reporting Requirement in Michigan
bull LARA ndash MIOSHAPhysician hospital clinic or employer
having a known or suspected occupational disease or health condition aggravated by workplace exposures shall report within 10 days after discovery
Misdemeanor punishable by a fine of not more than $50
Methodology of Multi-Source Surveillance
Amputations 2006- DateHospitalsEDOutpatient ClinicsWorkersrsquo Compensation Wage Replacement
Crushing Injuries 2013- Date+ FACE Program
Skull Fractures 2012-DateBurns 2009-Date
+ Poison Control Center
bull Quarterly Reporting Specified ICD codes -134 Hospitalsbull Quarterly Reporting all Work-related Events ndash Poison Control Centerbull Electronic Data Base All Paid Claims ndash Workersrsquo Compensationbull FACE ndash Death CertificatesOSHA Hot LinePolice Reports
Work-Related Burn Reports ndash By Source Total 1461 Michigan 2009
n=1460 individuals
450
BLS
HOSPITALSEDs (1248)
4501054
BLSMIFACE 1(2) 1
16721
5 PCC (106)
1321 79
WC(306)
(Kica and Rosenman JOEM 2012)
IndustryCA Rate per 100
FTENational Overall SOII
Rate per 100 FTE
Interurban and Rural Bus Transportation 150 30
Building Material and Supplies Dealers 106 48
Waste Treatment and Disposal 90 33
Motor Vehicle Body and Trailer Manufacturing 85 79
Other General Merchandise Stores 80 49
Other Ambulatory Health Care Services 80 30
Waste Collection 76 46
Other Furniture Related Product Manufacturing 71 55
Logging 69 37
Collaboration
Data sharing agreements
Pilot rates
Sharable repeatable methods and code
Contribution to national discussions about
use of WC data
Workers not captured by our method
Public sector
People who do not file claims
Data analysis for 2015-2016 Data analysis report Surveillance system evaluation
Publicly available dataset Disseminate findings Sustainability
California Department of Public Health John Beckman Matt Frederick Bob Harrison
California Department of Industrial Relations Genet Daba John Gordon Liza Dizon Glenn Shor Meitong Jin
California Employment Development Department Andy Wong Spencer Wong
Terry Bunn PhDDirector Kentucky Injury Prevention and Research
Center bona fide agent for the Kentucky Department for Public Health
Associate Professor Departments of Epidemiology and Preventive Medicine and Environmental Health University of Kentucky College of Public Health
bull Occupational motor vehicle crash investigations a priority focus area since 2005
KOSHS
Case Example
Case Example
bull Substance abuse a priority focus areabull State injury prevention planbull Legislation data support (HB1)
ndash Pill millsndash Clinical prescribing regulationsndash Decedent controlled substance testing lawndash Inter-state prescription drug monitoring
program (PDMP) data sharing
bull Use of PDMP data for public health surveillance
bull Inform community interventions bull Evaluate and perform cost-benefit
analysis of drug-related laws bull Establish substance use disorder
information and referral service ndash physicians (eg prevention of needle sticks
when lancing drug abuse-related abscesses)ndash first responders (eg handling of fentanyl
analogs at drug overdose scenes) ndash law enforcement (eg naloxone
administration training)ndash general public
bull Increase timeliness of public health data sources
bull Use syndromic surveillance data for drug overdose and injury surveillance
bull Algorithm development for milligram morphine equivalent calculations in PDMP reports
bull Death certificate and PDMP data linkage to identify possible drug diversion
bull State advisory group
bull Link Ky CRASH and trauma registry data with FARS driver drug testing results from fatal crashes in 2014
bull Link 2014 trauma registry toxicology result data with inpatient hospitalization data to assess drug overdose and drug abuse coding
Primary populations
bull Opioid overdose victims
bull Pregnant and parenting women
bull Individuals re-entering society upon criminal justice release
bull Adolescents and young adults
Goals
bull Prevent opioid misuse and abuse
bull Increase access to OUD treatment services (eg MAT)
bull Increase availability of recovery support services
bull Increase availability of naloxone
bull Enhance coordination and evaluation of OUD healthcare and public safety strategies
bull KRS 217186- A person or agency including a peace officer jailer firefighter paramedic or emergency medical technician or a school employee authorized to administer medication under KRS 156502 may ndash Receive a prescription for the drug
naloxonendash Possess naloxone pursuant to this
subsection and any equipment needed for its administration
ndash Administer naloxone to an individual suffering from an apparent opiate-related overdose
bull Reduce prescriber opioid prescribing (physicians APRNs etc) to a 3-day supply for injured workers
bull First line treatment based on non-opioid therapy alternatives (physical therapy acupuncture etc)
bull Revise drug formularies for treatment of pain associated with occupational injuries
Prevention Decrease likelihood that Kentuckians develop a SUD through strategies to decrease overexposure of opioid medications and illicit opioids
bull prescriptions (dosage units) overdose deaths containing fentanyl
Harm Reduction Improve Access to Harm Reduction Services to Save Lives
bull naloxone kits dispensed to first responders and public people in syringe exchange programs who received naloxone
Treatment and Recovery Expand access to treatment and recovery supports
bull peer recovery coaches Emergency Departments with peer recovery coaches people with SUD who interact with peer recovery coaches and enter treatment Emergency Department peer follow-up individuals with SUD who receive residential services calls to SUD treatment locator and portal
bull Louisville Metro Police Department presentation
bull Breakout Session
bull First Responder Opioid Exposure Survey development
bull Focus Groups
bull Survey Administration
bull Data Analysis
bull Use of Data Results
bull UK ERC first responder overdose response exposure pilot project opportunity
bull Multistate or single state applicationsndash Use of survey
ndash development of other first responder-related pilot project
FACE case investigations
bull initiated drug overdose prevention conversations
bull enhanced collaborations
bull provided evidence of need for enhanced multidisciplinary drug overdose prevention efforts1 Interventions
2 Policies
3 Research
Ladder rap
httpswwwyoutubecomwatchv=FsW6eb3aO8gampfeature=youtube
BLS Survey of Employers vs Multi-Source Surveillance of Work-Related Injuries
Kenneth D Rosenman MDProfessor of MedicineMichigan State Universitywwwoemmsuedu
NIOSH Expanding Research Partnerships Conference Denver Colorado June 21-23 2017
Funding NIOSH U60 OH008466
Survey of Occupational Injuries and Illnesses (SOII)
bull Injuries and illnesses (based on OSHArsquos recordkeeping standards) from 230000 establishments (sample by state and NAICS code)
bull Redesigned in 1992 to collect circumstances of injuries and illnesses that lead to days away from work and characteristics of affected workers
bull Scope limitations no small farms private household or self-employed workers (lt 2008 no public sector workers)
NATIONAL ACADEMY OF SCIENCES 1987
New Jersey24 Deaths not covered by OSHA35 Deaths covered by OSHA butemployer had NOT recorded on OSHAlog or did NOT keep OSHA log
TexasNIOSH Fatal Occupational Trauma Surveillance
CENSUS OF FATAL OCCUPATIONAL INJURIES (CFOI) BEGAN IN 1992
Multiple death sourcesDeath certificatesEmployer reportingState PoliceNewspaper Clipping ServiceMedical ExaminersAgricultural Extension Service
Number of deaths doubled from previous BLS estimate
How Much Work-Related Injury and Illness is Missed By the Current National Surveillance System
Rosenman KD Kalush A Reilly MJ Gardiner JC Reeves M Luo Z JOEM 2006 48357-365Funding NIOSH 5 R01 OH004276-03
Summary of Analysis Comparing BLS and Worker Comp data Michigan 2009-2001Days away from workbull BLS estimate
37-41 BLS+ WC31-34 BLS + WC+ CaptureRecapture
1999-2001 Estimates - Michiganbull BLS -281567 vs Our Estimate - 868241
1 in 15 workers vs 1 in 5 workers
(Rosenman et al JOEM 2006)
Simplified Flowchart of Events Necessary to the Documentation of Work-Related Injuries and Illnesses
(Azaroff et al AJPH 2002)
Filters to Identifying Work-Related Injuries and Illnesses
a Filters To Reporting to Supervisorsb Filters To Losing Work Time c Filters to Obtaining Medical Cared Filters to Recognizing Work-Related by Doctore Filters to Workersrsquo Compensation being the Payerf Filters To Recording on OSHA Logg Filters to Reporting by Employers to Workersrsquo
Compensation Agencyh Filters to Reporting by Doctors
(Azaroff et al AJPH 2002)
Capture-Recapture Estimates of Workplace Injury and Illness Reporting by BLS Adjusted for Capture
Heterogeneity Lost-Time Cases 1998-2001
Percent Reported to WA WV OR WI NM MNNo Source Dependence 55 76 56 65 51 68
Source Dependence 52 71 45 53 37 53
(Adapted Boden and Ozonoff Annals Epidemiology 2008)
Workersrsquo CompensationState Specific Program
Mandatory insurance or if large enough self-insured
Michigan WC Excludesbull Federal employeesbull Interstate railroad workersbull Maritime workersbull Less than 3 employees at any one timebull All employees work less than 35 hoursweek or
if more hours less than 13 weeksbull Self-employed
Not computerizedbull Medical claims only
Proportion of Work-Injured Adults for Whom Treatment was paid by Workersrsquo Compensation by State-BRFSS 10 States 2007
State Injured with Payment by Workersrsquo Compensation
Texas 47 (95 CI 35-59)New York 50 (95 CI 39-60)Michigan 56 (95 CI 41-69)Massachusetts 60 (95 CI 45-75)California 61 (95 CI 55-66)Washington 61 (95 CI 55-67)Oregon 62 (95 CI 50-74)Connecticut 63 (95 CI 53-74)New Jersey 64 (95 CI 51-78)Kentucky 77 (95 CI 65-89)
Excludes self-employed
(Adapted Bonauto et al MMWR 2010)
Percentage Received Workersrsquo Compensation by Condition Michigan
WageReplacement
Medical Only
No CompEmployed
No Comp Self -Employed
Amputations 64 22 17 6Burns 17 48 33 2Skull Fractures 36 32 29 3
Percent Applied for Workersrsquo Comp among 2016 Cases of Work-Related Asthma Michigan
Overall 484
Still ExposedConditions Unchanged 239No Longer Exposed 575
Quit on Doctorrsquos Advice 778Sick Leave 727Fired 621New Controls 589Chemical Substitution 536Quit on Own 431Reassigned 360
Reasons Didnrsquot File a Workersrsquo Compensation Claims for a Repetitive Trauma Michigan
Only 397 (251) of 1598 Filed WC Claim
Injury Not Serious Enough 705 (591)Did Not Expect to Miss Work 694 (583)Expect to Receive Sick Leave or
Disability 337 (283) Medical Expenses Covered by
Other Insurance 427 (359)Did Not Think Injury Work Related 242 (204)
(Rosenman et al JOEM 2000)
Goals of Surveillance Population-Based
bull Assess Magnitude of Problembull NumbersRatesTrends
bull Determine Relative Importance vs Other Health Issuesbull Identify High Risk
bull IndustriesOccupationsWorker Populations
bull Prioritize Interventions bull Evaluate Interventionsbull Generate Hypotheses for Researchbull Identify Emerging Problemsbull Identify Workplaces for Intervention
Case-Based
Reportable Conditions in Michigan
Local Health DepartmentsCommunicable Diseases (83)
ldquoUnusual occurrence outbreak or epidemic of any disease or conditionsrdquoMDHHS
AbortionsBirth DefectsCancerChemical Poisonings including Carbon MonoxideInjuries Nursing Home Abuse
LARAOccupational Illnesses
County Department of Social ServicesChild AbuseAdult Abuse
PoliceInjury from Knife Gun or Deadly WeaponMental Health Patient Abuse
On Request Only
Laboratory Reporting Regulations Michigan
bull Arsenicbull Cadmiumbull Carboxyhemoglobinbull Cholinesterasebull IgE Antibodiesbull Leadbull Mercury
Occupational Illness Reporting Requirement in Michigan
bull LARA ndash MIOSHAPhysician hospital clinic or employer
having a known or suspected occupational disease or health condition aggravated by workplace exposures shall report within 10 days after discovery
Misdemeanor punishable by a fine of not more than $50
Methodology of Multi-Source Surveillance
Amputations 2006- DateHospitalsEDOutpatient ClinicsWorkersrsquo Compensation Wage Replacement
Crushing Injuries 2013- Date+ FACE Program
Skull Fractures 2012-DateBurns 2009-Date
+ Poison Control Center
bull Quarterly Reporting Specified ICD codes -134 Hospitalsbull Quarterly Reporting all Work-related Events ndash Poison Control Centerbull Electronic Data Base All Paid Claims ndash Workersrsquo Compensationbull FACE ndash Death CertificatesOSHA Hot LinePolice Reports
Work-Related Burn Reports ndash By Source Total 1461 Michigan 2009
n=1460 individuals
450
BLS
HOSPITALSEDs (1248)
4501054
BLSMIFACE 1(2) 1
16721
5 PCC (106)
1321 79
WC(306)
(Kica and Rosenman JOEM 2012)
Collaboration
Data sharing agreements
Pilot rates
Sharable repeatable methods and code
Contribution to national discussions about
use of WC data
Workers not captured by our method
Public sector
People who do not file claims
Data analysis for 2015-2016 Data analysis report Surveillance system evaluation
Publicly available dataset Disseminate findings Sustainability
California Department of Public Health John Beckman Matt Frederick Bob Harrison
California Department of Industrial Relations Genet Daba John Gordon Liza Dizon Glenn Shor Meitong Jin
California Employment Development Department Andy Wong Spencer Wong
Terry Bunn PhDDirector Kentucky Injury Prevention and Research
Center bona fide agent for the Kentucky Department for Public Health
Associate Professor Departments of Epidemiology and Preventive Medicine and Environmental Health University of Kentucky College of Public Health
bull Occupational motor vehicle crash investigations a priority focus area since 2005
KOSHS
Case Example
Case Example
bull Substance abuse a priority focus areabull State injury prevention planbull Legislation data support (HB1)
ndash Pill millsndash Clinical prescribing regulationsndash Decedent controlled substance testing lawndash Inter-state prescription drug monitoring
program (PDMP) data sharing
bull Use of PDMP data for public health surveillance
bull Inform community interventions bull Evaluate and perform cost-benefit
analysis of drug-related laws bull Establish substance use disorder
information and referral service ndash physicians (eg prevention of needle sticks
when lancing drug abuse-related abscesses)ndash first responders (eg handling of fentanyl
analogs at drug overdose scenes) ndash law enforcement (eg naloxone
administration training)ndash general public
bull Increase timeliness of public health data sources
bull Use syndromic surveillance data for drug overdose and injury surveillance
bull Algorithm development for milligram morphine equivalent calculations in PDMP reports
bull Death certificate and PDMP data linkage to identify possible drug diversion
bull State advisory group
bull Link Ky CRASH and trauma registry data with FARS driver drug testing results from fatal crashes in 2014
bull Link 2014 trauma registry toxicology result data with inpatient hospitalization data to assess drug overdose and drug abuse coding
Primary populations
bull Opioid overdose victims
bull Pregnant and parenting women
bull Individuals re-entering society upon criminal justice release
bull Adolescents and young adults
Goals
bull Prevent opioid misuse and abuse
bull Increase access to OUD treatment services (eg MAT)
bull Increase availability of recovery support services
bull Increase availability of naloxone
bull Enhance coordination and evaluation of OUD healthcare and public safety strategies
bull KRS 217186- A person or agency including a peace officer jailer firefighter paramedic or emergency medical technician or a school employee authorized to administer medication under KRS 156502 may ndash Receive a prescription for the drug
naloxonendash Possess naloxone pursuant to this
subsection and any equipment needed for its administration
ndash Administer naloxone to an individual suffering from an apparent opiate-related overdose
bull Reduce prescriber opioid prescribing (physicians APRNs etc) to a 3-day supply for injured workers
bull First line treatment based on non-opioid therapy alternatives (physical therapy acupuncture etc)
bull Revise drug formularies for treatment of pain associated with occupational injuries
Prevention Decrease likelihood that Kentuckians develop a SUD through strategies to decrease overexposure of opioid medications and illicit opioids
bull prescriptions (dosage units) overdose deaths containing fentanyl
Harm Reduction Improve Access to Harm Reduction Services to Save Lives
bull naloxone kits dispensed to first responders and public people in syringe exchange programs who received naloxone
Treatment and Recovery Expand access to treatment and recovery supports
bull peer recovery coaches Emergency Departments with peer recovery coaches people with SUD who interact with peer recovery coaches and enter treatment Emergency Department peer follow-up individuals with SUD who receive residential services calls to SUD treatment locator and portal
bull Louisville Metro Police Department presentation
bull Breakout Session
bull First Responder Opioid Exposure Survey development
bull Focus Groups
bull Survey Administration
bull Data Analysis
bull Use of Data Results
bull UK ERC first responder overdose response exposure pilot project opportunity
bull Multistate or single state applicationsndash Use of survey
ndash development of other first responder-related pilot project
FACE case investigations
bull initiated drug overdose prevention conversations
bull enhanced collaborations
bull provided evidence of need for enhanced multidisciplinary drug overdose prevention efforts1 Interventions
2 Policies
3 Research
Ladder rap
httpswwwyoutubecomwatchv=FsW6eb3aO8gampfeature=youtube
BLS Survey of Employers vs Multi-Source Surveillance of Work-Related Injuries
Kenneth D Rosenman MDProfessor of MedicineMichigan State Universitywwwoemmsuedu
NIOSH Expanding Research Partnerships Conference Denver Colorado June 21-23 2017
Funding NIOSH U60 OH008466
Survey of Occupational Injuries and Illnesses (SOII)
bull Injuries and illnesses (based on OSHArsquos recordkeeping standards) from 230000 establishments (sample by state and NAICS code)
bull Redesigned in 1992 to collect circumstances of injuries and illnesses that lead to days away from work and characteristics of affected workers
bull Scope limitations no small farms private household or self-employed workers (lt 2008 no public sector workers)
NATIONAL ACADEMY OF SCIENCES 1987
New Jersey24 Deaths not covered by OSHA35 Deaths covered by OSHA butemployer had NOT recorded on OSHAlog or did NOT keep OSHA log
TexasNIOSH Fatal Occupational Trauma Surveillance
CENSUS OF FATAL OCCUPATIONAL INJURIES (CFOI) BEGAN IN 1992
Multiple death sourcesDeath certificatesEmployer reportingState PoliceNewspaper Clipping ServiceMedical ExaminersAgricultural Extension Service
Number of deaths doubled from previous BLS estimate
How Much Work-Related Injury and Illness is Missed By the Current National Surveillance System
Rosenman KD Kalush A Reilly MJ Gardiner JC Reeves M Luo Z JOEM 2006 48357-365Funding NIOSH 5 R01 OH004276-03
Summary of Analysis Comparing BLS and Worker Comp data Michigan 2009-2001Days away from workbull BLS estimate
37-41 BLS+ WC31-34 BLS + WC+ CaptureRecapture
1999-2001 Estimates - Michiganbull BLS -281567 vs Our Estimate - 868241
1 in 15 workers vs 1 in 5 workers
(Rosenman et al JOEM 2006)
Simplified Flowchart of Events Necessary to the Documentation of Work-Related Injuries and Illnesses
(Azaroff et al AJPH 2002)
Filters to Identifying Work-Related Injuries and Illnesses
a Filters To Reporting to Supervisorsb Filters To Losing Work Time c Filters to Obtaining Medical Cared Filters to Recognizing Work-Related by Doctore Filters to Workersrsquo Compensation being the Payerf Filters To Recording on OSHA Logg Filters to Reporting by Employers to Workersrsquo
Compensation Agencyh Filters to Reporting by Doctors
(Azaroff et al AJPH 2002)
Capture-Recapture Estimates of Workplace Injury and Illness Reporting by BLS Adjusted for Capture
Heterogeneity Lost-Time Cases 1998-2001
Percent Reported to WA WV OR WI NM MNNo Source Dependence 55 76 56 65 51 68
Source Dependence 52 71 45 53 37 53
(Adapted Boden and Ozonoff Annals Epidemiology 2008)
Workersrsquo CompensationState Specific Program
Mandatory insurance or if large enough self-insured
Michigan WC Excludesbull Federal employeesbull Interstate railroad workersbull Maritime workersbull Less than 3 employees at any one timebull All employees work less than 35 hoursweek or
if more hours less than 13 weeksbull Self-employed
Not computerizedbull Medical claims only
Proportion of Work-Injured Adults for Whom Treatment was paid by Workersrsquo Compensation by State-BRFSS 10 States 2007
State Injured with Payment by Workersrsquo Compensation
Texas 47 (95 CI 35-59)New York 50 (95 CI 39-60)Michigan 56 (95 CI 41-69)Massachusetts 60 (95 CI 45-75)California 61 (95 CI 55-66)Washington 61 (95 CI 55-67)Oregon 62 (95 CI 50-74)Connecticut 63 (95 CI 53-74)New Jersey 64 (95 CI 51-78)Kentucky 77 (95 CI 65-89)
Excludes self-employed
(Adapted Bonauto et al MMWR 2010)
Percentage Received Workersrsquo Compensation by Condition Michigan
WageReplacement
Medical Only
No CompEmployed
No Comp Self -Employed
Amputations 64 22 17 6Burns 17 48 33 2Skull Fractures 36 32 29 3
Percent Applied for Workersrsquo Comp among 2016 Cases of Work-Related Asthma Michigan
Overall 484
Still ExposedConditions Unchanged 239No Longer Exposed 575
Quit on Doctorrsquos Advice 778Sick Leave 727Fired 621New Controls 589Chemical Substitution 536Quit on Own 431Reassigned 360
Reasons Didnrsquot File a Workersrsquo Compensation Claims for a Repetitive Trauma Michigan
Only 397 (251) of 1598 Filed WC Claim
Injury Not Serious Enough 705 (591)Did Not Expect to Miss Work 694 (583)Expect to Receive Sick Leave or
Disability 337 (283) Medical Expenses Covered by
Other Insurance 427 (359)Did Not Think Injury Work Related 242 (204)
(Rosenman et al JOEM 2000)
Goals of Surveillance Population-Based
bull Assess Magnitude of Problembull NumbersRatesTrends
bull Determine Relative Importance vs Other Health Issuesbull Identify High Risk
bull IndustriesOccupationsWorker Populations
bull Prioritize Interventions bull Evaluate Interventionsbull Generate Hypotheses for Researchbull Identify Emerging Problemsbull Identify Workplaces for Intervention
Case-Based
Reportable Conditions in Michigan
Local Health DepartmentsCommunicable Diseases (83)
ldquoUnusual occurrence outbreak or epidemic of any disease or conditionsrdquoMDHHS
AbortionsBirth DefectsCancerChemical Poisonings including Carbon MonoxideInjuries Nursing Home Abuse
LARAOccupational Illnesses
County Department of Social ServicesChild AbuseAdult Abuse
PoliceInjury from Knife Gun or Deadly WeaponMental Health Patient Abuse
On Request Only
Laboratory Reporting Regulations Michigan
bull Arsenicbull Cadmiumbull Carboxyhemoglobinbull Cholinesterasebull IgE Antibodiesbull Leadbull Mercury
Occupational Illness Reporting Requirement in Michigan
bull LARA ndash MIOSHAPhysician hospital clinic or employer
having a known or suspected occupational disease or health condition aggravated by workplace exposures shall report within 10 days after discovery
Misdemeanor punishable by a fine of not more than $50
Methodology of Multi-Source Surveillance
Amputations 2006- DateHospitalsEDOutpatient ClinicsWorkersrsquo Compensation Wage Replacement
Crushing Injuries 2013- Date+ FACE Program
Skull Fractures 2012-DateBurns 2009-Date
+ Poison Control Center
bull Quarterly Reporting Specified ICD codes -134 Hospitalsbull Quarterly Reporting all Work-related Events ndash Poison Control Centerbull Electronic Data Base All Paid Claims ndash Workersrsquo Compensationbull FACE ndash Death CertificatesOSHA Hot LinePolice Reports
Work-Related Burn Reports ndash By Source Total 1461 Michigan 2009
n=1460 individuals
450
BLS
HOSPITALSEDs (1248)
4501054
BLSMIFACE 1(2) 1
16721
5 PCC (106)
1321 79
WC(306)
(Kica and Rosenman JOEM 2012)
Workers not captured by our method
Public sector
People who do not file claims
Data analysis for 2015-2016 Data analysis report Surveillance system evaluation
Publicly available dataset Disseminate findings Sustainability
California Department of Public Health John Beckman Matt Frederick Bob Harrison
California Department of Industrial Relations Genet Daba John Gordon Liza Dizon Glenn Shor Meitong Jin
California Employment Development Department Andy Wong Spencer Wong
Terry Bunn PhDDirector Kentucky Injury Prevention and Research
Center bona fide agent for the Kentucky Department for Public Health
Associate Professor Departments of Epidemiology and Preventive Medicine and Environmental Health University of Kentucky College of Public Health
bull Occupational motor vehicle crash investigations a priority focus area since 2005
KOSHS
Case Example
Case Example
bull Substance abuse a priority focus areabull State injury prevention planbull Legislation data support (HB1)
ndash Pill millsndash Clinical prescribing regulationsndash Decedent controlled substance testing lawndash Inter-state prescription drug monitoring
program (PDMP) data sharing
bull Use of PDMP data for public health surveillance
bull Inform community interventions bull Evaluate and perform cost-benefit
analysis of drug-related laws bull Establish substance use disorder
information and referral service ndash physicians (eg prevention of needle sticks
when lancing drug abuse-related abscesses)ndash first responders (eg handling of fentanyl
analogs at drug overdose scenes) ndash law enforcement (eg naloxone
administration training)ndash general public
bull Increase timeliness of public health data sources
bull Use syndromic surveillance data for drug overdose and injury surveillance
bull Algorithm development for milligram morphine equivalent calculations in PDMP reports
bull Death certificate and PDMP data linkage to identify possible drug diversion
bull State advisory group
bull Link Ky CRASH and trauma registry data with FARS driver drug testing results from fatal crashes in 2014
bull Link 2014 trauma registry toxicology result data with inpatient hospitalization data to assess drug overdose and drug abuse coding
Primary populations
bull Opioid overdose victims
bull Pregnant and parenting women
bull Individuals re-entering society upon criminal justice release
bull Adolescents and young adults
Goals
bull Prevent opioid misuse and abuse
bull Increase access to OUD treatment services (eg MAT)
bull Increase availability of recovery support services
bull Increase availability of naloxone
bull Enhance coordination and evaluation of OUD healthcare and public safety strategies
bull KRS 217186- A person or agency including a peace officer jailer firefighter paramedic or emergency medical technician or a school employee authorized to administer medication under KRS 156502 may ndash Receive a prescription for the drug
naloxonendash Possess naloxone pursuant to this
subsection and any equipment needed for its administration
ndash Administer naloxone to an individual suffering from an apparent opiate-related overdose
bull Reduce prescriber opioid prescribing (physicians APRNs etc) to a 3-day supply for injured workers
bull First line treatment based on non-opioid therapy alternatives (physical therapy acupuncture etc)
bull Revise drug formularies for treatment of pain associated with occupational injuries
Prevention Decrease likelihood that Kentuckians develop a SUD through strategies to decrease overexposure of opioid medications and illicit opioids
bull prescriptions (dosage units) overdose deaths containing fentanyl
Harm Reduction Improve Access to Harm Reduction Services to Save Lives
bull naloxone kits dispensed to first responders and public people in syringe exchange programs who received naloxone
Treatment and Recovery Expand access to treatment and recovery supports
bull peer recovery coaches Emergency Departments with peer recovery coaches people with SUD who interact with peer recovery coaches and enter treatment Emergency Department peer follow-up individuals with SUD who receive residential services calls to SUD treatment locator and portal
bull Louisville Metro Police Department presentation
bull Breakout Session
bull First Responder Opioid Exposure Survey development
bull Focus Groups
bull Survey Administration
bull Data Analysis
bull Use of Data Results
bull UK ERC first responder overdose response exposure pilot project opportunity
bull Multistate or single state applicationsndash Use of survey
ndash development of other first responder-related pilot project
FACE case investigations
bull initiated drug overdose prevention conversations
bull enhanced collaborations
bull provided evidence of need for enhanced multidisciplinary drug overdose prevention efforts1 Interventions
2 Policies
3 Research
Ladder rap
httpswwwyoutubecomwatchv=FsW6eb3aO8gampfeature=youtube
BLS Survey of Employers vs Multi-Source Surveillance of Work-Related Injuries
Kenneth D Rosenman MDProfessor of MedicineMichigan State Universitywwwoemmsuedu
NIOSH Expanding Research Partnerships Conference Denver Colorado June 21-23 2017
Funding NIOSH U60 OH008466
Survey of Occupational Injuries and Illnesses (SOII)
bull Injuries and illnesses (based on OSHArsquos recordkeeping standards) from 230000 establishments (sample by state and NAICS code)
bull Redesigned in 1992 to collect circumstances of injuries and illnesses that lead to days away from work and characteristics of affected workers
bull Scope limitations no small farms private household or self-employed workers (lt 2008 no public sector workers)
NATIONAL ACADEMY OF SCIENCES 1987
New Jersey24 Deaths not covered by OSHA35 Deaths covered by OSHA butemployer had NOT recorded on OSHAlog or did NOT keep OSHA log
TexasNIOSH Fatal Occupational Trauma Surveillance
CENSUS OF FATAL OCCUPATIONAL INJURIES (CFOI) BEGAN IN 1992
Multiple death sourcesDeath certificatesEmployer reportingState PoliceNewspaper Clipping ServiceMedical ExaminersAgricultural Extension Service
Number of deaths doubled from previous BLS estimate
How Much Work-Related Injury and Illness is Missed By the Current National Surveillance System
Rosenman KD Kalush A Reilly MJ Gardiner JC Reeves M Luo Z JOEM 2006 48357-365Funding NIOSH 5 R01 OH004276-03
Summary of Analysis Comparing BLS and Worker Comp data Michigan 2009-2001Days away from workbull BLS estimate
37-41 BLS+ WC31-34 BLS + WC+ CaptureRecapture
1999-2001 Estimates - Michiganbull BLS -281567 vs Our Estimate - 868241
1 in 15 workers vs 1 in 5 workers
(Rosenman et al JOEM 2006)
Simplified Flowchart of Events Necessary to the Documentation of Work-Related Injuries and Illnesses
(Azaroff et al AJPH 2002)
Filters to Identifying Work-Related Injuries and Illnesses
a Filters To Reporting to Supervisorsb Filters To Losing Work Time c Filters to Obtaining Medical Cared Filters to Recognizing Work-Related by Doctore Filters to Workersrsquo Compensation being the Payerf Filters To Recording on OSHA Logg Filters to Reporting by Employers to Workersrsquo
Compensation Agencyh Filters to Reporting by Doctors
(Azaroff et al AJPH 2002)
Capture-Recapture Estimates of Workplace Injury and Illness Reporting by BLS Adjusted for Capture
Heterogeneity Lost-Time Cases 1998-2001
Percent Reported to WA WV OR WI NM MNNo Source Dependence 55 76 56 65 51 68
Source Dependence 52 71 45 53 37 53
(Adapted Boden and Ozonoff Annals Epidemiology 2008)
Workersrsquo CompensationState Specific Program
Mandatory insurance or if large enough self-insured
Michigan WC Excludesbull Federal employeesbull Interstate railroad workersbull Maritime workersbull Less than 3 employees at any one timebull All employees work less than 35 hoursweek or
if more hours less than 13 weeksbull Self-employed
Not computerizedbull Medical claims only
Proportion of Work-Injured Adults for Whom Treatment was paid by Workersrsquo Compensation by State-BRFSS 10 States 2007
State Injured with Payment by Workersrsquo Compensation
Texas 47 (95 CI 35-59)New York 50 (95 CI 39-60)Michigan 56 (95 CI 41-69)Massachusetts 60 (95 CI 45-75)California 61 (95 CI 55-66)Washington 61 (95 CI 55-67)Oregon 62 (95 CI 50-74)Connecticut 63 (95 CI 53-74)New Jersey 64 (95 CI 51-78)Kentucky 77 (95 CI 65-89)
Excludes self-employed
(Adapted Bonauto et al MMWR 2010)
Percentage Received Workersrsquo Compensation by Condition Michigan
WageReplacement
Medical Only
No CompEmployed
No Comp Self -Employed
Amputations 64 22 17 6Burns 17 48 33 2Skull Fractures 36 32 29 3
Percent Applied for Workersrsquo Comp among 2016 Cases of Work-Related Asthma Michigan
Overall 484
Still ExposedConditions Unchanged 239No Longer Exposed 575
Quit on Doctorrsquos Advice 778Sick Leave 727Fired 621New Controls 589Chemical Substitution 536Quit on Own 431Reassigned 360
Reasons Didnrsquot File a Workersrsquo Compensation Claims for a Repetitive Trauma Michigan
Only 397 (251) of 1598 Filed WC Claim
Injury Not Serious Enough 705 (591)Did Not Expect to Miss Work 694 (583)Expect to Receive Sick Leave or
Disability 337 (283) Medical Expenses Covered by
Other Insurance 427 (359)Did Not Think Injury Work Related 242 (204)
(Rosenman et al JOEM 2000)
Goals of Surveillance Population-Based
bull Assess Magnitude of Problembull NumbersRatesTrends
bull Determine Relative Importance vs Other Health Issuesbull Identify High Risk
bull IndustriesOccupationsWorker Populations
bull Prioritize Interventions bull Evaluate Interventionsbull Generate Hypotheses for Researchbull Identify Emerging Problemsbull Identify Workplaces for Intervention
Case-Based
Reportable Conditions in Michigan
Local Health DepartmentsCommunicable Diseases (83)
ldquoUnusual occurrence outbreak or epidemic of any disease or conditionsrdquoMDHHS
AbortionsBirth DefectsCancerChemical Poisonings including Carbon MonoxideInjuries Nursing Home Abuse
LARAOccupational Illnesses
County Department of Social ServicesChild AbuseAdult Abuse
PoliceInjury from Knife Gun or Deadly WeaponMental Health Patient Abuse
On Request Only
Laboratory Reporting Regulations Michigan
bull Arsenicbull Cadmiumbull Carboxyhemoglobinbull Cholinesterasebull IgE Antibodiesbull Leadbull Mercury
Occupational Illness Reporting Requirement in Michigan
bull LARA ndash MIOSHAPhysician hospital clinic or employer
having a known or suspected occupational disease or health condition aggravated by workplace exposures shall report within 10 days after discovery
Misdemeanor punishable by a fine of not more than $50
Methodology of Multi-Source Surveillance
Amputations 2006- DateHospitalsEDOutpatient ClinicsWorkersrsquo Compensation Wage Replacement
Crushing Injuries 2013- Date+ FACE Program
Skull Fractures 2012-DateBurns 2009-Date
+ Poison Control Center
bull Quarterly Reporting Specified ICD codes -134 Hospitalsbull Quarterly Reporting all Work-related Events ndash Poison Control Centerbull Electronic Data Base All Paid Claims ndash Workersrsquo Compensationbull FACE ndash Death CertificatesOSHA Hot LinePolice Reports
Work-Related Burn Reports ndash By Source Total 1461 Michigan 2009
n=1460 individuals
450
BLS
HOSPITALSEDs (1248)
4501054
BLSMIFACE 1(2) 1
16721
5 PCC (106)
1321 79
WC(306)
(Kica and Rosenman JOEM 2012)
Data analysis for 2015-2016 Data analysis report Surveillance system evaluation
Publicly available dataset Disseminate findings Sustainability
California Department of Public Health John Beckman Matt Frederick Bob Harrison
California Department of Industrial Relations Genet Daba John Gordon Liza Dizon Glenn Shor Meitong Jin
California Employment Development Department Andy Wong Spencer Wong
Terry Bunn PhDDirector Kentucky Injury Prevention and Research
Center bona fide agent for the Kentucky Department for Public Health
Associate Professor Departments of Epidemiology and Preventive Medicine and Environmental Health University of Kentucky College of Public Health
bull Occupational motor vehicle crash investigations a priority focus area since 2005
KOSHS
Case Example
Case Example
bull Substance abuse a priority focus areabull State injury prevention planbull Legislation data support (HB1)
ndash Pill millsndash Clinical prescribing regulationsndash Decedent controlled substance testing lawndash Inter-state prescription drug monitoring
program (PDMP) data sharing
bull Use of PDMP data for public health surveillance
bull Inform community interventions bull Evaluate and perform cost-benefit
analysis of drug-related laws bull Establish substance use disorder
information and referral service ndash physicians (eg prevention of needle sticks
when lancing drug abuse-related abscesses)ndash first responders (eg handling of fentanyl
analogs at drug overdose scenes) ndash law enforcement (eg naloxone
administration training)ndash general public
bull Increase timeliness of public health data sources
bull Use syndromic surveillance data for drug overdose and injury surveillance
bull Algorithm development for milligram morphine equivalent calculations in PDMP reports
bull Death certificate and PDMP data linkage to identify possible drug diversion
bull State advisory group
bull Link Ky CRASH and trauma registry data with FARS driver drug testing results from fatal crashes in 2014
bull Link 2014 trauma registry toxicology result data with inpatient hospitalization data to assess drug overdose and drug abuse coding
Primary populations
bull Opioid overdose victims
bull Pregnant and parenting women
bull Individuals re-entering society upon criminal justice release
bull Adolescents and young adults
Goals
bull Prevent opioid misuse and abuse
bull Increase access to OUD treatment services (eg MAT)
bull Increase availability of recovery support services
bull Increase availability of naloxone
bull Enhance coordination and evaluation of OUD healthcare and public safety strategies
bull KRS 217186- A person or agency including a peace officer jailer firefighter paramedic or emergency medical technician or a school employee authorized to administer medication under KRS 156502 may ndash Receive a prescription for the drug
naloxonendash Possess naloxone pursuant to this
subsection and any equipment needed for its administration
ndash Administer naloxone to an individual suffering from an apparent opiate-related overdose
bull Reduce prescriber opioid prescribing (physicians APRNs etc) to a 3-day supply for injured workers
bull First line treatment based on non-opioid therapy alternatives (physical therapy acupuncture etc)
bull Revise drug formularies for treatment of pain associated with occupational injuries
Prevention Decrease likelihood that Kentuckians develop a SUD through strategies to decrease overexposure of opioid medications and illicit opioids
bull prescriptions (dosage units) overdose deaths containing fentanyl
Harm Reduction Improve Access to Harm Reduction Services to Save Lives
bull naloxone kits dispensed to first responders and public people in syringe exchange programs who received naloxone
Treatment and Recovery Expand access to treatment and recovery supports
bull peer recovery coaches Emergency Departments with peer recovery coaches people with SUD who interact with peer recovery coaches and enter treatment Emergency Department peer follow-up individuals with SUD who receive residential services calls to SUD treatment locator and portal
bull Louisville Metro Police Department presentation
bull Breakout Session
bull First Responder Opioid Exposure Survey development
bull Focus Groups
bull Survey Administration
bull Data Analysis
bull Use of Data Results
bull UK ERC first responder overdose response exposure pilot project opportunity
bull Multistate or single state applicationsndash Use of survey
ndash development of other first responder-related pilot project
FACE case investigations
bull initiated drug overdose prevention conversations
bull enhanced collaborations
bull provided evidence of need for enhanced multidisciplinary drug overdose prevention efforts1 Interventions
2 Policies
3 Research
Ladder rap
httpswwwyoutubecomwatchv=FsW6eb3aO8gampfeature=youtube
BLS Survey of Employers vs Multi-Source Surveillance of Work-Related Injuries
Kenneth D Rosenman MDProfessor of MedicineMichigan State Universitywwwoemmsuedu
NIOSH Expanding Research Partnerships Conference Denver Colorado June 21-23 2017
Funding NIOSH U60 OH008466
Survey of Occupational Injuries and Illnesses (SOII)
bull Injuries and illnesses (based on OSHArsquos recordkeeping standards) from 230000 establishments (sample by state and NAICS code)
bull Redesigned in 1992 to collect circumstances of injuries and illnesses that lead to days away from work and characteristics of affected workers
bull Scope limitations no small farms private household or self-employed workers (lt 2008 no public sector workers)
NATIONAL ACADEMY OF SCIENCES 1987
New Jersey24 Deaths not covered by OSHA35 Deaths covered by OSHA butemployer had NOT recorded on OSHAlog or did NOT keep OSHA log
TexasNIOSH Fatal Occupational Trauma Surveillance
CENSUS OF FATAL OCCUPATIONAL INJURIES (CFOI) BEGAN IN 1992
Multiple death sourcesDeath certificatesEmployer reportingState PoliceNewspaper Clipping ServiceMedical ExaminersAgricultural Extension Service
Number of deaths doubled from previous BLS estimate
How Much Work-Related Injury and Illness is Missed By the Current National Surveillance System
Rosenman KD Kalush A Reilly MJ Gardiner JC Reeves M Luo Z JOEM 2006 48357-365Funding NIOSH 5 R01 OH004276-03
Summary of Analysis Comparing BLS and Worker Comp data Michigan 2009-2001Days away from workbull BLS estimate
37-41 BLS+ WC31-34 BLS + WC+ CaptureRecapture
1999-2001 Estimates - Michiganbull BLS -281567 vs Our Estimate - 868241
1 in 15 workers vs 1 in 5 workers
(Rosenman et al JOEM 2006)
Simplified Flowchart of Events Necessary to the Documentation of Work-Related Injuries and Illnesses
(Azaroff et al AJPH 2002)
Filters to Identifying Work-Related Injuries and Illnesses
a Filters To Reporting to Supervisorsb Filters To Losing Work Time c Filters to Obtaining Medical Cared Filters to Recognizing Work-Related by Doctore Filters to Workersrsquo Compensation being the Payerf Filters To Recording on OSHA Logg Filters to Reporting by Employers to Workersrsquo
Compensation Agencyh Filters to Reporting by Doctors
(Azaroff et al AJPH 2002)
Capture-Recapture Estimates of Workplace Injury and Illness Reporting by BLS Adjusted for Capture
Heterogeneity Lost-Time Cases 1998-2001
Percent Reported to WA WV OR WI NM MNNo Source Dependence 55 76 56 65 51 68
Source Dependence 52 71 45 53 37 53
(Adapted Boden and Ozonoff Annals Epidemiology 2008)
Workersrsquo CompensationState Specific Program
Mandatory insurance or if large enough self-insured
Michigan WC Excludesbull Federal employeesbull Interstate railroad workersbull Maritime workersbull Less than 3 employees at any one timebull All employees work less than 35 hoursweek or
if more hours less than 13 weeksbull Self-employed
Not computerizedbull Medical claims only
Proportion of Work-Injured Adults for Whom Treatment was paid by Workersrsquo Compensation by State-BRFSS 10 States 2007
State Injured with Payment by Workersrsquo Compensation
Texas 47 (95 CI 35-59)New York 50 (95 CI 39-60)Michigan 56 (95 CI 41-69)Massachusetts 60 (95 CI 45-75)California 61 (95 CI 55-66)Washington 61 (95 CI 55-67)Oregon 62 (95 CI 50-74)Connecticut 63 (95 CI 53-74)New Jersey 64 (95 CI 51-78)Kentucky 77 (95 CI 65-89)
Excludes self-employed
(Adapted Bonauto et al MMWR 2010)
Percentage Received Workersrsquo Compensation by Condition Michigan
WageReplacement
Medical Only
No CompEmployed
No Comp Self -Employed
Amputations 64 22 17 6Burns 17 48 33 2Skull Fractures 36 32 29 3
Percent Applied for Workersrsquo Comp among 2016 Cases of Work-Related Asthma Michigan
Overall 484
Still ExposedConditions Unchanged 239No Longer Exposed 575
Quit on Doctorrsquos Advice 778Sick Leave 727Fired 621New Controls 589Chemical Substitution 536Quit on Own 431Reassigned 360
Reasons Didnrsquot File a Workersrsquo Compensation Claims for a Repetitive Trauma Michigan
Only 397 (251) of 1598 Filed WC Claim
Injury Not Serious Enough 705 (591)Did Not Expect to Miss Work 694 (583)Expect to Receive Sick Leave or
Disability 337 (283) Medical Expenses Covered by
Other Insurance 427 (359)Did Not Think Injury Work Related 242 (204)
(Rosenman et al JOEM 2000)
Goals of Surveillance Population-Based
bull Assess Magnitude of Problembull NumbersRatesTrends
bull Determine Relative Importance vs Other Health Issuesbull Identify High Risk
bull IndustriesOccupationsWorker Populations
bull Prioritize Interventions bull Evaluate Interventionsbull Generate Hypotheses for Researchbull Identify Emerging Problemsbull Identify Workplaces for Intervention
Case-Based
Reportable Conditions in Michigan
Local Health DepartmentsCommunicable Diseases (83)
ldquoUnusual occurrence outbreak or epidemic of any disease or conditionsrdquoMDHHS
AbortionsBirth DefectsCancerChemical Poisonings including Carbon MonoxideInjuries Nursing Home Abuse
LARAOccupational Illnesses
County Department of Social ServicesChild AbuseAdult Abuse
PoliceInjury from Knife Gun or Deadly WeaponMental Health Patient Abuse
On Request Only
Laboratory Reporting Regulations Michigan
bull Arsenicbull Cadmiumbull Carboxyhemoglobinbull Cholinesterasebull IgE Antibodiesbull Leadbull Mercury
Occupational Illness Reporting Requirement in Michigan
bull LARA ndash MIOSHAPhysician hospital clinic or employer
having a known or suspected occupational disease or health condition aggravated by workplace exposures shall report within 10 days after discovery
Misdemeanor punishable by a fine of not more than $50
Methodology of Multi-Source Surveillance
Amputations 2006- DateHospitalsEDOutpatient ClinicsWorkersrsquo Compensation Wage Replacement
Crushing Injuries 2013- Date+ FACE Program
Skull Fractures 2012-DateBurns 2009-Date
+ Poison Control Center
bull Quarterly Reporting Specified ICD codes -134 Hospitalsbull Quarterly Reporting all Work-related Events ndash Poison Control Centerbull Electronic Data Base All Paid Claims ndash Workersrsquo Compensationbull FACE ndash Death CertificatesOSHA Hot LinePolice Reports
Work-Related Burn Reports ndash By Source Total 1461 Michigan 2009
n=1460 individuals
450
BLS
HOSPITALSEDs (1248)
4501054
BLSMIFACE 1(2) 1
16721
5 PCC (106)
1321 79
WC(306)
(Kica and Rosenman JOEM 2012)
California Department of Public Health John Beckman Matt Frederick Bob Harrison
California Department of Industrial Relations Genet Daba John Gordon Liza Dizon Glenn Shor Meitong Jin
California Employment Development Department Andy Wong Spencer Wong
Terry Bunn PhDDirector Kentucky Injury Prevention and Research
Center bona fide agent for the Kentucky Department for Public Health
Associate Professor Departments of Epidemiology and Preventive Medicine and Environmental Health University of Kentucky College of Public Health
bull Occupational motor vehicle crash investigations a priority focus area since 2005
KOSHS
Case Example
Case Example
bull Substance abuse a priority focus areabull State injury prevention planbull Legislation data support (HB1)
ndash Pill millsndash Clinical prescribing regulationsndash Decedent controlled substance testing lawndash Inter-state prescription drug monitoring
program (PDMP) data sharing
bull Use of PDMP data for public health surveillance
bull Inform community interventions bull Evaluate and perform cost-benefit
analysis of drug-related laws bull Establish substance use disorder
information and referral service ndash physicians (eg prevention of needle sticks
when lancing drug abuse-related abscesses)ndash first responders (eg handling of fentanyl
analogs at drug overdose scenes) ndash law enforcement (eg naloxone
administration training)ndash general public
bull Increase timeliness of public health data sources
bull Use syndromic surveillance data for drug overdose and injury surveillance
bull Algorithm development for milligram morphine equivalent calculations in PDMP reports
bull Death certificate and PDMP data linkage to identify possible drug diversion
bull State advisory group
bull Link Ky CRASH and trauma registry data with FARS driver drug testing results from fatal crashes in 2014
bull Link 2014 trauma registry toxicology result data with inpatient hospitalization data to assess drug overdose and drug abuse coding
Primary populations
bull Opioid overdose victims
bull Pregnant and parenting women
bull Individuals re-entering society upon criminal justice release
bull Adolescents and young adults
Goals
bull Prevent opioid misuse and abuse
bull Increase access to OUD treatment services (eg MAT)
bull Increase availability of recovery support services
bull Increase availability of naloxone
bull Enhance coordination and evaluation of OUD healthcare and public safety strategies
bull KRS 217186- A person or agency including a peace officer jailer firefighter paramedic or emergency medical technician or a school employee authorized to administer medication under KRS 156502 may ndash Receive a prescription for the drug
naloxonendash Possess naloxone pursuant to this
subsection and any equipment needed for its administration
ndash Administer naloxone to an individual suffering from an apparent opiate-related overdose
bull Reduce prescriber opioid prescribing (physicians APRNs etc) to a 3-day supply for injured workers
bull First line treatment based on non-opioid therapy alternatives (physical therapy acupuncture etc)
bull Revise drug formularies for treatment of pain associated with occupational injuries
Prevention Decrease likelihood that Kentuckians develop a SUD through strategies to decrease overexposure of opioid medications and illicit opioids
bull prescriptions (dosage units) overdose deaths containing fentanyl
Harm Reduction Improve Access to Harm Reduction Services to Save Lives
bull naloxone kits dispensed to first responders and public people in syringe exchange programs who received naloxone
Treatment and Recovery Expand access to treatment and recovery supports
bull peer recovery coaches Emergency Departments with peer recovery coaches people with SUD who interact with peer recovery coaches and enter treatment Emergency Department peer follow-up individuals with SUD who receive residential services calls to SUD treatment locator and portal
bull Louisville Metro Police Department presentation
bull Breakout Session
bull First Responder Opioid Exposure Survey development
bull Focus Groups
bull Survey Administration
bull Data Analysis
bull Use of Data Results
bull UK ERC first responder overdose response exposure pilot project opportunity
bull Multistate or single state applicationsndash Use of survey
ndash development of other first responder-related pilot project
FACE case investigations
bull initiated drug overdose prevention conversations
bull enhanced collaborations
bull provided evidence of need for enhanced multidisciplinary drug overdose prevention efforts1 Interventions
2 Policies
3 Research
Ladder rap
httpswwwyoutubecomwatchv=FsW6eb3aO8gampfeature=youtube
BLS Survey of Employers vs Multi-Source Surveillance of Work-Related Injuries
Kenneth D Rosenman MDProfessor of MedicineMichigan State Universitywwwoemmsuedu
NIOSH Expanding Research Partnerships Conference Denver Colorado June 21-23 2017
Funding NIOSH U60 OH008466
Survey of Occupational Injuries and Illnesses (SOII)
bull Injuries and illnesses (based on OSHArsquos recordkeeping standards) from 230000 establishments (sample by state and NAICS code)
bull Redesigned in 1992 to collect circumstances of injuries and illnesses that lead to days away from work and characteristics of affected workers
bull Scope limitations no small farms private household or self-employed workers (lt 2008 no public sector workers)
NATIONAL ACADEMY OF SCIENCES 1987
New Jersey24 Deaths not covered by OSHA35 Deaths covered by OSHA butemployer had NOT recorded on OSHAlog or did NOT keep OSHA log
TexasNIOSH Fatal Occupational Trauma Surveillance
CENSUS OF FATAL OCCUPATIONAL INJURIES (CFOI) BEGAN IN 1992
Multiple death sourcesDeath certificatesEmployer reportingState PoliceNewspaper Clipping ServiceMedical ExaminersAgricultural Extension Service
Number of deaths doubled from previous BLS estimate
How Much Work-Related Injury and Illness is Missed By the Current National Surveillance System
Rosenman KD Kalush A Reilly MJ Gardiner JC Reeves M Luo Z JOEM 2006 48357-365Funding NIOSH 5 R01 OH004276-03
Summary of Analysis Comparing BLS and Worker Comp data Michigan 2009-2001Days away from workbull BLS estimate
37-41 BLS+ WC31-34 BLS + WC+ CaptureRecapture
1999-2001 Estimates - Michiganbull BLS -281567 vs Our Estimate - 868241
1 in 15 workers vs 1 in 5 workers
(Rosenman et al JOEM 2006)
Simplified Flowchart of Events Necessary to the Documentation of Work-Related Injuries and Illnesses
(Azaroff et al AJPH 2002)
Filters to Identifying Work-Related Injuries and Illnesses
a Filters To Reporting to Supervisorsb Filters To Losing Work Time c Filters to Obtaining Medical Cared Filters to Recognizing Work-Related by Doctore Filters to Workersrsquo Compensation being the Payerf Filters To Recording on OSHA Logg Filters to Reporting by Employers to Workersrsquo
Compensation Agencyh Filters to Reporting by Doctors
(Azaroff et al AJPH 2002)
Capture-Recapture Estimates of Workplace Injury and Illness Reporting by BLS Adjusted for Capture
Heterogeneity Lost-Time Cases 1998-2001
Percent Reported to WA WV OR WI NM MNNo Source Dependence 55 76 56 65 51 68
Source Dependence 52 71 45 53 37 53
(Adapted Boden and Ozonoff Annals Epidemiology 2008)
Workersrsquo CompensationState Specific Program
Mandatory insurance or if large enough self-insured
Michigan WC Excludesbull Federal employeesbull Interstate railroad workersbull Maritime workersbull Less than 3 employees at any one timebull All employees work less than 35 hoursweek or
if more hours less than 13 weeksbull Self-employed
Not computerizedbull Medical claims only
Proportion of Work-Injured Adults for Whom Treatment was paid by Workersrsquo Compensation by State-BRFSS 10 States 2007
State Injured with Payment by Workersrsquo Compensation
Texas 47 (95 CI 35-59)New York 50 (95 CI 39-60)Michigan 56 (95 CI 41-69)Massachusetts 60 (95 CI 45-75)California 61 (95 CI 55-66)Washington 61 (95 CI 55-67)Oregon 62 (95 CI 50-74)Connecticut 63 (95 CI 53-74)New Jersey 64 (95 CI 51-78)Kentucky 77 (95 CI 65-89)
Excludes self-employed
(Adapted Bonauto et al MMWR 2010)
Percentage Received Workersrsquo Compensation by Condition Michigan
WageReplacement
Medical Only
No CompEmployed
No Comp Self -Employed
Amputations 64 22 17 6Burns 17 48 33 2Skull Fractures 36 32 29 3
Percent Applied for Workersrsquo Comp among 2016 Cases of Work-Related Asthma Michigan
Overall 484
Still ExposedConditions Unchanged 239No Longer Exposed 575
Quit on Doctorrsquos Advice 778Sick Leave 727Fired 621New Controls 589Chemical Substitution 536Quit on Own 431Reassigned 360
Reasons Didnrsquot File a Workersrsquo Compensation Claims for a Repetitive Trauma Michigan
Only 397 (251) of 1598 Filed WC Claim
Injury Not Serious Enough 705 (591)Did Not Expect to Miss Work 694 (583)Expect to Receive Sick Leave or
Disability 337 (283) Medical Expenses Covered by
Other Insurance 427 (359)Did Not Think Injury Work Related 242 (204)
(Rosenman et al JOEM 2000)
Goals of Surveillance Population-Based
bull Assess Magnitude of Problembull NumbersRatesTrends
bull Determine Relative Importance vs Other Health Issuesbull Identify High Risk
bull IndustriesOccupationsWorker Populations
bull Prioritize Interventions bull Evaluate Interventionsbull Generate Hypotheses for Researchbull Identify Emerging Problemsbull Identify Workplaces for Intervention
Case-Based
Reportable Conditions in Michigan
Local Health DepartmentsCommunicable Diseases (83)
ldquoUnusual occurrence outbreak or epidemic of any disease or conditionsrdquoMDHHS
AbortionsBirth DefectsCancerChemical Poisonings including Carbon MonoxideInjuries Nursing Home Abuse
LARAOccupational Illnesses
County Department of Social ServicesChild AbuseAdult Abuse
PoliceInjury from Knife Gun or Deadly WeaponMental Health Patient Abuse
On Request Only
Laboratory Reporting Regulations Michigan
bull Arsenicbull Cadmiumbull Carboxyhemoglobinbull Cholinesterasebull IgE Antibodiesbull Leadbull Mercury
Occupational Illness Reporting Requirement in Michigan
bull LARA ndash MIOSHAPhysician hospital clinic or employer
having a known or suspected occupational disease or health condition aggravated by workplace exposures shall report within 10 days after discovery
Misdemeanor punishable by a fine of not more than $50
Methodology of Multi-Source Surveillance
Amputations 2006- DateHospitalsEDOutpatient ClinicsWorkersrsquo Compensation Wage Replacement
Crushing Injuries 2013- Date+ FACE Program
Skull Fractures 2012-DateBurns 2009-Date
+ Poison Control Center
bull Quarterly Reporting Specified ICD codes -134 Hospitalsbull Quarterly Reporting all Work-related Events ndash Poison Control Centerbull Electronic Data Base All Paid Claims ndash Workersrsquo Compensationbull FACE ndash Death CertificatesOSHA Hot LinePolice Reports
Work-Related Burn Reports ndash By Source Total 1461 Michigan 2009
n=1460 individuals
450
BLS
HOSPITALSEDs (1248)
4501054
BLSMIFACE 1(2) 1
16721
5 PCC (106)
1321 79
WC(306)
(Kica and Rosenman JOEM 2012)
Terry Bunn PhDDirector Kentucky Injury Prevention and Research
Center bona fide agent for the Kentucky Department for Public Health
Associate Professor Departments of Epidemiology and Preventive Medicine and Environmental Health University of Kentucky College of Public Health
bull Occupational motor vehicle crash investigations a priority focus area since 2005
KOSHS
Case Example
Case Example
bull Substance abuse a priority focus areabull State injury prevention planbull Legislation data support (HB1)
ndash Pill millsndash Clinical prescribing regulationsndash Decedent controlled substance testing lawndash Inter-state prescription drug monitoring
program (PDMP) data sharing
bull Use of PDMP data for public health surveillance
bull Inform community interventions bull Evaluate and perform cost-benefit
analysis of drug-related laws bull Establish substance use disorder
information and referral service ndash physicians (eg prevention of needle sticks
when lancing drug abuse-related abscesses)ndash first responders (eg handling of fentanyl
analogs at drug overdose scenes) ndash law enforcement (eg naloxone
administration training)ndash general public
bull Increase timeliness of public health data sources
bull Use syndromic surveillance data for drug overdose and injury surveillance
bull Algorithm development for milligram morphine equivalent calculations in PDMP reports
bull Death certificate and PDMP data linkage to identify possible drug diversion
bull State advisory group
bull Link Ky CRASH and trauma registry data with FARS driver drug testing results from fatal crashes in 2014
bull Link 2014 trauma registry toxicology result data with inpatient hospitalization data to assess drug overdose and drug abuse coding
Primary populations
bull Opioid overdose victims
bull Pregnant and parenting women
bull Individuals re-entering society upon criminal justice release
bull Adolescents and young adults
Goals
bull Prevent opioid misuse and abuse
bull Increase access to OUD treatment services (eg MAT)
bull Increase availability of recovery support services
bull Increase availability of naloxone
bull Enhance coordination and evaluation of OUD healthcare and public safety strategies
bull KRS 217186- A person or agency including a peace officer jailer firefighter paramedic or emergency medical technician or a school employee authorized to administer medication under KRS 156502 may ndash Receive a prescription for the drug
naloxonendash Possess naloxone pursuant to this
subsection and any equipment needed for its administration
ndash Administer naloxone to an individual suffering from an apparent opiate-related overdose
bull Reduce prescriber opioid prescribing (physicians APRNs etc) to a 3-day supply for injured workers
bull First line treatment based on non-opioid therapy alternatives (physical therapy acupuncture etc)
bull Revise drug formularies for treatment of pain associated with occupational injuries
Prevention Decrease likelihood that Kentuckians develop a SUD through strategies to decrease overexposure of opioid medications and illicit opioids
bull prescriptions (dosage units) overdose deaths containing fentanyl
Harm Reduction Improve Access to Harm Reduction Services to Save Lives
bull naloxone kits dispensed to first responders and public people in syringe exchange programs who received naloxone
Treatment and Recovery Expand access to treatment and recovery supports
bull peer recovery coaches Emergency Departments with peer recovery coaches people with SUD who interact with peer recovery coaches and enter treatment Emergency Department peer follow-up individuals with SUD who receive residential services calls to SUD treatment locator and portal
bull Louisville Metro Police Department presentation
bull Breakout Session
bull First Responder Opioid Exposure Survey development
bull Focus Groups
bull Survey Administration
bull Data Analysis
bull Use of Data Results
bull UK ERC first responder overdose response exposure pilot project opportunity
bull Multistate or single state applicationsndash Use of survey
ndash development of other first responder-related pilot project
FACE case investigations
bull initiated drug overdose prevention conversations
bull enhanced collaborations
bull provided evidence of need for enhanced multidisciplinary drug overdose prevention efforts1 Interventions
2 Policies
3 Research
Ladder rap
httpswwwyoutubecomwatchv=FsW6eb3aO8gampfeature=youtube
BLS Survey of Employers vs Multi-Source Surveillance of Work-Related Injuries
Kenneth D Rosenman MDProfessor of MedicineMichigan State Universitywwwoemmsuedu
NIOSH Expanding Research Partnerships Conference Denver Colorado June 21-23 2017
Funding NIOSH U60 OH008466
Survey of Occupational Injuries and Illnesses (SOII)
bull Injuries and illnesses (based on OSHArsquos recordkeeping standards) from 230000 establishments (sample by state and NAICS code)
bull Redesigned in 1992 to collect circumstances of injuries and illnesses that lead to days away from work and characteristics of affected workers
bull Scope limitations no small farms private household or self-employed workers (lt 2008 no public sector workers)
NATIONAL ACADEMY OF SCIENCES 1987
New Jersey24 Deaths not covered by OSHA35 Deaths covered by OSHA butemployer had NOT recorded on OSHAlog or did NOT keep OSHA log
TexasNIOSH Fatal Occupational Trauma Surveillance
CENSUS OF FATAL OCCUPATIONAL INJURIES (CFOI) BEGAN IN 1992
Multiple death sourcesDeath certificatesEmployer reportingState PoliceNewspaper Clipping ServiceMedical ExaminersAgricultural Extension Service
Number of deaths doubled from previous BLS estimate
How Much Work-Related Injury and Illness is Missed By the Current National Surveillance System
Rosenman KD Kalush A Reilly MJ Gardiner JC Reeves M Luo Z JOEM 2006 48357-365Funding NIOSH 5 R01 OH004276-03
Summary of Analysis Comparing BLS and Worker Comp data Michigan 2009-2001Days away from workbull BLS estimate
37-41 BLS+ WC31-34 BLS + WC+ CaptureRecapture
1999-2001 Estimates - Michiganbull BLS -281567 vs Our Estimate - 868241
1 in 15 workers vs 1 in 5 workers
(Rosenman et al JOEM 2006)
Simplified Flowchart of Events Necessary to the Documentation of Work-Related Injuries and Illnesses
(Azaroff et al AJPH 2002)
Filters to Identifying Work-Related Injuries and Illnesses
a Filters To Reporting to Supervisorsb Filters To Losing Work Time c Filters to Obtaining Medical Cared Filters to Recognizing Work-Related by Doctore Filters to Workersrsquo Compensation being the Payerf Filters To Recording on OSHA Logg Filters to Reporting by Employers to Workersrsquo
Compensation Agencyh Filters to Reporting by Doctors
(Azaroff et al AJPH 2002)
Capture-Recapture Estimates of Workplace Injury and Illness Reporting by BLS Adjusted for Capture
Heterogeneity Lost-Time Cases 1998-2001
Percent Reported to WA WV OR WI NM MNNo Source Dependence 55 76 56 65 51 68
Source Dependence 52 71 45 53 37 53
(Adapted Boden and Ozonoff Annals Epidemiology 2008)
Workersrsquo CompensationState Specific Program
Mandatory insurance or if large enough self-insured
Michigan WC Excludesbull Federal employeesbull Interstate railroad workersbull Maritime workersbull Less than 3 employees at any one timebull All employees work less than 35 hoursweek or
if more hours less than 13 weeksbull Self-employed
Not computerizedbull Medical claims only
Proportion of Work-Injured Adults for Whom Treatment was paid by Workersrsquo Compensation by State-BRFSS 10 States 2007
State Injured with Payment by Workersrsquo Compensation
Texas 47 (95 CI 35-59)New York 50 (95 CI 39-60)Michigan 56 (95 CI 41-69)Massachusetts 60 (95 CI 45-75)California 61 (95 CI 55-66)Washington 61 (95 CI 55-67)Oregon 62 (95 CI 50-74)Connecticut 63 (95 CI 53-74)New Jersey 64 (95 CI 51-78)Kentucky 77 (95 CI 65-89)
Excludes self-employed
(Adapted Bonauto et al MMWR 2010)
Percentage Received Workersrsquo Compensation by Condition Michigan
WageReplacement
Medical Only
No CompEmployed
No Comp Self -Employed
Amputations 64 22 17 6Burns 17 48 33 2Skull Fractures 36 32 29 3
Percent Applied for Workersrsquo Comp among 2016 Cases of Work-Related Asthma Michigan
Overall 484
Still ExposedConditions Unchanged 239No Longer Exposed 575
Quit on Doctorrsquos Advice 778Sick Leave 727Fired 621New Controls 589Chemical Substitution 536Quit on Own 431Reassigned 360
Reasons Didnrsquot File a Workersrsquo Compensation Claims for a Repetitive Trauma Michigan
Only 397 (251) of 1598 Filed WC Claim
Injury Not Serious Enough 705 (591)Did Not Expect to Miss Work 694 (583)Expect to Receive Sick Leave or
Disability 337 (283) Medical Expenses Covered by
Other Insurance 427 (359)Did Not Think Injury Work Related 242 (204)
(Rosenman et al JOEM 2000)
Goals of Surveillance Population-Based
bull Assess Magnitude of Problembull NumbersRatesTrends
bull Determine Relative Importance vs Other Health Issuesbull Identify High Risk
bull IndustriesOccupationsWorker Populations
bull Prioritize Interventions bull Evaluate Interventionsbull Generate Hypotheses for Researchbull Identify Emerging Problemsbull Identify Workplaces for Intervention
Case-Based
Reportable Conditions in Michigan
Local Health DepartmentsCommunicable Diseases (83)
ldquoUnusual occurrence outbreak or epidemic of any disease or conditionsrdquoMDHHS
AbortionsBirth DefectsCancerChemical Poisonings including Carbon MonoxideInjuries Nursing Home Abuse
LARAOccupational Illnesses
County Department of Social ServicesChild AbuseAdult Abuse
PoliceInjury from Knife Gun or Deadly WeaponMental Health Patient Abuse
On Request Only
Laboratory Reporting Regulations Michigan
bull Arsenicbull Cadmiumbull Carboxyhemoglobinbull Cholinesterasebull IgE Antibodiesbull Leadbull Mercury
Occupational Illness Reporting Requirement in Michigan
bull LARA ndash MIOSHAPhysician hospital clinic or employer
having a known or suspected occupational disease or health condition aggravated by workplace exposures shall report within 10 days after discovery
Misdemeanor punishable by a fine of not more than $50
Methodology of Multi-Source Surveillance
Amputations 2006- DateHospitalsEDOutpatient ClinicsWorkersrsquo Compensation Wage Replacement
Crushing Injuries 2013- Date+ FACE Program
Skull Fractures 2012-DateBurns 2009-Date
+ Poison Control Center
bull Quarterly Reporting Specified ICD codes -134 Hospitalsbull Quarterly Reporting all Work-related Events ndash Poison Control Centerbull Electronic Data Base All Paid Claims ndash Workersrsquo Compensationbull FACE ndash Death CertificatesOSHA Hot LinePolice Reports
Work-Related Burn Reports ndash By Source Total 1461 Michigan 2009
n=1460 individuals
450
BLS
HOSPITALSEDs (1248)
4501054
BLSMIFACE 1(2) 1
16721
5 PCC (106)
1321 79
WC(306)
(Kica and Rosenman JOEM 2012)
bull Occupational motor vehicle crash investigations a priority focus area since 2005
KOSHS
Case Example
Case Example
bull Substance abuse a priority focus areabull State injury prevention planbull Legislation data support (HB1)
ndash Pill millsndash Clinical prescribing regulationsndash Decedent controlled substance testing lawndash Inter-state prescription drug monitoring
program (PDMP) data sharing
bull Use of PDMP data for public health surveillance
bull Inform community interventions bull Evaluate and perform cost-benefit
analysis of drug-related laws bull Establish substance use disorder
information and referral service ndash physicians (eg prevention of needle sticks
when lancing drug abuse-related abscesses)ndash first responders (eg handling of fentanyl
analogs at drug overdose scenes) ndash law enforcement (eg naloxone
administration training)ndash general public
bull Increase timeliness of public health data sources
bull Use syndromic surveillance data for drug overdose and injury surveillance
bull Algorithm development for milligram morphine equivalent calculations in PDMP reports
bull Death certificate and PDMP data linkage to identify possible drug diversion
bull State advisory group
bull Link Ky CRASH and trauma registry data with FARS driver drug testing results from fatal crashes in 2014
bull Link 2014 trauma registry toxicology result data with inpatient hospitalization data to assess drug overdose and drug abuse coding
Primary populations
bull Opioid overdose victims
bull Pregnant and parenting women
bull Individuals re-entering society upon criminal justice release
bull Adolescents and young adults
Goals
bull Prevent opioid misuse and abuse
bull Increase access to OUD treatment services (eg MAT)
bull Increase availability of recovery support services
bull Increase availability of naloxone
bull Enhance coordination and evaluation of OUD healthcare and public safety strategies
bull KRS 217186- A person or agency including a peace officer jailer firefighter paramedic or emergency medical technician or a school employee authorized to administer medication under KRS 156502 may ndash Receive a prescription for the drug
naloxonendash Possess naloxone pursuant to this
subsection and any equipment needed for its administration
ndash Administer naloxone to an individual suffering from an apparent opiate-related overdose
bull Reduce prescriber opioid prescribing (physicians APRNs etc) to a 3-day supply for injured workers
bull First line treatment based on non-opioid therapy alternatives (physical therapy acupuncture etc)
bull Revise drug formularies for treatment of pain associated with occupational injuries
Prevention Decrease likelihood that Kentuckians develop a SUD through strategies to decrease overexposure of opioid medications and illicit opioids
bull prescriptions (dosage units) overdose deaths containing fentanyl
Harm Reduction Improve Access to Harm Reduction Services to Save Lives
bull naloxone kits dispensed to first responders and public people in syringe exchange programs who received naloxone
Treatment and Recovery Expand access to treatment and recovery supports
bull peer recovery coaches Emergency Departments with peer recovery coaches people with SUD who interact with peer recovery coaches and enter treatment Emergency Department peer follow-up individuals with SUD who receive residential services calls to SUD treatment locator and portal
bull Louisville Metro Police Department presentation
bull Breakout Session
bull First Responder Opioid Exposure Survey development
bull Focus Groups
bull Survey Administration
bull Data Analysis
bull Use of Data Results
bull UK ERC first responder overdose response exposure pilot project opportunity
bull Multistate or single state applicationsndash Use of survey
ndash development of other first responder-related pilot project
FACE case investigations
bull initiated drug overdose prevention conversations
bull enhanced collaborations
bull provided evidence of need for enhanced multidisciplinary drug overdose prevention efforts1 Interventions
2 Policies
3 Research
Ladder rap
httpswwwyoutubecomwatchv=FsW6eb3aO8gampfeature=youtube
BLS Survey of Employers vs Multi-Source Surveillance of Work-Related Injuries
Kenneth D Rosenman MDProfessor of MedicineMichigan State Universitywwwoemmsuedu
NIOSH Expanding Research Partnerships Conference Denver Colorado June 21-23 2017
Funding NIOSH U60 OH008466
Survey of Occupational Injuries and Illnesses (SOII)
bull Injuries and illnesses (based on OSHArsquos recordkeeping standards) from 230000 establishments (sample by state and NAICS code)
bull Redesigned in 1992 to collect circumstances of injuries and illnesses that lead to days away from work and characteristics of affected workers
bull Scope limitations no small farms private household or self-employed workers (lt 2008 no public sector workers)
NATIONAL ACADEMY OF SCIENCES 1987
New Jersey24 Deaths not covered by OSHA35 Deaths covered by OSHA butemployer had NOT recorded on OSHAlog or did NOT keep OSHA log
TexasNIOSH Fatal Occupational Trauma Surveillance
CENSUS OF FATAL OCCUPATIONAL INJURIES (CFOI) BEGAN IN 1992
Multiple death sourcesDeath certificatesEmployer reportingState PoliceNewspaper Clipping ServiceMedical ExaminersAgricultural Extension Service
Number of deaths doubled from previous BLS estimate
How Much Work-Related Injury and Illness is Missed By the Current National Surveillance System
Rosenman KD Kalush A Reilly MJ Gardiner JC Reeves M Luo Z JOEM 2006 48357-365Funding NIOSH 5 R01 OH004276-03
Summary of Analysis Comparing BLS and Worker Comp data Michigan 2009-2001Days away from workbull BLS estimate
37-41 BLS+ WC31-34 BLS + WC+ CaptureRecapture
1999-2001 Estimates - Michiganbull BLS -281567 vs Our Estimate - 868241
1 in 15 workers vs 1 in 5 workers
(Rosenman et al JOEM 2006)
Simplified Flowchart of Events Necessary to the Documentation of Work-Related Injuries and Illnesses
(Azaroff et al AJPH 2002)
Filters to Identifying Work-Related Injuries and Illnesses
a Filters To Reporting to Supervisorsb Filters To Losing Work Time c Filters to Obtaining Medical Cared Filters to Recognizing Work-Related by Doctore Filters to Workersrsquo Compensation being the Payerf Filters To Recording on OSHA Logg Filters to Reporting by Employers to Workersrsquo
Compensation Agencyh Filters to Reporting by Doctors
(Azaroff et al AJPH 2002)
Capture-Recapture Estimates of Workplace Injury and Illness Reporting by BLS Adjusted for Capture
Heterogeneity Lost-Time Cases 1998-2001
Percent Reported to WA WV OR WI NM MNNo Source Dependence 55 76 56 65 51 68
Source Dependence 52 71 45 53 37 53
(Adapted Boden and Ozonoff Annals Epidemiology 2008)
Workersrsquo CompensationState Specific Program
Mandatory insurance or if large enough self-insured
Michigan WC Excludesbull Federal employeesbull Interstate railroad workersbull Maritime workersbull Less than 3 employees at any one timebull All employees work less than 35 hoursweek or
if more hours less than 13 weeksbull Self-employed
Not computerizedbull Medical claims only
Proportion of Work-Injured Adults for Whom Treatment was paid by Workersrsquo Compensation by State-BRFSS 10 States 2007
State Injured with Payment by Workersrsquo Compensation
Texas 47 (95 CI 35-59)New York 50 (95 CI 39-60)Michigan 56 (95 CI 41-69)Massachusetts 60 (95 CI 45-75)California 61 (95 CI 55-66)Washington 61 (95 CI 55-67)Oregon 62 (95 CI 50-74)Connecticut 63 (95 CI 53-74)New Jersey 64 (95 CI 51-78)Kentucky 77 (95 CI 65-89)
Excludes self-employed
(Adapted Bonauto et al MMWR 2010)
Percentage Received Workersrsquo Compensation by Condition Michigan
WageReplacement
Medical Only
No CompEmployed
No Comp Self -Employed
Amputations 64 22 17 6Burns 17 48 33 2Skull Fractures 36 32 29 3
Percent Applied for Workersrsquo Comp among 2016 Cases of Work-Related Asthma Michigan
Overall 484
Still ExposedConditions Unchanged 239No Longer Exposed 575
Quit on Doctorrsquos Advice 778Sick Leave 727Fired 621New Controls 589Chemical Substitution 536Quit on Own 431Reassigned 360
Reasons Didnrsquot File a Workersrsquo Compensation Claims for a Repetitive Trauma Michigan
Only 397 (251) of 1598 Filed WC Claim
Injury Not Serious Enough 705 (591)Did Not Expect to Miss Work 694 (583)Expect to Receive Sick Leave or
Disability 337 (283) Medical Expenses Covered by
Other Insurance 427 (359)Did Not Think Injury Work Related 242 (204)
(Rosenman et al JOEM 2000)
Goals of Surveillance Population-Based
bull Assess Magnitude of Problembull NumbersRatesTrends
bull Determine Relative Importance vs Other Health Issuesbull Identify High Risk
bull IndustriesOccupationsWorker Populations
bull Prioritize Interventions bull Evaluate Interventionsbull Generate Hypotheses for Researchbull Identify Emerging Problemsbull Identify Workplaces for Intervention
Case-Based
Reportable Conditions in Michigan
Local Health DepartmentsCommunicable Diseases (83)
ldquoUnusual occurrence outbreak or epidemic of any disease or conditionsrdquoMDHHS
AbortionsBirth DefectsCancerChemical Poisonings including Carbon MonoxideInjuries Nursing Home Abuse
LARAOccupational Illnesses
County Department of Social ServicesChild AbuseAdult Abuse
PoliceInjury from Knife Gun or Deadly WeaponMental Health Patient Abuse
On Request Only
Laboratory Reporting Regulations Michigan
bull Arsenicbull Cadmiumbull Carboxyhemoglobinbull Cholinesterasebull IgE Antibodiesbull Leadbull Mercury
Occupational Illness Reporting Requirement in Michigan
bull LARA ndash MIOSHAPhysician hospital clinic or employer
having a known or suspected occupational disease or health condition aggravated by workplace exposures shall report within 10 days after discovery
Misdemeanor punishable by a fine of not more than $50
Methodology of Multi-Source Surveillance
Amputations 2006- DateHospitalsEDOutpatient ClinicsWorkersrsquo Compensation Wage Replacement
Crushing Injuries 2013- Date+ FACE Program
Skull Fractures 2012-DateBurns 2009-Date
+ Poison Control Center
bull Quarterly Reporting Specified ICD codes -134 Hospitalsbull Quarterly Reporting all Work-related Events ndash Poison Control Centerbull Electronic Data Base All Paid Claims ndash Workersrsquo Compensationbull FACE ndash Death CertificatesOSHA Hot LinePolice Reports
Work-Related Burn Reports ndash By Source Total 1461 Michigan 2009
n=1460 individuals
450
BLS
HOSPITALSEDs (1248)
4501054
BLSMIFACE 1(2) 1
16721
5 PCC (106)
1321 79
WC(306)
(Kica and Rosenman JOEM 2012)
KOSHS
Case Example
Case Example
bull Substance abuse a priority focus areabull State injury prevention planbull Legislation data support (HB1)
ndash Pill millsndash Clinical prescribing regulationsndash Decedent controlled substance testing lawndash Inter-state prescription drug monitoring
program (PDMP) data sharing
bull Use of PDMP data for public health surveillance
bull Inform community interventions bull Evaluate and perform cost-benefit
analysis of drug-related laws bull Establish substance use disorder
information and referral service ndash physicians (eg prevention of needle sticks
when lancing drug abuse-related abscesses)ndash first responders (eg handling of fentanyl
analogs at drug overdose scenes) ndash law enforcement (eg naloxone
administration training)ndash general public
bull Increase timeliness of public health data sources
bull Use syndromic surveillance data for drug overdose and injury surveillance
bull Algorithm development for milligram morphine equivalent calculations in PDMP reports
bull Death certificate and PDMP data linkage to identify possible drug diversion
bull State advisory group
bull Link Ky CRASH and trauma registry data with FARS driver drug testing results from fatal crashes in 2014
bull Link 2014 trauma registry toxicology result data with inpatient hospitalization data to assess drug overdose and drug abuse coding
Primary populations
bull Opioid overdose victims
bull Pregnant and parenting women
bull Individuals re-entering society upon criminal justice release
bull Adolescents and young adults
Goals
bull Prevent opioid misuse and abuse
bull Increase access to OUD treatment services (eg MAT)
bull Increase availability of recovery support services
bull Increase availability of naloxone
bull Enhance coordination and evaluation of OUD healthcare and public safety strategies
bull KRS 217186- A person or agency including a peace officer jailer firefighter paramedic or emergency medical technician or a school employee authorized to administer medication under KRS 156502 may ndash Receive a prescription for the drug
naloxonendash Possess naloxone pursuant to this
subsection and any equipment needed for its administration
ndash Administer naloxone to an individual suffering from an apparent opiate-related overdose
bull Reduce prescriber opioid prescribing (physicians APRNs etc) to a 3-day supply for injured workers
bull First line treatment based on non-opioid therapy alternatives (physical therapy acupuncture etc)
bull Revise drug formularies for treatment of pain associated with occupational injuries
Prevention Decrease likelihood that Kentuckians develop a SUD through strategies to decrease overexposure of opioid medications and illicit opioids
bull prescriptions (dosage units) overdose deaths containing fentanyl
Harm Reduction Improve Access to Harm Reduction Services to Save Lives
bull naloxone kits dispensed to first responders and public people in syringe exchange programs who received naloxone
Treatment and Recovery Expand access to treatment and recovery supports
bull peer recovery coaches Emergency Departments with peer recovery coaches people with SUD who interact with peer recovery coaches and enter treatment Emergency Department peer follow-up individuals with SUD who receive residential services calls to SUD treatment locator and portal
bull Louisville Metro Police Department presentation
bull Breakout Session
bull First Responder Opioid Exposure Survey development
bull Focus Groups
bull Survey Administration
bull Data Analysis
bull Use of Data Results
bull UK ERC first responder overdose response exposure pilot project opportunity
bull Multistate or single state applicationsndash Use of survey
ndash development of other first responder-related pilot project
FACE case investigations
bull initiated drug overdose prevention conversations
bull enhanced collaborations
bull provided evidence of need for enhanced multidisciplinary drug overdose prevention efforts1 Interventions
2 Policies
3 Research
Ladder rap
httpswwwyoutubecomwatchv=FsW6eb3aO8gampfeature=youtube
BLS Survey of Employers vs Multi-Source Surveillance of Work-Related Injuries
Kenneth D Rosenman MDProfessor of MedicineMichigan State Universitywwwoemmsuedu
NIOSH Expanding Research Partnerships Conference Denver Colorado June 21-23 2017
Funding NIOSH U60 OH008466
Survey of Occupational Injuries and Illnesses (SOII)
bull Injuries and illnesses (based on OSHArsquos recordkeeping standards) from 230000 establishments (sample by state and NAICS code)
bull Redesigned in 1992 to collect circumstances of injuries and illnesses that lead to days away from work and characteristics of affected workers
bull Scope limitations no small farms private household or self-employed workers (lt 2008 no public sector workers)
NATIONAL ACADEMY OF SCIENCES 1987
New Jersey24 Deaths not covered by OSHA35 Deaths covered by OSHA butemployer had NOT recorded on OSHAlog or did NOT keep OSHA log
TexasNIOSH Fatal Occupational Trauma Surveillance
CENSUS OF FATAL OCCUPATIONAL INJURIES (CFOI) BEGAN IN 1992
Multiple death sourcesDeath certificatesEmployer reportingState PoliceNewspaper Clipping ServiceMedical ExaminersAgricultural Extension Service
Number of deaths doubled from previous BLS estimate
How Much Work-Related Injury and Illness is Missed By the Current National Surveillance System
Rosenman KD Kalush A Reilly MJ Gardiner JC Reeves M Luo Z JOEM 2006 48357-365Funding NIOSH 5 R01 OH004276-03
Summary of Analysis Comparing BLS and Worker Comp data Michigan 2009-2001Days away from workbull BLS estimate
37-41 BLS+ WC31-34 BLS + WC+ CaptureRecapture
1999-2001 Estimates - Michiganbull BLS -281567 vs Our Estimate - 868241
1 in 15 workers vs 1 in 5 workers
(Rosenman et al JOEM 2006)
Simplified Flowchart of Events Necessary to the Documentation of Work-Related Injuries and Illnesses
(Azaroff et al AJPH 2002)
Filters to Identifying Work-Related Injuries and Illnesses
a Filters To Reporting to Supervisorsb Filters To Losing Work Time c Filters to Obtaining Medical Cared Filters to Recognizing Work-Related by Doctore Filters to Workersrsquo Compensation being the Payerf Filters To Recording on OSHA Logg Filters to Reporting by Employers to Workersrsquo
Compensation Agencyh Filters to Reporting by Doctors
(Azaroff et al AJPH 2002)
Capture-Recapture Estimates of Workplace Injury and Illness Reporting by BLS Adjusted for Capture
Heterogeneity Lost-Time Cases 1998-2001
Percent Reported to WA WV OR WI NM MNNo Source Dependence 55 76 56 65 51 68
Source Dependence 52 71 45 53 37 53
(Adapted Boden and Ozonoff Annals Epidemiology 2008)
Workersrsquo CompensationState Specific Program
Mandatory insurance or if large enough self-insured
Michigan WC Excludesbull Federal employeesbull Interstate railroad workersbull Maritime workersbull Less than 3 employees at any one timebull All employees work less than 35 hoursweek or
if more hours less than 13 weeksbull Self-employed
Not computerizedbull Medical claims only
Proportion of Work-Injured Adults for Whom Treatment was paid by Workersrsquo Compensation by State-BRFSS 10 States 2007
State Injured with Payment by Workersrsquo Compensation
Texas 47 (95 CI 35-59)New York 50 (95 CI 39-60)Michigan 56 (95 CI 41-69)Massachusetts 60 (95 CI 45-75)California 61 (95 CI 55-66)Washington 61 (95 CI 55-67)Oregon 62 (95 CI 50-74)Connecticut 63 (95 CI 53-74)New Jersey 64 (95 CI 51-78)Kentucky 77 (95 CI 65-89)
Excludes self-employed
(Adapted Bonauto et al MMWR 2010)
Percentage Received Workersrsquo Compensation by Condition Michigan
WageReplacement
Medical Only
No CompEmployed
No Comp Self -Employed
Amputations 64 22 17 6Burns 17 48 33 2Skull Fractures 36 32 29 3
Percent Applied for Workersrsquo Comp among 2016 Cases of Work-Related Asthma Michigan
Overall 484
Still ExposedConditions Unchanged 239No Longer Exposed 575
Quit on Doctorrsquos Advice 778Sick Leave 727Fired 621New Controls 589Chemical Substitution 536Quit on Own 431Reassigned 360
Reasons Didnrsquot File a Workersrsquo Compensation Claims for a Repetitive Trauma Michigan
Only 397 (251) of 1598 Filed WC Claim
Injury Not Serious Enough 705 (591)Did Not Expect to Miss Work 694 (583)Expect to Receive Sick Leave or
Disability 337 (283) Medical Expenses Covered by
Other Insurance 427 (359)Did Not Think Injury Work Related 242 (204)
(Rosenman et al JOEM 2000)
Goals of Surveillance Population-Based
bull Assess Magnitude of Problembull NumbersRatesTrends
bull Determine Relative Importance vs Other Health Issuesbull Identify High Risk
bull IndustriesOccupationsWorker Populations
bull Prioritize Interventions bull Evaluate Interventionsbull Generate Hypotheses for Researchbull Identify Emerging Problemsbull Identify Workplaces for Intervention
Case-Based
Reportable Conditions in Michigan
Local Health DepartmentsCommunicable Diseases (83)
ldquoUnusual occurrence outbreak or epidemic of any disease or conditionsrdquoMDHHS
AbortionsBirth DefectsCancerChemical Poisonings including Carbon MonoxideInjuries Nursing Home Abuse
LARAOccupational Illnesses
County Department of Social ServicesChild AbuseAdult Abuse
PoliceInjury from Knife Gun or Deadly WeaponMental Health Patient Abuse
On Request Only
Laboratory Reporting Regulations Michigan
bull Arsenicbull Cadmiumbull Carboxyhemoglobinbull Cholinesterasebull IgE Antibodiesbull Leadbull Mercury
Occupational Illness Reporting Requirement in Michigan
bull LARA ndash MIOSHAPhysician hospital clinic or employer
having a known or suspected occupational disease or health condition aggravated by workplace exposures shall report within 10 days after discovery
Misdemeanor punishable by a fine of not more than $50
Methodology of Multi-Source Surveillance
Amputations 2006- DateHospitalsEDOutpatient ClinicsWorkersrsquo Compensation Wage Replacement
Crushing Injuries 2013- Date+ FACE Program
Skull Fractures 2012-DateBurns 2009-Date
+ Poison Control Center
bull Quarterly Reporting Specified ICD codes -134 Hospitalsbull Quarterly Reporting all Work-related Events ndash Poison Control Centerbull Electronic Data Base All Paid Claims ndash Workersrsquo Compensationbull FACE ndash Death CertificatesOSHA Hot LinePolice Reports
Work-Related Burn Reports ndash By Source Total 1461 Michigan 2009
n=1460 individuals
450
BLS
HOSPITALSEDs (1248)
4501054
BLSMIFACE 1(2) 1
16721
5 PCC (106)
1321 79
WC(306)
(Kica and Rosenman JOEM 2012)
Case Example
bull Substance abuse a priority focus areabull State injury prevention planbull Legislation data support (HB1)
ndash Pill millsndash Clinical prescribing regulationsndash Decedent controlled substance testing lawndash Inter-state prescription drug monitoring
program (PDMP) data sharing
bull Use of PDMP data for public health surveillance
bull Inform community interventions bull Evaluate and perform cost-benefit
analysis of drug-related laws bull Establish substance use disorder
information and referral service ndash physicians (eg prevention of needle sticks
when lancing drug abuse-related abscesses)ndash first responders (eg handling of fentanyl
analogs at drug overdose scenes) ndash law enforcement (eg naloxone
administration training)ndash general public
bull Increase timeliness of public health data sources
bull Use syndromic surveillance data for drug overdose and injury surveillance
bull Algorithm development for milligram morphine equivalent calculations in PDMP reports
bull Death certificate and PDMP data linkage to identify possible drug diversion
bull State advisory group
bull Link Ky CRASH and trauma registry data with FARS driver drug testing results from fatal crashes in 2014
bull Link 2014 trauma registry toxicology result data with inpatient hospitalization data to assess drug overdose and drug abuse coding
Primary populations
bull Opioid overdose victims
bull Pregnant and parenting women
bull Individuals re-entering society upon criminal justice release
bull Adolescents and young adults
Goals
bull Prevent opioid misuse and abuse
bull Increase access to OUD treatment services (eg MAT)
bull Increase availability of recovery support services
bull Increase availability of naloxone
bull Enhance coordination and evaluation of OUD healthcare and public safety strategies
bull KRS 217186- A person or agency including a peace officer jailer firefighter paramedic or emergency medical technician or a school employee authorized to administer medication under KRS 156502 may ndash Receive a prescription for the drug
naloxonendash Possess naloxone pursuant to this
subsection and any equipment needed for its administration
ndash Administer naloxone to an individual suffering from an apparent opiate-related overdose
bull Reduce prescriber opioid prescribing (physicians APRNs etc) to a 3-day supply for injured workers
bull First line treatment based on non-opioid therapy alternatives (physical therapy acupuncture etc)
bull Revise drug formularies for treatment of pain associated with occupational injuries
Prevention Decrease likelihood that Kentuckians develop a SUD through strategies to decrease overexposure of opioid medications and illicit opioids
bull prescriptions (dosage units) overdose deaths containing fentanyl
Harm Reduction Improve Access to Harm Reduction Services to Save Lives
bull naloxone kits dispensed to first responders and public people in syringe exchange programs who received naloxone
Treatment and Recovery Expand access to treatment and recovery supports
bull peer recovery coaches Emergency Departments with peer recovery coaches people with SUD who interact with peer recovery coaches and enter treatment Emergency Department peer follow-up individuals with SUD who receive residential services calls to SUD treatment locator and portal
bull Louisville Metro Police Department presentation
bull Breakout Session
bull First Responder Opioid Exposure Survey development
bull Focus Groups
bull Survey Administration
bull Data Analysis
bull Use of Data Results
bull UK ERC first responder overdose response exposure pilot project opportunity
bull Multistate or single state applicationsndash Use of survey
ndash development of other first responder-related pilot project
FACE case investigations
bull initiated drug overdose prevention conversations
bull enhanced collaborations
bull provided evidence of need for enhanced multidisciplinary drug overdose prevention efforts1 Interventions
2 Policies
3 Research
Ladder rap
httpswwwyoutubecomwatchv=FsW6eb3aO8gampfeature=youtube
BLS Survey of Employers vs Multi-Source Surveillance of Work-Related Injuries
Kenneth D Rosenman MDProfessor of MedicineMichigan State Universitywwwoemmsuedu
NIOSH Expanding Research Partnerships Conference Denver Colorado June 21-23 2017
Funding NIOSH U60 OH008466
Survey of Occupational Injuries and Illnesses (SOII)
bull Injuries and illnesses (based on OSHArsquos recordkeeping standards) from 230000 establishments (sample by state and NAICS code)
bull Redesigned in 1992 to collect circumstances of injuries and illnesses that lead to days away from work and characteristics of affected workers
bull Scope limitations no small farms private household or self-employed workers (lt 2008 no public sector workers)
NATIONAL ACADEMY OF SCIENCES 1987
New Jersey24 Deaths not covered by OSHA35 Deaths covered by OSHA butemployer had NOT recorded on OSHAlog or did NOT keep OSHA log
TexasNIOSH Fatal Occupational Trauma Surveillance
CENSUS OF FATAL OCCUPATIONAL INJURIES (CFOI) BEGAN IN 1992
Multiple death sourcesDeath certificatesEmployer reportingState PoliceNewspaper Clipping ServiceMedical ExaminersAgricultural Extension Service
Number of deaths doubled from previous BLS estimate
How Much Work-Related Injury and Illness is Missed By the Current National Surveillance System
Rosenman KD Kalush A Reilly MJ Gardiner JC Reeves M Luo Z JOEM 2006 48357-365Funding NIOSH 5 R01 OH004276-03
Summary of Analysis Comparing BLS and Worker Comp data Michigan 2009-2001Days away from workbull BLS estimate
37-41 BLS+ WC31-34 BLS + WC+ CaptureRecapture
1999-2001 Estimates - Michiganbull BLS -281567 vs Our Estimate - 868241
1 in 15 workers vs 1 in 5 workers
(Rosenman et al JOEM 2006)
Simplified Flowchart of Events Necessary to the Documentation of Work-Related Injuries and Illnesses
(Azaroff et al AJPH 2002)
Filters to Identifying Work-Related Injuries and Illnesses
a Filters To Reporting to Supervisorsb Filters To Losing Work Time c Filters to Obtaining Medical Cared Filters to Recognizing Work-Related by Doctore Filters to Workersrsquo Compensation being the Payerf Filters To Recording on OSHA Logg Filters to Reporting by Employers to Workersrsquo
Compensation Agencyh Filters to Reporting by Doctors
(Azaroff et al AJPH 2002)
Capture-Recapture Estimates of Workplace Injury and Illness Reporting by BLS Adjusted for Capture
Heterogeneity Lost-Time Cases 1998-2001
Percent Reported to WA WV OR WI NM MNNo Source Dependence 55 76 56 65 51 68
Source Dependence 52 71 45 53 37 53
(Adapted Boden and Ozonoff Annals Epidemiology 2008)
Workersrsquo CompensationState Specific Program
Mandatory insurance or if large enough self-insured
Michigan WC Excludesbull Federal employeesbull Interstate railroad workersbull Maritime workersbull Less than 3 employees at any one timebull All employees work less than 35 hoursweek or
if more hours less than 13 weeksbull Self-employed
Not computerizedbull Medical claims only
Proportion of Work-Injured Adults for Whom Treatment was paid by Workersrsquo Compensation by State-BRFSS 10 States 2007
State Injured with Payment by Workersrsquo Compensation
Texas 47 (95 CI 35-59)New York 50 (95 CI 39-60)Michigan 56 (95 CI 41-69)Massachusetts 60 (95 CI 45-75)California 61 (95 CI 55-66)Washington 61 (95 CI 55-67)Oregon 62 (95 CI 50-74)Connecticut 63 (95 CI 53-74)New Jersey 64 (95 CI 51-78)Kentucky 77 (95 CI 65-89)
Excludes self-employed
(Adapted Bonauto et al MMWR 2010)
Percentage Received Workersrsquo Compensation by Condition Michigan
WageReplacement
Medical Only
No CompEmployed
No Comp Self -Employed
Amputations 64 22 17 6Burns 17 48 33 2Skull Fractures 36 32 29 3
Percent Applied for Workersrsquo Comp among 2016 Cases of Work-Related Asthma Michigan
Overall 484
Still ExposedConditions Unchanged 239No Longer Exposed 575
Quit on Doctorrsquos Advice 778Sick Leave 727Fired 621New Controls 589Chemical Substitution 536Quit on Own 431Reassigned 360
Reasons Didnrsquot File a Workersrsquo Compensation Claims for a Repetitive Trauma Michigan
Only 397 (251) of 1598 Filed WC Claim
Injury Not Serious Enough 705 (591)Did Not Expect to Miss Work 694 (583)Expect to Receive Sick Leave or
Disability 337 (283) Medical Expenses Covered by
Other Insurance 427 (359)Did Not Think Injury Work Related 242 (204)
(Rosenman et al JOEM 2000)
Goals of Surveillance Population-Based
bull Assess Magnitude of Problembull NumbersRatesTrends
bull Determine Relative Importance vs Other Health Issuesbull Identify High Risk
bull IndustriesOccupationsWorker Populations
bull Prioritize Interventions bull Evaluate Interventionsbull Generate Hypotheses for Researchbull Identify Emerging Problemsbull Identify Workplaces for Intervention
Case-Based
Reportable Conditions in Michigan
Local Health DepartmentsCommunicable Diseases (83)
ldquoUnusual occurrence outbreak or epidemic of any disease or conditionsrdquoMDHHS
AbortionsBirth DefectsCancerChemical Poisonings including Carbon MonoxideInjuries Nursing Home Abuse
LARAOccupational Illnesses
County Department of Social ServicesChild AbuseAdult Abuse
PoliceInjury from Knife Gun or Deadly WeaponMental Health Patient Abuse
On Request Only
Laboratory Reporting Regulations Michigan
bull Arsenicbull Cadmiumbull Carboxyhemoglobinbull Cholinesterasebull IgE Antibodiesbull Leadbull Mercury
Occupational Illness Reporting Requirement in Michigan
bull LARA ndash MIOSHAPhysician hospital clinic or employer
having a known or suspected occupational disease or health condition aggravated by workplace exposures shall report within 10 days after discovery
Misdemeanor punishable by a fine of not more than $50
Methodology of Multi-Source Surveillance
Amputations 2006- DateHospitalsEDOutpatient ClinicsWorkersrsquo Compensation Wage Replacement
Crushing Injuries 2013- Date+ FACE Program
Skull Fractures 2012-DateBurns 2009-Date
+ Poison Control Center
bull Quarterly Reporting Specified ICD codes -134 Hospitalsbull Quarterly Reporting all Work-related Events ndash Poison Control Centerbull Electronic Data Base All Paid Claims ndash Workersrsquo Compensationbull FACE ndash Death CertificatesOSHA Hot LinePolice Reports
Work-Related Burn Reports ndash By Source Total 1461 Michigan 2009
n=1460 individuals
450
BLS
HOSPITALSEDs (1248)
4501054
BLSMIFACE 1(2) 1
16721
5 PCC (106)
1321 79
WC(306)
(Kica and Rosenman JOEM 2012)
bull Substance abuse a priority focus areabull State injury prevention planbull Legislation data support (HB1)
ndash Pill millsndash Clinical prescribing regulationsndash Decedent controlled substance testing lawndash Inter-state prescription drug monitoring
program (PDMP) data sharing
bull Use of PDMP data for public health surveillance
bull Inform community interventions bull Evaluate and perform cost-benefit
analysis of drug-related laws bull Establish substance use disorder
information and referral service ndash physicians (eg prevention of needle sticks
when lancing drug abuse-related abscesses)ndash first responders (eg handling of fentanyl
analogs at drug overdose scenes) ndash law enforcement (eg naloxone
administration training)ndash general public
bull Increase timeliness of public health data sources
bull Use syndromic surveillance data for drug overdose and injury surveillance
bull Algorithm development for milligram morphine equivalent calculations in PDMP reports
bull Death certificate and PDMP data linkage to identify possible drug diversion
bull State advisory group
bull Link Ky CRASH and trauma registry data with FARS driver drug testing results from fatal crashes in 2014
bull Link 2014 trauma registry toxicology result data with inpatient hospitalization data to assess drug overdose and drug abuse coding
Primary populations
bull Opioid overdose victims
bull Pregnant and parenting women
bull Individuals re-entering society upon criminal justice release
bull Adolescents and young adults
Goals
bull Prevent opioid misuse and abuse
bull Increase access to OUD treatment services (eg MAT)
bull Increase availability of recovery support services
bull Increase availability of naloxone
bull Enhance coordination and evaluation of OUD healthcare and public safety strategies
bull KRS 217186- A person or agency including a peace officer jailer firefighter paramedic or emergency medical technician or a school employee authorized to administer medication under KRS 156502 may ndash Receive a prescription for the drug
naloxonendash Possess naloxone pursuant to this
subsection and any equipment needed for its administration
ndash Administer naloxone to an individual suffering from an apparent opiate-related overdose
bull Reduce prescriber opioid prescribing (physicians APRNs etc) to a 3-day supply for injured workers
bull First line treatment based on non-opioid therapy alternatives (physical therapy acupuncture etc)
bull Revise drug formularies for treatment of pain associated with occupational injuries
Prevention Decrease likelihood that Kentuckians develop a SUD through strategies to decrease overexposure of opioid medications and illicit opioids
bull prescriptions (dosage units) overdose deaths containing fentanyl
Harm Reduction Improve Access to Harm Reduction Services to Save Lives
bull naloxone kits dispensed to first responders and public people in syringe exchange programs who received naloxone
Treatment and Recovery Expand access to treatment and recovery supports
bull peer recovery coaches Emergency Departments with peer recovery coaches people with SUD who interact with peer recovery coaches and enter treatment Emergency Department peer follow-up individuals with SUD who receive residential services calls to SUD treatment locator and portal
bull Louisville Metro Police Department presentation
bull Breakout Session
bull First Responder Opioid Exposure Survey development
bull Focus Groups
bull Survey Administration
bull Data Analysis
bull Use of Data Results
bull UK ERC first responder overdose response exposure pilot project opportunity
bull Multistate or single state applicationsndash Use of survey
ndash development of other first responder-related pilot project
FACE case investigations
bull initiated drug overdose prevention conversations
bull enhanced collaborations
bull provided evidence of need for enhanced multidisciplinary drug overdose prevention efforts1 Interventions
2 Policies
3 Research
Ladder rap
httpswwwyoutubecomwatchv=FsW6eb3aO8gampfeature=youtube
BLS Survey of Employers vs Multi-Source Surveillance of Work-Related Injuries
Kenneth D Rosenman MDProfessor of MedicineMichigan State Universitywwwoemmsuedu
NIOSH Expanding Research Partnerships Conference Denver Colorado June 21-23 2017
Funding NIOSH U60 OH008466
Survey of Occupational Injuries and Illnesses (SOII)
bull Injuries and illnesses (based on OSHArsquos recordkeeping standards) from 230000 establishments (sample by state and NAICS code)
bull Redesigned in 1992 to collect circumstances of injuries and illnesses that lead to days away from work and characteristics of affected workers
bull Scope limitations no small farms private household or self-employed workers (lt 2008 no public sector workers)
NATIONAL ACADEMY OF SCIENCES 1987
New Jersey24 Deaths not covered by OSHA35 Deaths covered by OSHA butemployer had NOT recorded on OSHAlog or did NOT keep OSHA log
TexasNIOSH Fatal Occupational Trauma Surveillance
CENSUS OF FATAL OCCUPATIONAL INJURIES (CFOI) BEGAN IN 1992
Multiple death sourcesDeath certificatesEmployer reportingState PoliceNewspaper Clipping ServiceMedical ExaminersAgricultural Extension Service
Number of deaths doubled from previous BLS estimate
How Much Work-Related Injury and Illness is Missed By the Current National Surveillance System
Rosenman KD Kalush A Reilly MJ Gardiner JC Reeves M Luo Z JOEM 2006 48357-365Funding NIOSH 5 R01 OH004276-03
Summary of Analysis Comparing BLS and Worker Comp data Michigan 2009-2001Days away from workbull BLS estimate
37-41 BLS+ WC31-34 BLS + WC+ CaptureRecapture
1999-2001 Estimates - Michiganbull BLS -281567 vs Our Estimate - 868241
1 in 15 workers vs 1 in 5 workers
(Rosenman et al JOEM 2006)
Simplified Flowchart of Events Necessary to the Documentation of Work-Related Injuries and Illnesses
(Azaroff et al AJPH 2002)
Filters to Identifying Work-Related Injuries and Illnesses
a Filters To Reporting to Supervisorsb Filters To Losing Work Time c Filters to Obtaining Medical Cared Filters to Recognizing Work-Related by Doctore Filters to Workersrsquo Compensation being the Payerf Filters To Recording on OSHA Logg Filters to Reporting by Employers to Workersrsquo
Compensation Agencyh Filters to Reporting by Doctors
(Azaroff et al AJPH 2002)
Capture-Recapture Estimates of Workplace Injury and Illness Reporting by BLS Adjusted for Capture
Heterogeneity Lost-Time Cases 1998-2001
Percent Reported to WA WV OR WI NM MNNo Source Dependence 55 76 56 65 51 68
Source Dependence 52 71 45 53 37 53
(Adapted Boden and Ozonoff Annals Epidemiology 2008)
Workersrsquo CompensationState Specific Program
Mandatory insurance or if large enough self-insured
Michigan WC Excludesbull Federal employeesbull Interstate railroad workersbull Maritime workersbull Less than 3 employees at any one timebull All employees work less than 35 hoursweek or
if more hours less than 13 weeksbull Self-employed
Not computerizedbull Medical claims only
Proportion of Work-Injured Adults for Whom Treatment was paid by Workersrsquo Compensation by State-BRFSS 10 States 2007
State Injured with Payment by Workersrsquo Compensation
Texas 47 (95 CI 35-59)New York 50 (95 CI 39-60)Michigan 56 (95 CI 41-69)Massachusetts 60 (95 CI 45-75)California 61 (95 CI 55-66)Washington 61 (95 CI 55-67)Oregon 62 (95 CI 50-74)Connecticut 63 (95 CI 53-74)New Jersey 64 (95 CI 51-78)Kentucky 77 (95 CI 65-89)
Excludes self-employed
(Adapted Bonauto et al MMWR 2010)
Percentage Received Workersrsquo Compensation by Condition Michigan
WageReplacement
Medical Only
No CompEmployed
No Comp Self -Employed
Amputations 64 22 17 6Burns 17 48 33 2Skull Fractures 36 32 29 3
Percent Applied for Workersrsquo Comp among 2016 Cases of Work-Related Asthma Michigan
Overall 484
Still ExposedConditions Unchanged 239No Longer Exposed 575
Quit on Doctorrsquos Advice 778Sick Leave 727Fired 621New Controls 589Chemical Substitution 536Quit on Own 431Reassigned 360
Reasons Didnrsquot File a Workersrsquo Compensation Claims for a Repetitive Trauma Michigan
Only 397 (251) of 1598 Filed WC Claim
Injury Not Serious Enough 705 (591)Did Not Expect to Miss Work 694 (583)Expect to Receive Sick Leave or
Disability 337 (283) Medical Expenses Covered by
Other Insurance 427 (359)Did Not Think Injury Work Related 242 (204)
(Rosenman et al JOEM 2000)
Goals of Surveillance Population-Based
bull Assess Magnitude of Problembull NumbersRatesTrends
bull Determine Relative Importance vs Other Health Issuesbull Identify High Risk
bull IndustriesOccupationsWorker Populations
bull Prioritize Interventions bull Evaluate Interventionsbull Generate Hypotheses for Researchbull Identify Emerging Problemsbull Identify Workplaces for Intervention
Case-Based
Reportable Conditions in Michigan
Local Health DepartmentsCommunicable Diseases (83)
ldquoUnusual occurrence outbreak or epidemic of any disease or conditionsrdquoMDHHS
AbortionsBirth DefectsCancerChemical Poisonings including Carbon MonoxideInjuries Nursing Home Abuse
LARAOccupational Illnesses
County Department of Social ServicesChild AbuseAdult Abuse
PoliceInjury from Knife Gun or Deadly WeaponMental Health Patient Abuse
On Request Only
Laboratory Reporting Regulations Michigan
bull Arsenicbull Cadmiumbull Carboxyhemoglobinbull Cholinesterasebull IgE Antibodiesbull Leadbull Mercury
Occupational Illness Reporting Requirement in Michigan
bull LARA ndash MIOSHAPhysician hospital clinic or employer
having a known or suspected occupational disease or health condition aggravated by workplace exposures shall report within 10 days after discovery
Misdemeanor punishable by a fine of not more than $50
Methodology of Multi-Source Surveillance
Amputations 2006- DateHospitalsEDOutpatient ClinicsWorkersrsquo Compensation Wage Replacement
Crushing Injuries 2013- Date+ FACE Program
Skull Fractures 2012-DateBurns 2009-Date
+ Poison Control Center
bull Quarterly Reporting Specified ICD codes -134 Hospitalsbull Quarterly Reporting all Work-related Events ndash Poison Control Centerbull Electronic Data Base All Paid Claims ndash Workersrsquo Compensationbull FACE ndash Death CertificatesOSHA Hot LinePolice Reports
Work-Related Burn Reports ndash By Source Total 1461 Michigan 2009
n=1460 individuals
450
BLS
HOSPITALSEDs (1248)
4501054
BLSMIFACE 1(2) 1
16721
5 PCC (106)
1321 79
WC(306)
(Kica and Rosenman JOEM 2012)
bull Use of PDMP data for public health surveillance
bull Inform community interventions bull Evaluate and perform cost-benefit
analysis of drug-related laws bull Establish substance use disorder
information and referral service ndash physicians (eg prevention of needle sticks
when lancing drug abuse-related abscesses)ndash first responders (eg handling of fentanyl
analogs at drug overdose scenes) ndash law enforcement (eg naloxone
administration training)ndash general public
bull Increase timeliness of public health data sources
bull Use syndromic surveillance data for drug overdose and injury surveillance
bull Algorithm development for milligram morphine equivalent calculations in PDMP reports
bull Death certificate and PDMP data linkage to identify possible drug diversion
bull State advisory group
bull Link Ky CRASH and trauma registry data with FARS driver drug testing results from fatal crashes in 2014
bull Link 2014 trauma registry toxicology result data with inpatient hospitalization data to assess drug overdose and drug abuse coding
Primary populations
bull Opioid overdose victims
bull Pregnant and parenting women
bull Individuals re-entering society upon criminal justice release
bull Adolescents and young adults
Goals
bull Prevent opioid misuse and abuse
bull Increase access to OUD treatment services (eg MAT)
bull Increase availability of recovery support services
bull Increase availability of naloxone
bull Enhance coordination and evaluation of OUD healthcare and public safety strategies
bull KRS 217186- A person or agency including a peace officer jailer firefighter paramedic or emergency medical technician or a school employee authorized to administer medication under KRS 156502 may ndash Receive a prescription for the drug
naloxonendash Possess naloxone pursuant to this
subsection and any equipment needed for its administration
ndash Administer naloxone to an individual suffering from an apparent opiate-related overdose
bull Reduce prescriber opioid prescribing (physicians APRNs etc) to a 3-day supply for injured workers
bull First line treatment based on non-opioid therapy alternatives (physical therapy acupuncture etc)
bull Revise drug formularies for treatment of pain associated with occupational injuries
Prevention Decrease likelihood that Kentuckians develop a SUD through strategies to decrease overexposure of opioid medications and illicit opioids
bull prescriptions (dosage units) overdose deaths containing fentanyl
Harm Reduction Improve Access to Harm Reduction Services to Save Lives
bull naloxone kits dispensed to first responders and public people in syringe exchange programs who received naloxone
Treatment and Recovery Expand access to treatment and recovery supports
bull peer recovery coaches Emergency Departments with peer recovery coaches people with SUD who interact with peer recovery coaches and enter treatment Emergency Department peer follow-up individuals with SUD who receive residential services calls to SUD treatment locator and portal
bull Louisville Metro Police Department presentation
bull Breakout Session
bull First Responder Opioid Exposure Survey development
bull Focus Groups
bull Survey Administration
bull Data Analysis
bull Use of Data Results
bull UK ERC first responder overdose response exposure pilot project opportunity
bull Multistate or single state applicationsndash Use of survey
ndash development of other first responder-related pilot project
FACE case investigations
bull initiated drug overdose prevention conversations
bull enhanced collaborations
bull provided evidence of need for enhanced multidisciplinary drug overdose prevention efforts1 Interventions
2 Policies
3 Research
Ladder rap
httpswwwyoutubecomwatchv=FsW6eb3aO8gampfeature=youtube
BLS Survey of Employers vs Multi-Source Surveillance of Work-Related Injuries
Kenneth D Rosenman MDProfessor of MedicineMichigan State Universitywwwoemmsuedu
NIOSH Expanding Research Partnerships Conference Denver Colorado June 21-23 2017
Funding NIOSH U60 OH008466
Survey of Occupational Injuries and Illnesses (SOII)
bull Injuries and illnesses (based on OSHArsquos recordkeeping standards) from 230000 establishments (sample by state and NAICS code)
bull Redesigned in 1992 to collect circumstances of injuries and illnesses that lead to days away from work and characteristics of affected workers
bull Scope limitations no small farms private household or self-employed workers (lt 2008 no public sector workers)
NATIONAL ACADEMY OF SCIENCES 1987
New Jersey24 Deaths not covered by OSHA35 Deaths covered by OSHA butemployer had NOT recorded on OSHAlog or did NOT keep OSHA log
TexasNIOSH Fatal Occupational Trauma Surveillance
CENSUS OF FATAL OCCUPATIONAL INJURIES (CFOI) BEGAN IN 1992
Multiple death sourcesDeath certificatesEmployer reportingState PoliceNewspaper Clipping ServiceMedical ExaminersAgricultural Extension Service
Number of deaths doubled from previous BLS estimate
How Much Work-Related Injury and Illness is Missed By the Current National Surveillance System
Rosenman KD Kalush A Reilly MJ Gardiner JC Reeves M Luo Z JOEM 2006 48357-365Funding NIOSH 5 R01 OH004276-03
Summary of Analysis Comparing BLS and Worker Comp data Michigan 2009-2001Days away from workbull BLS estimate
37-41 BLS+ WC31-34 BLS + WC+ CaptureRecapture
1999-2001 Estimates - Michiganbull BLS -281567 vs Our Estimate - 868241
1 in 15 workers vs 1 in 5 workers
(Rosenman et al JOEM 2006)
Simplified Flowchart of Events Necessary to the Documentation of Work-Related Injuries and Illnesses
(Azaroff et al AJPH 2002)
Filters to Identifying Work-Related Injuries and Illnesses
a Filters To Reporting to Supervisorsb Filters To Losing Work Time c Filters to Obtaining Medical Cared Filters to Recognizing Work-Related by Doctore Filters to Workersrsquo Compensation being the Payerf Filters To Recording on OSHA Logg Filters to Reporting by Employers to Workersrsquo
Compensation Agencyh Filters to Reporting by Doctors
(Azaroff et al AJPH 2002)
Capture-Recapture Estimates of Workplace Injury and Illness Reporting by BLS Adjusted for Capture
Heterogeneity Lost-Time Cases 1998-2001
Percent Reported to WA WV OR WI NM MNNo Source Dependence 55 76 56 65 51 68
Source Dependence 52 71 45 53 37 53
(Adapted Boden and Ozonoff Annals Epidemiology 2008)
Workersrsquo CompensationState Specific Program
Mandatory insurance or if large enough self-insured
Michigan WC Excludesbull Federal employeesbull Interstate railroad workersbull Maritime workersbull Less than 3 employees at any one timebull All employees work less than 35 hoursweek or
if more hours less than 13 weeksbull Self-employed
Not computerizedbull Medical claims only
Proportion of Work-Injured Adults for Whom Treatment was paid by Workersrsquo Compensation by State-BRFSS 10 States 2007
State Injured with Payment by Workersrsquo Compensation
Texas 47 (95 CI 35-59)New York 50 (95 CI 39-60)Michigan 56 (95 CI 41-69)Massachusetts 60 (95 CI 45-75)California 61 (95 CI 55-66)Washington 61 (95 CI 55-67)Oregon 62 (95 CI 50-74)Connecticut 63 (95 CI 53-74)New Jersey 64 (95 CI 51-78)Kentucky 77 (95 CI 65-89)
Excludes self-employed
(Adapted Bonauto et al MMWR 2010)
Percentage Received Workersrsquo Compensation by Condition Michigan
WageReplacement
Medical Only
No CompEmployed
No Comp Self -Employed
Amputations 64 22 17 6Burns 17 48 33 2Skull Fractures 36 32 29 3
Percent Applied for Workersrsquo Comp among 2016 Cases of Work-Related Asthma Michigan
Overall 484
Still ExposedConditions Unchanged 239No Longer Exposed 575
Quit on Doctorrsquos Advice 778Sick Leave 727Fired 621New Controls 589Chemical Substitution 536Quit on Own 431Reassigned 360
Reasons Didnrsquot File a Workersrsquo Compensation Claims for a Repetitive Trauma Michigan
Only 397 (251) of 1598 Filed WC Claim
Injury Not Serious Enough 705 (591)Did Not Expect to Miss Work 694 (583)Expect to Receive Sick Leave or
Disability 337 (283) Medical Expenses Covered by
Other Insurance 427 (359)Did Not Think Injury Work Related 242 (204)
(Rosenman et al JOEM 2000)
Goals of Surveillance Population-Based
bull Assess Magnitude of Problembull NumbersRatesTrends
bull Determine Relative Importance vs Other Health Issuesbull Identify High Risk
bull IndustriesOccupationsWorker Populations
bull Prioritize Interventions bull Evaluate Interventionsbull Generate Hypotheses for Researchbull Identify Emerging Problemsbull Identify Workplaces for Intervention
Case-Based
Reportable Conditions in Michigan
Local Health DepartmentsCommunicable Diseases (83)
ldquoUnusual occurrence outbreak or epidemic of any disease or conditionsrdquoMDHHS
AbortionsBirth DefectsCancerChemical Poisonings including Carbon MonoxideInjuries Nursing Home Abuse
LARAOccupational Illnesses
County Department of Social ServicesChild AbuseAdult Abuse
PoliceInjury from Knife Gun or Deadly WeaponMental Health Patient Abuse
On Request Only
Laboratory Reporting Regulations Michigan
bull Arsenicbull Cadmiumbull Carboxyhemoglobinbull Cholinesterasebull IgE Antibodiesbull Leadbull Mercury
Occupational Illness Reporting Requirement in Michigan
bull LARA ndash MIOSHAPhysician hospital clinic or employer
having a known or suspected occupational disease or health condition aggravated by workplace exposures shall report within 10 days after discovery
Misdemeanor punishable by a fine of not more than $50
Methodology of Multi-Source Surveillance
Amputations 2006- DateHospitalsEDOutpatient ClinicsWorkersrsquo Compensation Wage Replacement
Crushing Injuries 2013- Date+ FACE Program
Skull Fractures 2012-DateBurns 2009-Date
+ Poison Control Center
bull Quarterly Reporting Specified ICD codes -134 Hospitalsbull Quarterly Reporting all Work-related Events ndash Poison Control Centerbull Electronic Data Base All Paid Claims ndash Workersrsquo Compensationbull FACE ndash Death CertificatesOSHA Hot LinePolice Reports
Work-Related Burn Reports ndash By Source Total 1461 Michigan 2009
n=1460 individuals
450
BLS
HOSPITALSEDs (1248)
4501054
BLSMIFACE 1(2) 1
16721
5 PCC (106)
1321 79
WC(306)
(Kica and Rosenman JOEM 2012)
bull Increase timeliness of public health data sources
bull Use syndromic surveillance data for drug overdose and injury surveillance
bull Algorithm development for milligram morphine equivalent calculations in PDMP reports
bull Death certificate and PDMP data linkage to identify possible drug diversion
bull State advisory group
bull Link Ky CRASH and trauma registry data with FARS driver drug testing results from fatal crashes in 2014
bull Link 2014 trauma registry toxicology result data with inpatient hospitalization data to assess drug overdose and drug abuse coding
Primary populations
bull Opioid overdose victims
bull Pregnant and parenting women
bull Individuals re-entering society upon criminal justice release
bull Adolescents and young adults
Goals
bull Prevent opioid misuse and abuse
bull Increase access to OUD treatment services (eg MAT)
bull Increase availability of recovery support services
bull Increase availability of naloxone
bull Enhance coordination and evaluation of OUD healthcare and public safety strategies
bull KRS 217186- A person or agency including a peace officer jailer firefighter paramedic or emergency medical technician or a school employee authorized to administer medication under KRS 156502 may ndash Receive a prescription for the drug
naloxonendash Possess naloxone pursuant to this
subsection and any equipment needed for its administration
ndash Administer naloxone to an individual suffering from an apparent opiate-related overdose
bull Reduce prescriber opioid prescribing (physicians APRNs etc) to a 3-day supply for injured workers
bull First line treatment based on non-opioid therapy alternatives (physical therapy acupuncture etc)
bull Revise drug formularies for treatment of pain associated with occupational injuries
Prevention Decrease likelihood that Kentuckians develop a SUD through strategies to decrease overexposure of opioid medications and illicit opioids
bull prescriptions (dosage units) overdose deaths containing fentanyl
Harm Reduction Improve Access to Harm Reduction Services to Save Lives
bull naloxone kits dispensed to first responders and public people in syringe exchange programs who received naloxone
Treatment and Recovery Expand access to treatment and recovery supports
bull peer recovery coaches Emergency Departments with peer recovery coaches people with SUD who interact with peer recovery coaches and enter treatment Emergency Department peer follow-up individuals with SUD who receive residential services calls to SUD treatment locator and portal
bull Louisville Metro Police Department presentation
bull Breakout Session
bull First Responder Opioid Exposure Survey development
bull Focus Groups
bull Survey Administration
bull Data Analysis
bull Use of Data Results
bull UK ERC first responder overdose response exposure pilot project opportunity
bull Multistate or single state applicationsndash Use of survey
ndash development of other first responder-related pilot project
FACE case investigations
bull initiated drug overdose prevention conversations
bull enhanced collaborations
bull provided evidence of need for enhanced multidisciplinary drug overdose prevention efforts1 Interventions
2 Policies
3 Research
Ladder rap
httpswwwyoutubecomwatchv=FsW6eb3aO8gampfeature=youtube
BLS Survey of Employers vs Multi-Source Surveillance of Work-Related Injuries
Kenneth D Rosenman MDProfessor of MedicineMichigan State Universitywwwoemmsuedu
NIOSH Expanding Research Partnerships Conference Denver Colorado June 21-23 2017
Funding NIOSH U60 OH008466
Survey of Occupational Injuries and Illnesses (SOII)
bull Injuries and illnesses (based on OSHArsquos recordkeeping standards) from 230000 establishments (sample by state and NAICS code)
bull Redesigned in 1992 to collect circumstances of injuries and illnesses that lead to days away from work and characteristics of affected workers
bull Scope limitations no small farms private household or self-employed workers (lt 2008 no public sector workers)
NATIONAL ACADEMY OF SCIENCES 1987
New Jersey24 Deaths not covered by OSHA35 Deaths covered by OSHA butemployer had NOT recorded on OSHAlog or did NOT keep OSHA log
TexasNIOSH Fatal Occupational Trauma Surveillance
CENSUS OF FATAL OCCUPATIONAL INJURIES (CFOI) BEGAN IN 1992
Multiple death sourcesDeath certificatesEmployer reportingState PoliceNewspaper Clipping ServiceMedical ExaminersAgricultural Extension Service
Number of deaths doubled from previous BLS estimate
How Much Work-Related Injury and Illness is Missed By the Current National Surveillance System
Rosenman KD Kalush A Reilly MJ Gardiner JC Reeves M Luo Z JOEM 2006 48357-365Funding NIOSH 5 R01 OH004276-03
Summary of Analysis Comparing BLS and Worker Comp data Michigan 2009-2001Days away from workbull BLS estimate
37-41 BLS+ WC31-34 BLS + WC+ CaptureRecapture
1999-2001 Estimates - Michiganbull BLS -281567 vs Our Estimate - 868241
1 in 15 workers vs 1 in 5 workers
(Rosenman et al JOEM 2006)
Simplified Flowchart of Events Necessary to the Documentation of Work-Related Injuries and Illnesses
(Azaroff et al AJPH 2002)
Filters to Identifying Work-Related Injuries and Illnesses
a Filters To Reporting to Supervisorsb Filters To Losing Work Time c Filters to Obtaining Medical Cared Filters to Recognizing Work-Related by Doctore Filters to Workersrsquo Compensation being the Payerf Filters To Recording on OSHA Logg Filters to Reporting by Employers to Workersrsquo
Compensation Agencyh Filters to Reporting by Doctors
(Azaroff et al AJPH 2002)
Capture-Recapture Estimates of Workplace Injury and Illness Reporting by BLS Adjusted for Capture
Heterogeneity Lost-Time Cases 1998-2001
Percent Reported to WA WV OR WI NM MNNo Source Dependence 55 76 56 65 51 68
Source Dependence 52 71 45 53 37 53
(Adapted Boden and Ozonoff Annals Epidemiology 2008)
Workersrsquo CompensationState Specific Program
Mandatory insurance or if large enough self-insured
Michigan WC Excludesbull Federal employeesbull Interstate railroad workersbull Maritime workersbull Less than 3 employees at any one timebull All employees work less than 35 hoursweek or
if more hours less than 13 weeksbull Self-employed
Not computerizedbull Medical claims only
Proportion of Work-Injured Adults for Whom Treatment was paid by Workersrsquo Compensation by State-BRFSS 10 States 2007
State Injured with Payment by Workersrsquo Compensation
Texas 47 (95 CI 35-59)New York 50 (95 CI 39-60)Michigan 56 (95 CI 41-69)Massachusetts 60 (95 CI 45-75)California 61 (95 CI 55-66)Washington 61 (95 CI 55-67)Oregon 62 (95 CI 50-74)Connecticut 63 (95 CI 53-74)New Jersey 64 (95 CI 51-78)Kentucky 77 (95 CI 65-89)
Excludes self-employed
(Adapted Bonauto et al MMWR 2010)
Percentage Received Workersrsquo Compensation by Condition Michigan
WageReplacement
Medical Only
No CompEmployed
No Comp Self -Employed
Amputations 64 22 17 6Burns 17 48 33 2Skull Fractures 36 32 29 3
Percent Applied for Workersrsquo Comp among 2016 Cases of Work-Related Asthma Michigan
Overall 484
Still ExposedConditions Unchanged 239No Longer Exposed 575
Quit on Doctorrsquos Advice 778Sick Leave 727Fired 621New Controls 589Chemical Substitution 536Quit on Own 431Reassigned 360
Reasons Didnrsquot File a Workersrsquo Compensation Claims for a Repetitive Trauma Michigan
Only 397 (251) of 1598 Filed WC Claim
Injury Not Serious Enough 705 (591)Did Not Expect to Miss Work 694 (583)Expect to Receive Sick Leave or
Disability 337 (283) Medical Expenses Covered by
Other Insurance 427 (359)Did Not Think Injury Work Related 242 (204)
(Rosenman et al JOEM 2000)
Goals of Surveillance Population-Based
bull Assess Magnitude of Problembull NumbersRatesTrends
bull Determine Relative Importance vs Other Health Issuesbull Identify High Risk
bull IndustriesOccupationsWorker Populations
bull Prioritize Interventions bull Evaluate Interventionsbull Generate Hypotheses for Researchbull Identify Emerging Problemsbull Identify Workplaces for Intervention
Case-Based
Reportable Conditions in Michigan
Local Health DepartmentsCommunicable Diseases (83)
ldquoUnusual occurrence outbreak or epidemic of any disease or conditionsrdquoMDHHS
AbortionsBirth DefectsCancerChemical Poisonings including Carbon MonoxideInjuries Nursing Home Abuse
LARAOccupational Illnesses
County Department of Social ServicesChild AbuseAdult Abuse
PoliceInjury from Knife Gun or Deadly WeaponMental Health Patient Abuse
On Request Only
Laboratory Reporting Regulations Michigan
bull Arsenicbull Cadmiumbull Carboxyhemoglobinbull Cholinesterasebull IgE Antibodiesbull Leadbull Mercury
Occupational Illness Reporting Requirement in Michigan
bull LARA ndash MIOSHAPhysician hospital clinic or employer
having a known or suspected occupational disease or health condition aggravated by workplace exposures shall report within 10 days after discovery
Misdemeanor punishable by a fine of not more than $50
Methodology of Multi-Source Surveillance
Amputations 2006- DateHospitalsEDOutpatient ClinicsWorkersrsquo Compensation Wage Replacement
Crushing Injuries 2013- Date+ FACE Program
Skull Fractures 2012-DateBurns 2009-Date
+ Poison Control Center
bull Quarterly Reporting Specified ICD codes -134 Hospitalsbull Quarterly Reporting all Work-related Events ndash Poison Control Centerbull Electronic Data Base All Paid Claims ndash Workersrsquo Compensationbull FACE ndash Death CertificatesOSHA Hot LinePolice Reports
Work-Related Burn Reports ndash By Source Total 1461 Michigan 2009
n=1460 individuals
450
BLS
HOSPITALSEDs (1248)
4501054
BLSMIFACE 1(2) 1
16721
5 PCC (106)
1321 79
WC(306)
(Kica and Rosenman JOEM 2012)
bull Algorithm development for milligram morphine equivalent calculations in PDMP reports
bull Death certificate and PDMP data linkage to identify possible drug diversion
bull State advisory group
bull Link Ky CRASH and trauma registry data with FARS driver drug testing results from fatal crashes in 2014
bull Link 2014 trauma registry toxicology result data with inpatient hospitalization data to assess drug overdose and drug abuse coding
Primary populations
bull Opioid overdose victims
bull Pregnant and parenting women
bull Individuals re-entering society upon criminal justice release
bull Adolescents and young adults
Goals
bull Prevent opioid misuse and abuse
bull Increase access to OUD treatment services (eg MAT)
bull Increase availability of recovery support services
bull Increase availability of naloxone
bull Enhance coordination and evaluation of OUD healthcare and public safety strategies
bull KRS 217186- A person or agency including a peace officer jailer firefighter paramedic or emergency medical technician or a school employee authorized to administer medication under KRS 156502 may ndash Receive a prescription for the drug
naloxonendash Possess naloxone pursuant to this
subsection and any equipment needed for its administration
ndash Administer naloxone to an individual suffering from an apparent opiate-related overdose
bull Reduce prescriber opioid prescribing (physicians APRNs etc) to a 3-day supply for injured workers
bull First line treatment based on non-opioid therapy alternatives (physical therapy acupuncture etc)
bull Revise drug formularies for treatment of pain associated with occupational injuries
Prevention Decrease likelihood that Kentuckians develop a SUD through strategies to decrease overexposure of opioid medications and illicit opioids
bull prescriptions (dosage units) overdose deaths containing fentanyl
Harm Reduction Improve Access to Harm Reduction Services to Save Lives
bull naloxone kits dispensed to first responders and public people in syringe exchange programs who received naloxone
Treatment and Recovery Expand access to treatment and recovery supports
bull peer recovery coaches Emergency Departments with peer recovery coaches people with SUD who interact with peer recovery coaches and enter treatment Emergency Department peer follow-up individuals with SUD who receive residential services calls to SUD treatment locator and portal
bull Louisville Metro Police Department presentation
bull Breakout Session
bull First Responder Opioid Exposure Survey development
bull Focus Groups
bull Survey Administration
bull Data Analysis
bull Use of Data Results
bull UK ERC first responder overdose response exposure pilot project opportunity
bull Multistate or single state applicationsndash Use of survey
ndash development of other first responder-related pilot project
FACE case investigations
bull initiated drug overdose prevention conversations
bull enhanced collaborations
bull provided evidence of need for enhanced multidisciplinary drug overdose prevention efforts1 Interventions
2 Policies
3 Research
Ladder rap
httpswwwyoutubecomwatchv=FsW6eb3aO8gampfeature=youtube
BLS Survey of Employers vs Multi-Source Surveillance of Work-Related Injuries
Kenneth D Rosenman MDProfessor of MedicineMichigan State Universitywwwoemmsuedu
NIOSH Expanding Research Partnerships Conference Denver Colorado June 21-23 2017
Funding NIOSH U60 OH008466
Survey of Occupational Injuries and Illnesses (SOII)
bull Injuries and illnesses (based on OSHArsquos recordkeeping standards) from 230000 establishments (sample by state and NAICS code)
bull Redesigned in 1992 to collect circumstances of injuries and illnesses that lead to days away from work and characteristics of affected workers
bull Scope limitations no small farms private household or self-employed workers (lt 2008 no public sector workers)
NATIONAL ACADEMY OF SCIENCES 1987
New Jersey24 Deaths not covered by OSHA35 Deaths covered by OSHA butemployer had NOT recorded on OSHAlog or did NOT keep OSHA log
TexasNIOSH Fatal Occupational Trauma Surveillance
CENSUS OF FATAL OCCUPATIONAL INJURIES (CFOI) BEGAN IN 1992
Multiple death sourcesDeath certificatesEmployer reportingState PoliceNewspaper Clipping ServiceMedical ExaminersAgricultural Extension Service
Number of deaths doubled from previous BLS estimate
How Much Work-Related Injury and Illness is Missed By the Current National Surveillance System
Rosenman KD Kalush A Reilly MJ Gardiner JC Reeves M Luo Z JOEM 2006 48357-365Funding NIOSH 5 R01 OH004276-03
Summary of Analysis Comparing BLS and Worker Comp data Michigan 2009-2001Days away from workbull BLS estimate
37-41 BLS+ WC31-34 BLS + WC+ CaptureRecapture
1999-2001 Estimates - Michiganbull BLS -281567 vs Our Estimate - 868241
1 in 15 workers vs 1 in 5 workers
(Rosenman et al JOEM 2006)
Simplified Flowchart of Events Necessary to the Documentation of Work-Related Injuries and Illnesses
(Azaroff et al AJPH 2002)
Filters to Identifying Work-Related Injuries and Illnesses
a Filters To Reporting to Supervisorsb Filters To Losing Work Time c Filters to Obtaining Medical Cared Filters to Recognizing Work-Related by Doctore Filters to Workersrsquo Compensation being the Payerf Filters To Recording on OSHA Logg Filters to Reporting by Employers to Workersrsquo
Compensation Agencyh Filters to Reporting by Doctors
(Azaroff et al AJPH 2002)
Capture-Recapture Estimates of Workplace Injury and Illness Reporting by BLS Adjusted for Capture
Heterogeneity Lost-Time Cases 1998-2001
Percent Reported to WA WV OR WI NM MNNo Source Dependence 55 76 56 65 51 68
Source Dependence 52 71 45 53 37 53
(Adapted Boden and Ozonoff Annals Epidemiology 2008)
Workersrsquo CompensationState Specific Program
Mandatory insurance or if large enough self-insured
Michigan WC Excludesbull Federal employeesbull Interstate railroad workersbull Maritime workersbull Less than 3 employees at any one timebull All employees work less than 35 hoursweek or
if more hours less than 13 weeksbull Self-employed
Not computerizedbull Medical claims only
Proportion of Work-Injured Adults for Whom Treatment was paid by Workersrsquo Compensation by State-BRFSS 10 States 2007
State Injured with Payment by Workersrsquo Compensation
Texas 47 (95 CI 35-59)New York 50 (95 CI 39-60)Michigan 56 (95 CI 41-69)Massachusetts 60 (95 CI 45-75)California 61 (95 CI 55-66)Washington 61 (95 CI 55-67)Oregon 62 (95 CI 50-74)Connecticut 63 (95 CI 53-74)New Jersey 64 (95 CI 51-78)Kentucky 77 (95 CI 65-89)
Excludes self-employed
(Adapted Bonauto et al MMWR 2010)
Percentage Received Workersrsquo Compensation by Condition Michigan
WageReplacement
Medical Only
No CompEmployed
No Comp Self -Employed
Amputations 64 22 17 6Burns 17 48 33 2Skull Fractures 36 32 29 3
Percent Applied for Workersrsquo Comp among 2016 Cases of Work-Related Asthma Michigan
Overall 484
Still ExposedConditions Unchanged 239No Longer Exposed 575
Quit on Doctorrsquos Advice 778Sick Leave 727Fired 621New Controls 589Chemical Substitution 536Quit on Own 431Reassigned 360
Reasons Didnrsquot File a Workersrsquo Compensation Claims for a Repetitive Trauma Michigan
Only 397 (251) of 1598 Filed WC Claim
Injury Not Serious Enough 705 (591)Did Not Expect to Miss Work 694 (583)Expect to Receive Sick Leave or
Disability 337 (283) Medical Expenses Covered by
Other Insurance 427 (359)Did Not Think Injury Work Related 242 (204)
(Rosenman et al JOEM 2000)
Goals of Surveillance Population-Based
bull Assess Magnitude of Problembull NumbersRatesTrends
bull Determine Relative Importance vs Other Health Issuesbull Identify High Risk
bull IndustriesOccupationsWorker Populations
bull Prioritize Interventions bull Evaluate Interventionsbull Generate Hypotheses for Researchbull Identify Emerging Problemsbull Identify Workplaces for Intervention
Case-Based
Reportable Conditions in Michigan
Local Health DepartmentsCommunicable Diseases (83)
ldquoUnusual occurrence outbreak or epidemic of any disease or conditionsrdquoMDHHS
AbortionsBirth DefectsCancerChemical Poisonings including Carbon MonoxideInjuries Nursing Home Abuse
LARAOccupational Illnesses
County Department of Social ServicesChild AbuseAdult Abuse
PoliceInjury from Knife Gun or Deadly WeaponMental Health Patient Abuse
On Request Only
Laboratory Reporting Regulations Michigan
bull Arsenicbull Cadmiumbull Carboxyhemoglobinbull Cholinesterasebull IgE Antibodiesbull Leadbull Mercury
Occupational Illness Reporting Requirement in Michigan
bull LARA ndash MIOSHAPhysician hospital clinic or employer
having a known or suspected occupational disease or health condition aggravated by workplace exposures shall report within 10 days after discovery
Misdemeanor punishable by a fine of not more than $50
Methodology of Multi-Source Surveillance
Amputations 2006- DateHospitalsEDOutpatient ClinicsWorkersrsquo Compensation Wage Replacement
Crushing Injuries 2013- Date+ FACE Program
Skull Fractures 2012-DateBurns 2009-Date
+ Poison Control Center
bull Quarterly Reporting Specified ICD codes -134 Hospitalsbull Quarterly Reporting all Work-related Events ndash Poison Control Centerbull Electronic Data Base All Paid Claims ndash Workersrsquo Compensationbull FACE ndash Death CertificatesOSHA Hot LinePolice Reports
Work-Related Burn Reports ndash By Source Total 1461 Michigan 2009
n=1460 individuals
450
BLS
HOSPITALSEDs (1248)
4501054
BLSMIFACE 1(2) 1
16721
5 PCC (106)
1321 79
WC(306)
(Kica and Rosenman JOEM 2012)
bull Link Ky CRASH and trauma registry data with FARS driver drug testing results from fatal crashes in 2014
bull Link 2014 trauma registry toxicology result data with inpatient hospitalization data to assess drug overdose and drug abuse coding
Primary populations
bull Opioid overdose victims
bull Pregnant and parenting women
bull Individuals re-entering society upon criminal justice release
bull Adolescents and young adults
Goals
bull Prevent opioid misuse and abuse
bull Increase access to OUD treatment services (eg MAT)
bull Increase availability of recovery support services
bull Increase availability of naloxone
bull Enhance coordination and evaluation of OUD healthcare and public safety strategies
bull KRS 217186- A person or agency including a peace officer jailer firefighter paramedic or emergency medical technician or a school employee authorized to administer medication under KRS 156502 may ndash Receive a prescription for the drug
naloxonendash Possess naloxone pursuant to this
subsection and any equipment needed for its administration
ndash Administer naloxone to an individual suffering from an apparent opiate-related overdose
bull Reduce prescriber opioid prescribing (physicians APRNs etc) to a 3-day supply for injured workers
bull First line treatment based on non-opioid therapy alternatives (physical therapy acupuncture etc)
bull Revise drug formularies for treatment of pain associated with occupational injuries
Prevention Decrease likelihood that Kentuckians develop a SUD through strategies to decrease overexposure of opioid medications and illicit opioids
bull prescriptions (dosage units) overdose deaths containing fentanyl
Harm Reduction Improve Access to Harm Reduction Services to Save Lives
bull naloxone kits dispensed to first responders and public people in syringe exchange programs who received naloxone
Treatment and Recovery Expand access to treatment and recovery supports
bull peer recovery coaches Emergency Departments with peer recovery coaches people with SUD who interact with peer recovery coaches and enter treatment Emergency Department peer follow-up individuals with SUD who receive residential services calls to SUD treatment locator and portal
bull Louisville Metro Police Department presentation
bull Breakout Session
bull First Responder Opioid Exposure Survey development
bull Focus Groups
bull Survey Administration
bull Data Analysis
bull Use of Data Results
bull UK ERC first responder overdose response exposure pilot project opportunity
bull Multistate or single state applicationsndash Use of survey
ndash development of other first responder-related pilot project
FACE case investigations
bull initiated drug overdose prevention conversations
bull enhanced collaborations
bull provided evidence of need for enhanced multidisciplinary drug overdose prevention efforts1 Interventions
2 Policies
3 Research
Ladder rap
httpswwwyoutubecomwatchv=FsW6eb3aO8gampfeature=youtube
BLS Survey of Employers vs Multi-Source Surveillance of Work-Related Injuries
Kenneth D Rosenman MDProfessor of MedicineMichigan State Universitywwwoemmsuedu
NIOSH Expanding Research Partnerships Conference Denver Colorado June 21-23 2017
Funding NIOSH U60 OH008466
Survey of Occupational Injuries and Illnesses (SOII)
bull Injuries and illnesses (based on OSHArsquos recordkeeping standards) from 230000 establishments (sample by state and NAICS code)
bull Redesigned in 1992 to collect circumstances of injuries and illnesses that lead to days away from work and characteristics of affected workers
bull Scope limitations no small farms private household or self-employed workers (lt 2008 no public sector workers)
NATIONAL ACADEMY OF SCIENCES 1987
New Jersey24 Deaths not covered by OSHA35 Deaths covered by OSHA butemployer had NOT recorded on OSHAlog or did NOT keep OSHA log
TexasNIOSH Fatal Occupational Trauma Surveillance
CENSUS OF FATAL OCCUPATIONAL INJURIES (CFOI) BEGAN IN 1992
Multiple death sourcesDeath certificatesEmployer reportingState PoliceNewspaper Clipping ServiceMedical ExaminersAgricultural Extension Service
Number of deaths doubled from previous BLS estimate
How Much Work-Related Injury and Illness is Missed By the Current National Surveillance System
Rosenman KD Kalush A Reilly MJ Gardiner JC Reeves M Luo Z JOEM 2006 48357-365Funding NIOSH 5 R01 OH004276-03
Summary of Analysis Comparing BLS and Worker Comp data Michigan 2009-2001Days away from workbull BLS estimate
37-41 BLS+ WC31-34 BLS + WC+ CaptureRecapture
1999-2001 Estimates - Michiganbull BLS -281567 vs Our Estimate - 868241
1 in 15 workers vs 1 in 5 workers
(Rosenman et al JOEM 2006)
Simplified Flowchart of Events Necessary to the Documentation of Work-Related Injuries and Illnesses
(Azaroff et al AJPH 2002)
Filters to Identifying Work-Related Injuries and Illnesses
a Filters To Reporting to Supervisorsb Filters To Losing Work Time c Filters to Obtaining Medical Cared Filters to Recognizing Work-Related by Doctore Filters to Workersrsquo Compensation being the Payerf Filters To Recording on OSHA Logg Filters to Reporting by Employers to Workersrsquo
Compensation Agencyh Filters to Reporting by Doctors
(Azaroff et al AJPH 2002)
Capture-Recapture Estimates of Workplace Injury and Illness Reporting by BLS Adjusted for Capture
Heterogeneity Lost-Time Cases 1998-2001
Percent Reported to WA WV OR WI NM MNNo Source Dependence 55 76 56 65 51 68
Source Dependence 52 71 45 53 37 53
(Adapted Boden and Ozonoff Annals Epidemiology 2008)
Workersrsquo CompensationState Specific Program
Mandatory insurance or if large enough self-insured
Michigan WC Excludesbull Federal employeesbull Interstate railroad workersbull Maritime workersbull Less than 3 employees at any one timebull All employees work less than 35 hoursweek or
if more hours less than 13 weeksbull Self-employed
Not computerizedbull Medical claims only
Proportion of Work-Injured Adults for Whom Treatment was paid by Workersrsquo Compensation by State-BRFSS 10 States 2007
State Injured with Payment by Workersrsquo Compensation
Texas 47 (95 CI 35-59)New York 50 (95 CI 39-60)Michigan 56 (95 CI 41-69)Massachusetts 60 (95 CI 45-75)California 61 (95 CI 55-66)Washington 61 (95 CI 55-67)Oregon 62 (95 CI 50-74)Connecticut 63 (95 CI 53-74)New Jersey 64 (95 CI 51-78)Kentucky 77 (95 CI 65-89)
Excludes self-employed
(Adapted Bonauto et al MMWR 2010)
Percentage Received Workersrsquo Compensation by Condition Michigan
WageReplacement
Medical Only
No CompEmployed
No Comp Self -Employed
Amputations 64 22 17 6Burns 17 48 33 2Skull Fractures 36 32 29 3
Percent Applied for Workersrsquo Comp among 2016 Cases of Work-Related Asthma Michigan
Overall 484
Still ExposedConditions Unchanged 239No Longer Exposed 575
Quit on Doctorrsquos Advice 778Sick Leave 727Fired 621New Controls 589Chemical Substitution 536Quit on Own 431Reassigned 360
Reasons Didnrsquot File a Workersrsquo Compensation Claims for a Repetitive Trauma Michigan
Only 397 (251) of 1598 Filed WC Claim
Injury Not Serious Enough 705 (591)Did Not Expect to Miss Work 694 (583)Expect to Receive Sick Leave or
Disability 337 (283) Medical Expenses Covered by
Other Insurance 427 (359)Did Not Think Injury Work Related 242 (204)
(Rosenman et al JOEM 2000)
Goals of Surveillance Population-Based
bull Assess Magnitude of Problembull NumbersRatesTrends
bull Determine Relative Importance vs Other Health Issuesbull Identify High Risk
bull IndustriesOccupationsWorker Populations
bull Prioritize Interventions bull Evaluate Interventionsbull Generate Hypotheses for Researchbull Identify Emerging Problemsbull Identify Workplaces for Intervention
Case-Based
Reportable Conditions in Michigan
Local Health DepartmentsCommunicable Diseases (83)
ldquoUnusual occurrence outbreak or epidemic of any disease or conditionsrdquoMDHHS
AbortionsBirth DefectsCancerChemical Poisonings including Carbon MonoxideInjuries Nursing Home Abuse
LARAOccupational Illnesses
County Department of Social ServicesChild AbuseAdult Abuse
PoliceInjury from Knife Gun or Deadly WeaponMental Health Patient Abuse
On Request Only
Laboratory Reporting Regulations Michigan
bull Arsenicbull Cadmiumbull Carboxyhemoglobinbull Cholinesterasebull IgE Antibodiesbull Leadbull Mercury
Occupational Illness Reporting Requirement in Michigan
bull LARA ndash MIOSHAPhysician hospital clinic or employer
having a known or suspected occupational disease or health condition aggravated by workplace exposures shall report within 10 days after discovery
Misdemeanor punishable by a fine of not more than $50
Methodology of Multi-Source Surveillance
Amputations 2006- DateHospitalsEDOutpatient ClinicsWorkersrsquo Compensation Wage Replacement
Crushing Injuries 2013- Date+ FACE Program
Skull Fractures 2012-DateBurns 2009-Date
+ Poison Control Center
bull Quarterly Reporting Specified ICD codes -134 Hospitalsbull Quarterly Reporting all Work-related Events ndash Poison Control Centerbull Electronic Data Base All Paid Claims ndash Workersrsquo Compensationbull FACE ndash Death CertificatesOSHA Hot LinePolice Reports
Work-Related Burn Reports ndash By Source Total 1461 Michigan 2009
n=1460 individuals
450
BLS
HOSPITALSEDs (1248)
4501054
BLSMIFACE 1(2) 1
16721
5 PCC (106)
1321 79
WC(306)
(Kica and Rosenman JOEM 2012)
Primary populations
bull Opioid overdose victims
bull Pregnant and parenting women
bull Individuals re-entering society upon criminal justice release
bull Adolescents and young adults
Goals
bull Prevent opioid misuse and abuse
bull Increase access to OUD treatment services (eg MAT)
bull Increase availability of recovery support services
bull Increase availability of naloxone
bull Enhance coordination and evaluation of OUD healthcare and public safety strategies
bull KRS 217186- A person or agency including a peace officer jailer firefighter paramedic or emergency medical technician or a school employee authorized to administer medication under KRS 156502 may ndash Receive a prescription for the drug
naloxonendash Possess naloxone pursuant to this
subsection and any equipment needed for its administration
ndash Administer naloxone to an individual suffering from an apparent opiate-related overdose
bull Reduce prescriber opioid prescribing (physicians APRNs etc) to a 3-day supply for injured workers
bull First line treatment based on non-opioid therapy alternatives (physical therapy acupuncture etc)
bull Revise drug formularies for treatment of pain associated with occupational injuries
Prevention Decrease likelihood that Kentuckians develop a SUD through strategies to decrease overexposure of opioid medications and illicit opioids
bull prescriptions (dosage units) overdose deaths containing fentanyl
Harm Reduction Improve Access to Harm Reduction Services to Save Lives
bull naloxone kits dispensed to first responders and public people in syringe exchange programs who received naloxone
Treatment and Recovery Expand access to treatment and recovery supports
bull peer recovery coaches Emergency Departments with peer recovery coaches people with SUD who interact with peer recovery coaches and enter treatment Emergency Department peer follow-up individuals with SUD who receive residential services calls to SUD treatment locator and portal
bull Louisville Metro Police Department presentation
bull Breakout Session
bull First Responder Opioid Exposure Survey development
bull Focus Groups
bull Survey Administration
bull Data Analysis
bull Use of Data Results
bull UK ERC first responder overdose response exposure pilot project opportunity
bull Multistate or single state applicationsndash Use of survey
ndash development of other first responder-related pilot project
FACE case investigations
bull initiated drug overdose prevention conversations
bull enhanced collaborations
bull provided evidence of need for enhanced multidisciplinary drug overdose prevention efforts1 Interventions
2 Policies
3 Research
Ladder rap
httpswwwyoutubecomwatchv=FsW6eb3aO8gampfeature=youtube
BLS Survey of Employers vs Multi-Source Surveillance of Work-Related Injuries
Kenneth D Rosenman MDProfessor of MedicineMichigan State Universitywwwoemmsuedu
NIOSH Expanding Research Partnerships Conference Denver Colorado June 21-23 2017
Funding NIOSH U60 OH008466
Survey of Occupational Injuries and Illnesses (SOII)
bull Injuries and illnesses (based on OSHArsquos recordkeeping standards) from 230000 establishments (sample by state and NAICS code)
bull Redesigned in 1992 to collect circumstances of injuries and illnesses that lead to days away from work and characteristics of affected workers
bull Scope limitations no small farms private household or self-employed workers (lt 2008 no public sector workers)
NATIONAL ACADEMY OF SCIENCES 1987
New Jersey24 Deaths not covered by OSHA35 Deaths covered by OSHA butemployer had NOT recorded on OSHAlog or did NOT keep OSHA log
TexasNIOSH Fatal Occupational Trauma Surveillance
CENSUS OF FATAL OCCUPATIONAL INJURIES (CFOI) BEGAN IN 1992
Multiple death sourcesDeath certificatesEmployer reportingState PoliceNewspaper Clipping ServiceMedical ExaminersAgricultural Extension Service
Number of deaths doubled from previous BLS estimate
How Much Work-Related Injury and Illness is Missed By the Current National Surveillance System
Rosenman KD Kalush A Reilly MJ Gardiner JC Reeves M Luo Z JOEM 2006 48357-365Funding NIOSH 5 R01 OH004276-03
Summary of Analysis Comparing BLS and Worker Comp data Michigan 2009-2001Days away from workbull BLS estimate
37-41 BLS+ WC31-34 BLS + WC+ CaptureRecapture
1999-2001 Estimates - Michiganbull BLS -281567 vs Our Estimate - 868241
1 in 15 workers vs 1 in 5 workers
(Rosenman et al JOEM 2006)
Simplified Flowchart of Events Necessary to the Documentation of Work-Related Injuries and Illnesses
(Azaroff et al AJPH 2002)
Filters to Identifying Work-Related Injuries and Illnesses
a Filters To Reporting to Supervisorsb Filters To Losing Work Time c Filters to Obtaining Medical Cared Filters to Recognizing Work-Related by Doctore Filters to Workersrsquo Compensation being the Payerf Filters To Recording on OSHA Logg Filters to Reporting by Employers to Workersrsquo
Compensation Agencyh Filters to Reporting by Doctors
(Azaroff et al AJPH 2002)
Capture-Recapture Estimates of Workplace Injury and Illness Reporting by BLS Adjusted for Capture
Heterogeneity Lost-Time Cases 1998-2001
Percent Reported to WA WV OR WI NM MNNo Source Dependence 55 76 56 65 51 68
Source Dependence 52 71 45 53 37 53
(Adapted Boden and Ozonoff Annals Epidemiology 2008)
Workersrsquo CompensationState Specific Program
Mandatory insurance or if large enough self-insured
Michigan WC Excludesbull Federal employeesbull Interstate railroad workersbull Maritime workersbull Less than 3 employees at any one timebull All employees work less than 35 hoursweek or
if more hours less than 13 weeksbull Self-employed
Not computerizedbull Medical claims only
Proportion of Work-Injured Adults for Whom Treatment was paid by Workersrsquo Compensation by State-BRFSS 10 States 2007
State Injured with Payment by Workersrsquo Compensation
Texas 47 (95 CI 35-59)New York 50 (95 CI 39-60)Michigan 56 (95 CI 41-69)Massachusetts 60 (95 CI 45-75)California 61 (95 CI 55-66)Washington 61 (95 CI 55-67)Oregon 62 (95 CI 50-74)Connecticut 63 (95 CI 53-74)New Jersey 64 (95 CI 51-78)Kentucky 77 (95 CI 65-89)
Excludes self-employed
(Adapted Bonauto et al MMWR 2010)
Percentage Received Workersrsquo Compensation by Condition Michigan
WageReplacement
Medical Only
No CompEmployed
No Comp Self -Employed
Amputations 64 22 17 6Burns 17 48 33 2Skull Fractures 36 32 29 3
Percent Applied for Workersrsquo Comp among 2016 Cases of Work-Related Asthma Michigan
Overall 484
Still ExposedConditions Unchanged 239No Longer Exposed 575
Quit on Doctorrsquos Advice 778Sick Leave 727Fired 621New Controls 589Chemical Substitution 536Quit on Own 431Reassigned 360
Reasons Didnrsquot File a Workersrsquo Compensation Claims for a Repetitive Trauma Michigan
Only 397 (251) of 1598 Filed WC Claim
Injury Not Serious Enough 705 (591)Did Not Expect to Miss Work 694 (583)Expect to Receive Sick Leave or
Disability 337 (283) Medical Expenses Covered by
Other Insurance 427 (359)Did Not Think Injury Work Related 242 (204)
(Rosenman et al JOEM 2000)
Goals of Surveillance Population-Based
bull Assess Magnitude of Problembull NumbersRatesTrends
bull Determine Relative Importance vs Other Health Issuesbull Identify High Risk
bull IndustriesOccupationsWorker Populations
bull Prioritize Interventions bull Evaluate Interventionsbull Generate Hypotheses for Researchbull Identify Emerging Problemsbull Identify Workplaces for Intervention
Case-Based
Reportable Conditions in Michigan
Local Health DepartmentsCommunicable Diseases (83)
ldquoUnusual occurrence outbreak or epidemic of any disease or conditionsrdquoMDHHS
AbortionsBirth DefectsCancerChemical Poisonings including Carbon MonoxideInjuries Nursing Home Abuse
LARAOccupational Illnesses
County Department of Social ServicesChild AbuseAdult Abuse
PoliceInjury from Knife Gun or Deadly WeaponMental Health Patient Abuse
On Request Only
Laboratory Reporting Regulations Michigan
bull Arsenicbull Cadmiumbull Carboxyhemoglobinbull Cholinesterasebull IgE Antibodiesbull Leadbull Mercury
Occupational Illness Reporting Requirement in Michigan
bull LARA ndash MIOSHAPhysician hospital clinic or employer
having a known or suspected occupational disease or health condition aggravated by workplace exposures shall report within 10 days after discovery
Misdemeanor punishable by a fine of not more than $50
Methodology of Multi-Source Surveillance
Amputations 2006- DateHospitalsEDOutpatient ClinicsWorkersrsquo Compensation Wage Replacement
Crushing Injuries 2013- Date+ FACE Program
Skull Fractures 2012-DateBurns 2009-Date
+ Poison Control Center
bull Quarterly Reporting Specified ICD codes -134 Hospitalsbull Quarterly Reporting all Work-related Events ndash Poison Control Centerbull Electronic Data Base All Paid Claims ndash Workersrsquo Compensationbull FACE ndash Death CertificatesOSHA Hot LinePolice Reports
Work-Related Burn Reports ndash By Source Total 1461 Michigan 2009
n=1460 individuals
450
BLS
HOSPITALSEDs (1248)
4501054
BLSMIFACE 1(2) 1
16721
5 PCC (106)
1321 79
WC(306)
(Kica and Rosenman JOEM 2012)
bull KRS 217186- A person or agency including a peace officer jailer firefighter paramedic or emergency medical technician or a school employee authorized to administer medication under KRS 156502 may ndash Receive a prescription for the drug
naloxonendash Possess naloxone pursuant to this
subsection and any equipment needed for its administration
ndash Administer naloxone to an individual suffering from an apparent opiate-related overdose
bull Reduce prescriber opioid prescribing (physicians APRNs etc) to a 3-day supply for injured workers
bull First line treatment based on non-opioid therapy alternatives (physical therapy acupuncture etc)
bull Revise drug formularies for treatment of pain associated with occupational injuries
Prevention Decrease likelihood that Kentuckians develop a SUD through strategies to decrease overexposure of opioid medications and illicit opioids
bull prescriptions (dosage units) overdose deaths containing fentanyl
Harm Reduction Improve Access to Harm Reduction Services to Save Lives
bull naloxone kits dispensed to first responders and public people in syringe exchange programs who received naloxone
Treatment and Recovery Expand access to treatment and recovery supports
bull peer recovery coaches Emergency Departments with peer recovery coaches people with SUD who interact with peer recovery coaches and enter treatment Emergency Department peer follow-up individuals with SUD who receive residential services calls to SUD treatment locator and portal
bull Louisville Metro Police Department presentation
bull Breakout Session
bull First Responder Opioid Exposure Survey development
bull Focus Groups
bull Survey Administration
bull Data Analysis
bull Use of Data Results
bull UK ERC first responder overdose response exposure pilot project opportunity
bull Multistate or single state applicationsndash Use of survey
ndash development of other first responder-related pilot project
FACE case investigations
bull initiated drug overdose prevention conversations
bull enhanced collaborations
bull provided evidence of need for enhanced multidisciplinary drug overdose prevention efforts1 Interventions
2 Policies
3 Research
Ladder rap
httpswwwyoutubecomwatchv=FsW6eb3aO8gampfeature=youtube
BLS Survey of Employers vs Multi-Source Surveillance of Work-Related Injuries
Kenneth D Rosenman MDProfessor of MedicineMichigan State Universitywwwoemmsuedu
NIOSH Expanding Research Partnerships Conference Denver Colorado June 21-23 2017
Funding NIOSH U60 OH008466
Survey of Occupational Injuries and Illnesses (SOII)
bull Injuries and illnesses (based on OSHArsquos recordkeeping standards) from 230000 establishments (sample by state and NAICS code)
bull Redesigned in 1992 to collect circumstances of injuries and illnesses that lead to days away from work and characteristics of affected workers
bull Scope limitations no small farms private household or self-employed workers (lt 2008 no public sector workers)
NATIONAL ACADEMY OF SCIENCES 1987
New Jersey24 Deaths not covered by OSHA35 Deaths covered by OSHA butemployer had NOT recorded on OSHAlog or did NOT keep OSHA log
TexasNIOSH Fatal Occupational Trauma Surveillance
CENSUS OF FATAL OCCUPATIONAL INJURIES (CFOI) BEGAN IN 1992
Multiple death sourcesDeath certificatesEmployer reportingState PoliceNewspaper Clipping ServiceMedical ExaminersAgricultural Extension Service
Number of deaths doubled from previous BLS estimate
How Much Work-Related Injury and Illness is Missed By the Current National Surveillance System
Rosenman KD Kalush A Reilly MJ Gardiner JC Reeves M Luo Z JOEM 2006 48357-365Funding NIOSH 5 R01 OH004276-03
Summary of Analysis Comparing BLS and Worker Comp data Michigan 2009-2001Days away from workbull BLS estimate
37-41 BLS+ WC31-34 BLS + WC+ CaptureRecapture
1999-2001 Estimates - Michiganbull BLS -281567 vs Our Estimate - 868241
1 in 15 workers vs 1 in 5 workers
(Rosenman et al JOEM 2006)
Simplified Flowchart of Events Necessary to the Documentation of Work-Related Injuries and Illnesses
(Azaroff et al AJPH 2002)
Filters to Identifying Work-Related Injuries and Illnesses
a Filters To Reporting to Supervisorsb Filters To Losing Work Time c Filters to Obtaining Medical Cared Filters to Recognizing Work-Related by Doctore Filters to Workersrsquo Compensation being the Payerf Filters To Recording on OSHA Logg Filters to Reporting by Employers to Workersrsquo
Compensation Agencyh Filters to Reporting by Doctors
(Azaroff et al AJPH 2002)
Capture-Recapture Estimates of Workplace Injury and Illness Reporting by BLS Adjusted for Capture
Heterogeneity Lost-Time Cases 1998-2001
Percent Reported to WA WV OR WI NM MNNo Source Dependence 55 76 56 65 51 68
Source Dependence 52 71 45 53 37 53
(Adapted Boden and Ozonoff Annals Epidemiology 2008)
Workersrsquo CompensationState Specific Program
Mandatory insurance or if large enough self-insured
Michigan WC Excludesbull Federal employeesbull Interstate railroad workersbull Maritime workersbull Less than 3 employees at any one timebull All employees work less than 35 hoursweek or
if more hours less than 13 weeksbull Self-employed
Not computerizedbull Medical claims only
Proportion of Work-Injured Adults for Whom Treatment was paid by Workersrsquo Compensation by State-BRFSS 10 States 2007
State Injured with Payment by Workersrsquo Compensation
Texas 47 (95 CI 35-59)New York 50 (95 CI 39-60)Michigan 56 (95 CI 41-69)Massachusetts 60 (95 CI 45-75)California 61 (95 CI 55-66)Washington 61 (95 CI 55-67)Oregon 62 (95 CI 50-74)Connecticut 63 (95 CI 53-74)New Jersey 64 (95 CI 51-78)Kentucky 77 (95 CI 65-89)
Excludes self-employed
(Adapted Bonauto et al MMWR 2010)
Percentage Received Workersrsquo Compensation by Condition Michigan
WageReplacement
Medical Only
No CompEmployed
No Comp Self -Employed
Amputations 64 22 17 6Burns 17 48 33 2Skull Fractures 36 32 29 3
Percent Applied for Workersrsquo Comp among 2016 Cases of Work-Related Asthma Michigan
Overall 484
Still ExposedConditions Unchanged 239No Longer Exposed 575
Quit on Doctorrsquos Advice 778Sick Leave 727Fired 621New Controls 589Chemical Substitution 536Quit on Own 431Reassigned 360
Reasons Didnrsquot File a Workersrsquo Compensation Claims for a Repetitive Trauma Michigan
Only 397 (251) of 1598 Filed WC Claim
Injury Not Serious Enough 705 (591)Did Not Expect to Miss Work 694 (583)Expect to Receive Sick Leave or
Disability 337 (283) Medical Expenses Covered by
Other Insurance 427 (359)Did Not Think Injury Work Related 242 (204)
(Rosenman et al JOEM 2000)
Goals of Surveillance Population-Based
bull Assess Magnitude of Problembull NumbersRatesTrends
bull Determine Relative Importance vs Other Health Issuesbull Identify High Risk
bull IndustriesOccupationsWorker Populations
bull Prioritize Interventions bull Evaluate Interventionsbull Generate Hypotheses for Researchbull Identify Emerging Problemsbull Identify Workplaces for Intervention
Case-Based
Reportable Conditions in Michigan
Local Health DepartmentsCommunicable Diseases (83)
ldquoUnusual occurrence outbreak or epidemic of any disease or conditionsrdquoMDHHS
AbortionsBirth DefectsCancerChemical Poisonings including Carbon MonoxideInjuries Nursing Home Abuse
LARAOccupational Illnesses
County Department of Social ServicesChild AbuseAdult Abuse
PoliceInjury from Knife Gun or Deadly WeaponMental Health Patient Abuse
On Request Only
Laboratory Reporting Regulations Michigan
bull Arsenicbull Cadmiumbull Carboxyhemoglobinbull Cholinesterasebull IgE Antibodiesbull Leadbull Mercury
Occupational Illness Reporting Requirement in Michigan
bull LARA ndash MIOSHAPhysician hospital clinic or employer
having a known or suspected occupational disease or health condition aggravated by workplace exposures shall report within 10 days after discovery
Misdemeanor punishable by a fine of not more than $50
Methodology of Multi-Source Surveillance
Amputations 2006- DateHospitalsEDOutpatient ClinicsWorkersrsquo Compensation Wage Replacement
Crushing Injuries 2013- Date+ FACE Program
Skull Fractures 2012-DateBurns 2009-Date
+ Poison Control Center
bull Quarterly Reporting Specified ICD codes -134 Hospitalsbull Quarterly Reporting all Work-related Events ndash Poison Control Centerbull Electronic Data Base All Paid Claims ndash Workersrsquo Compensationbull FACE ndash Death CertificatesOSHA Hot LinePolice Reports
Work-Related Burn Reports ndash By Source Total 1461 Michigan 2009
n=1460 individuals
450
BLS
HOSPITALSEDs (1248)
4501054
BLSMIFACE 1(2) 1
16721
5 PCC (106)
1321 79
WC(306)
(Kica and Rosenman JOEM 2012)
bull Reduce prescriber opioid prescribing (physicians APRNs etc) to a 3-day supply for injured workers
bull First line treatment based on non-opioid therapy alternatives (physical therapy acupuncture etc)
bull Revise drug formularies for treatment of pain associated with occupational injuries
Prevention Decrease likelihood that Kentuckians develop a SUD through strategies to decrease overexposure of opioid medications and illicit opioids
bull prescriptions (dosage units) overdose deaths containing fentanyl
Harm Reduction Improve Access to Harm Reduction Services to Save Lives
bull naloxone kits dispensed to first responders and public people in syringe exchange programs who received naloxone
Treatment and Recovery Expand access to treatment and recovery supports
bull peer recovery coaches Emergency Departments with peer recovery coaches people with SUD who interact with peer recovery coaches and enter treatment Emergency Department peer follow-up individuals with SUD who receive residential services calls to SUD treatment locator and portal
bull Louisville Metro Police Department presentation
bull Breakout Session
bull First Responder Opioid Exposure Survey development
bull Focus Groups
bull Survey Administration
bull Data Analysis
bull Use of Data Results
bull UK ERC first responder overdose response exposure pilot project opportunity
bull Multistate or single state applicationsndash Use of survey
ndash development of other first responder-related pilot project
FACE case investigations
bull initiated drug overdose prevention conversations
bull enhanced collaborations
bull provided evidence of need for enhanced multidisciplinary drug overdose prevention efforts1 Interventions
2 Policies
3 Research
Ladder rap
httpswwwyoutubecomwatchv=FsW6eb3aO8gampfeature=youtube
BLS Survey of Employers vs Multi-Source Surveillance of Work-Related Injuries
Kenneth D Rosenman MDProfessor of MedicineMichigan State Universitywwwoemmsuedu
NIOSH Expanding Research Partnerships Conference Denver Colorado June 21-23 2017
Funding NIOSH U60 OH008466
Survey of Occupational Injuries and Illnesses (SOII)
bull Injuries and illnesses (based on OSHArsquos recordkeeping standards) from 230000 establishments (sample by state and NAICS code)
bull Redesigned in 1992 to collect circumstances of injuries and illnesses that lead to days away from work and characteristics of affected workers
bull Scope limitations no small farms private household or self-employed workers (lt 2008 no public sector workers)
NATIONAL ACADEMY OF SCIENCES 1987
New Jersey24 Deaths not covered by OSHA35 Deaths covered by OSHA butemployer had NOT recorded on OSHAlog or did NOT keep OSHA log
TexasNIOSH Fatal Occupational Trauma Surveillance
CENSUS OF FATAL OCCUPATIONAL INJURIES (CFOI) BEGAN IN 1992
Multiple death sourcesDeath certificatesEmployer reportingState PoliceNewspaper Clipping ServiceMedical ExaminersAgricultural Extension Service
Number of deaths doubled from previous BLS estimate
How Much Work-Related Injury and Illness is Missed By the Current National Surveillance System
Rosenman KD Kalush A Reilly MJ Gardiner JC Reeves M Luo Z JOEM 2006 48357-365Funding NIOSH 5 R01 OH004276-03
Summary of Analysis Comparing BLS and Worker Comp data Michigan 2009-2001Days away from workbull BLS estimate
37-41 BLS+ WC31-34 BLS + WC+ CaptureRecapture
1999-2001 Estimates - Michiganbull BLS -281567 vs Our Estimate - 868241
1 in 15 workers vs 1 in 5 workers
(Rosenman et al JOEM 2006)
Simplified Flowchart of Events Necessary to the Documentation of Work-Related Injuries and Illnesses
(Azaroff et al AJPH 2002)
Filters to Identifying Work-Related Injuries and Illnesses
a Filters To Reporting to Supervisorsb Filters To Losing Work Time c Filters to Obtaining Medical Cared Filters to Recognizing Work-Related by Doctore Filters to Workersrsquo Compensation being the Payerf Filters To Recording on OSHA Logg Filters to Reporting by Employers to Workersrsquo
Compensation Agencyh Filters to Reporting by Doctors
(Azaroff et al AJPH 2002)
Capture-Recapture Estimates of Workplace Injury and Illness Reporting by BLS Adjusted for Capture
Heterogeneity Lost-Time Cases 1998-2001
Percent Reported to WA WV OR WI NM MNNo Source Dependence 55 76 56 65 51 68
Source Dependence 52 71 45 53 37 53
(Adapted Boden and Ozonoff Annals Epidemiology 2008)
Workersrsquo CompensationState Specific Program
Mandatory insurance or if large enough self-insured
Michigan WC Excludesbull Federal employeesbull Interstate railroad workersbull Maritime workersbull Less than 3 employees at any one timebull All employees work less than 35 hoursweek or
if more hours less than 13 weeksbull Self-employed
Not computerizedbull Medical claims only
Proportion of Work-Injured Adults for Whom Treatment was paid by Workersrsquo Compensation by State-BRFSS 10 States 2007
State Injured with Payment by Workersrsquo Compensation
Texas 47 (95 CI 35-59)New York 50 (95 CI 39-60)Michigan 56 (95 CI 41-69)Massachusetts 60 (95 CI 45-75)California 61 (95 CI 55-66)Washington 61 (95 CI 55-67)Oregon 62 (95 CI 50-74)Connecticut 63 (95 CI 53-74)New Jersey 64 (95 CI 51-78)Kentucky 77 (95 CI 65-89)
Excludes self-employed
(Adapted Bonauto et al MMWR 2010)
Percentage Received Workersrsquo Compensation by Condition Michigan
WageReplacement
Medical Only
No CompEmployed
No Comp Self -Employed
Amputations 64 22 17 6Burns 17 48 33 2Skull Fractures 36 32 29 3
Percent Applied for Workersrsquo Comp among 2016 Cases of Work-Related Asthma Michigan
Overall 484
Still ExposedConditions Unchanged 239No Longer Exposed 575
Quit on Doctorrsquos Advice 778Sick Leave 727Fired 621New Controls 589Chemical Substitution 536Quit on Own 431Reassigned 360
Reasons Didnrsquot File a Workersrsquo Compensation Claims for a Repetitive Trauma Michigan
Only 397 (251) of 1598 Filed WC Claim
Injury Not Serious Enough 705 (591)Did Not Expect to Miss Work 694 (583)Expect to Receive Sick Leave or
Disability 337 (283) Medical Expenses Covered by
Other Insurance 427 (359)Did Not Think Injury Work Related 242 (204)
(Rosenman et al JOEM 2000)
Goals of Surveillance Population-Based
bull Assess Magnitude of Problembull NumbersRatesTrends
bull Determine Relative Importance vs Other Health Issuesbull Identify High Risk
bull IndustriesOccupationsWorker Populations
bull Prioritize Interventions bull Evaluate Interventionsbull Generate Hypotheses for Researchbull Identify Emerging Problemsbull Identify Workplaces for Intervention
Case-Based
Reportable Conditions in Michigan
Local Health DepartmentsCommunicable Diseases (83)
ldquoUnusual occurrence outbreak or epidemic of any disease or conditionsrdquoMDHHS
AbortionsBirth DefectsCancerChemical Poisonings including Carbon MonoxideInjuries Nursing Home Abuse
LARAOccupational Illnesses
County Department of Social ServicesChild AbuseAdult Abuse
PoliceInjury from Knife Gun or Deadly WeaponMental Health Patient Abuse
On Request Only
Laboratory Reporting Regulations Michigan
bull Arsenicbull Cadmiumbull Carboxyhemoglobinbull Cholinesterasebull IgE Antibodiesbull Leadbull Mercury
Occupational Illness Reporting Requirement in Michigan
bull LARA ndash MIOSHAPhysician hospital clinic or employer
having a known or suspected occupational disease or health condition aggravated by workplace exposures shall report within 10 days after discovery
Misdemeanor punishable by a fine of not more than $50
Methodology of Multi-Source Surveillance
Amputations 2006- DateHospitalsEDOutpatient ClinicsWorkersrsquo Compensation Wage Replacement
Crushing Injuries 2013- Date+ FACE Program
Skull Fractures 2012-DateBurns 2009-Date
+ Poison Control Center
bull Quarterly Reporting Specified ICD codes -134 Hospitalsbull Quarterly Reporting all Work-related Events ndash Poison Control Centerbull Electronic Data Base All Paid Claims ndash Workersrsquo Compensationbull FACE ndash Death CertificatesOSHA Hot LinePolice Reports
Work-Related Burn Reports ndash By Source Total 1461 Michigan 2009
n=1460 individuals
450
BLS
HOSPITALSEDs (1248)
4501054
BLSMIFACE 1(2) 1
16721
5 PCC (106)
1321 79
WC(306)
(Kica and Rosenman JOEM 2012)
Prevention Decrease likelihood that Kentuckians develop a SUD through strategies to decrease overexposure of opioid medications and illicit opioids
bull prescriptions (dosage units) overdose deaths containing fentanyl
Harm Reduction Improve Access to Harm Reduction Services to Save Lives
bull naloxone kits dispensed to first responders and public people in syringe exchange programs who received naloxone
Treatment and Recovery Expand access to treatment and recovery supports
bull peer recovery coaches Emergency Departments with peer recovery coaches people with SUD who interact with peer recovery coaches and enter treatment Emergency Department peer follow-up individuals with SUD who receive residential services calls to SUD treatment locator and portal
bull Louisville Metro Police Department presentation
bull Breakout Session
bull First Responder Opioid Exposure Survey development
bull Focus Groups
bull Survey Administration
bull Data Analysis
bull Use of Data Results
bull UK ERC first responder overdose response exposure pilot project opportunity
bull Multistate or single state applicationsndash Use of survey
ndash development of other first responder-related pilot project
FACE case investigations
bull initiated drug overdose prevention conversations
bull enhanced collaborations
bull provided evidence of need for enhanced multidisciplinary drug overdose prevention efforts1 Interventions
2 Policies
3 Research
Ladder rap
httpswwwyoutubecomwatchv=FsW6eb3aO8gampfeature=youtube
BLS Survey of Employers vs Multi-Source Surveillance of Work-Related Injuries
Kenneth D Rosenman MDProfessor of MedicineMichigan State Universitywwwoemmsuedu
NIOSH Expanding Research Partnerships Conference Denver Colorado June 21-23 2017
Funding NIOSH U60 OH008466
Survey of Occupational Injuries and Illnesses (SOII)
bull Injuries and illnesses (based on OSHArsquos recordkeeping standards) from 230000 establishments (sample by state and NAICS code)
bull Redesigned in 1992 to collect circumstances of injuries and illnesses that lead to days away from work and characteristics of affected workers
bull Scope limitations no small farms private household or self-employed workers (lt 2008 no public sector workers)
NATIONAL ACADEMY OF SCIENCES 1987
New Jersey24 Deaths not covered by OSHA35 Deaths covered by OSHA butemployer had NOT recorded on OSHAlog or did NOT keep OSHA log
TexasNIOSH Fatal Occupational Trauma Surveillance
CENSUS OF FATAL OCCUPATIONAL INJURIES (CFOI) BEGAN IN 1992
Multiple death sourcesDeath certificatesEmployer reportingState PoliceNewspaper Clipping ServiceMedical ExaminersAgricultural Extension Service
Number of deaths doubled from previous BLS estimate
How Much Work-Related Injury and Illness is Missed By the Current National Surveillance System
Rosenman KD Kalush A Reilly MJ Gardiner JC Reeves M Luo Z JOEM 2006 48357-365Funding NIOSH 5 R01 OH004276-03
Summary of Analysis Comparing BLS and Worker Comp data Michigan 2009-2001Days away from workbull BLS estimate
37-41 BLS+ WC31-34 BLS + WC+ CaptureRecapture
1999-2001 Estimates - Michiganbull BLS -281567 vs Our Estimate - 868241
1 in 15 workers vs 1 in 5 workers
(Rosenman et al JOEM 2006)
Simplified Flowchart of Events Necessary to the Documentation of Work-Related Injuries and Illnesses
(Azaroff et al AJPH 2002)
Filters to Identifying Work-Related Injuries and Illnesses
a Filters To Reporting to Supervisorsb Filters To Losing Work Time c Filters to Obtaining Medical Cared Filters to Recognizing Work-Related by Doctore Filters to Workersrsquo Compensation being the Payerf Filters To Recording on OSHA Logg Filters to Reporting by Employers to Workersrsquo
Compensation Agencyh Filters to Reporting by Doctors
(Azaroff et al AJPH 2002)
Capture-Recapture Estimates of Workplace Injury and Illness Reporting by BLS Adjusted for Capture
Heterogeneity Lost-Time Cases 1998-2001
Percent Reported to WA WV OR WI NM MNNo Source Dependence 55 76 56 65 51 68
Source Dependence 52 71 45 53 37 53
(Adapted Boden and Ozonoff Annals Epidemiology 2008)
Workersrsquo CompensationState Specific Program
Mandatory insurance or if large enough self-insured
Michigan WC Excludesbull Federal employeesbull Interstate railroad workersbull Maritime workersbull Less than 3 employees at any one timebull All employees work less than 35 hoursweek or
if more hours less than 13 weeksbull Self-employed
Not computerizedbull Medical claims only
Proportion of Work-Injured Adults for Whom Treatment was paid by Workersrsquo Compensation by State-BRFSS 10 States 2007
State Injured with Payment by Workersrsquo Compensation
Texas 47 (95 CI 35-59)New York 50 (95 CI 39-60)Michigan 56 (95 CI 41-69)Massachusetts 60 (95 CI 45-75)California 61 (95 CI 55-66)Washington 61 (95 CI 55-67)Oregon 62 (95 CI 50-74)Connecticut 63 (95 CI 53-74)New Jersey 64 (95 CI 51-78)Kentucky 77 (95 CI 65-89)
Excludes self-employed
(Adapted Bonauto et al MMWR 2010)
Percentage Received Workersrsquo Compensation by Condition Michigan
WageReplacement
Medical Only
No CompEmployed
No Comp Self -Employed
Amputations 64 22 17 6Burns 17 48 33 2Skull Fractures 36 32 29 3
Percent Applied for Workersrsquo Comp among 2016 Cases of Work-Related Asthma Michigan
Overall 484
Still ExposedConditions Unchanged 239No Longer Exposed 575
Quit on Doctorrsquos Advice 778Sick Leave 727Fired 621New Controls 589Chemical Substitution 536Quit on Own 431Reassigned 360
Reasons Didnrsquot File a Workersrsquo Compensation Claims for a Repetitive Trauma Michigan
Only 397 (251) of 1598 Filed WC Claim
Injury Not Serious Enough 705 (591)Did Not Expect to Miss Work 694 (583)Expect to Receive Sick Leave or
Disability 337 (283) Medical Expenses Covered by
Other Insurance 427 (359)Did Not Think Injury Work Related 242 (204)
(Rosenman et al JOEM 2000)
Goals of Surveillance Population-Based
bull Assess Magnitude of Problembull NumbersRatesTrends
bull Determine Relative Importance vs Other Health Issuesbull Identify High Risk
bull IndustriesOccupationsWorker Populations
bull Prioritize Interventions bull Evaluate Interventionsbull Generate Hypotheses for Researchbull Identify Emerging Problemsbull Identify Workplaces for Intervention
Case-Based
Reportable Conditions in Michigan
Local Health DepartmentsCommunicable Diseases (83)
ldquoUnusual occurrence outbreak or epidemic of any disease or conditionsrdquoMDHHS
AbortionsBirth DefectsCancerChemical Poisonings including Carbon MonoxideInjuries Nursing Home Abuse
LARAOccupational Illnesses
County Department of Social ServicesChild AbuseAdult Abuse
PoliceInjury from Knife Gun or Deadly WeaponMental Health Patient Abuse
On Request Only
Laboratory Reporting Regulations Michigan
bull Arsenicbull Cadmiumbull Carboxyhemoglobinbull Cholinesterasebull IgE Antibodiesbull Leadbull Mercury
Occupational Illness Reporting Requirement in Michigan
bull LARA ndash MIOSHAPhysician hospital clinic or employer
having a known or suspected occupational disease or health condition aggravated by workplace exposures shall report within 10 days after discovery
Misdemeanor punishable by a fine of not more than $50
Methodology of Multi-Source Surveillance
Amputations 2006- DateHospitalsEDOutpatient ClinicsWorkersrsquo Compensation Wage Replacement
Crushing Injuries 2013- Date+ FACE Program
Skull Fractures 2012-DateBurns 2009-Date
+ Poison Control Center
bull Quarterly Reporting Specified ICD codes -134 Hospitalsbull Quarterly Reporting all Work-related Events ndash Poison Control Centerbull Electronic Data Base All Paid Claims ndash Workersrsquo Compensationbull FACE ndash Death CertificatesOSHA Hot LinePolice Reports
Work-Related Burn Reports ndash By Source Total 1461 Michigan 2009
n=1460 individuals
450
BLS
HOSPITALSEDs (1248)
4501054
BLSMIFACE 1(2) 1
16721
5 PCC (106)
1321 79
WC(306)
(Kica and Rosenman JOEM 2012)
bull Louisville Metro Police Department presentation
bull Breakout Session
bull First Responder Opioid Exposure Survey development
bull Focus Groups
bull Survey Administration
bull Data Analysis
bull Use of Data Results
bull UK ERC first responder overdose response exposure pilot project opportunity
bull Multistate or single state applicationsndash Use of survey
ndash development of other first responder-related pilot project
FACE case investigations
bull initiated drug overdose prevention conversations
bull enhanced collaborations
bull provided evidence of need for enhanced multidisciplinary drug overdose prevention efforts1 Interventions
2 Policies
3 Research
Ladder rap
httpswwwyoutubecomwatchv=FsW6eb3aO8gampfeature=youtube
BLS Survey of Employers vs Multi-Source Surveillance of Work-Related Injuries
Kenneth D Rosenman MDProfessor of MedicineMichigan State Universitywwwoemmsuedu
NIOSH Expanding Research Partnerships Conference Denver Colorado June 21-23 2017
Funding NIOSH U60 OH008466
Survey of Occupational Injuries and Illnesses (SOII)
bull Injuries and illnesses (based on OSHArsquos recordkeeping standards) from 230000 establishments (sample by state and NAICS code)
bull Redesigned in 1992 to collect circumstances of injuries and illnesses that lead to days away from work and characteristics of affected workers
bull Scope limitations no small farms private household or self-employed workers (lt 2008 no public sector workers)
NATIONAL ACADEMY OF SCIENCES 1987
New Jersey24 Deaths not covered by OSHA35 Deaths covered by OSHA butemployer had NOT recorded on OSHAlog or did NOT keep OSHA log
TexasNIOSH Fatal Occupational Trauma Surveillance
CENSUS OF FATAL OCCUPATIONAL INJURIES (CFOI) BEGAN IN 1992
Multiple death sourcesDeath certificatesEmployer reportingState PoliceNewspaper Clipping ServiceMedical ExaminersAgricultural Extension Service
Number of deaths doubled from previous BLS estimate
How Much Work-Related Injury and Illness is Missed By the Current National Surveillance System
Rosenman KD Kalush A Reilly MJ Gardiner JC Reeves M Luo Z JOEM 2006 48357-365Funding NIOSH 5 R01 OH004276-03
Summary of Analysis Comparing BLS and Worker Comp data Michigan 2009-2001Days away from workbull BLS estimate
37-41 BLS+ WC31-34 BLS + WC+ CaptureRecapture
1999-2001 Estimates - Michiganbull BLS -281567 vs Our Estimate - 868241
1 in 15 workers vs 1 in 5 workers
(Rosenman et al JOEM 2006)
Simplified Flowchart of Events Necessary to the Documentation of Work-Related Injuries and Illnesses
(Azaroff et al AJPH 2002)
Filters to Identifying Work-Related Injuries and Illnesses
a Filters To Reporting to Supervisorsb Filters To Losing Work Time c Filters to Obtaining Medical Cared Filters to Recognizing Work-Related by Doctore Filters to Workersrsquo Compensation being the Payerf Filters To Recording on OSHA Logg Filters to Reporting by Employers to Workersrsquo
Compensation Agencyh Filters to Reporting by Doctors
(Azaroff et al AJPH 2002)
Capture-Recapture Estimates of Workplace Injury and Illness Reporting by BLS Adjusted for Capture
Heterogeneity Lost-Time Cases 1998-2001
Percent Reported to WA WV OR WI NM MNNo Source Dependence 55 76 56 65 51 68
Source Dependence 52 71 45 53 37 53
(Adapted Boden and Ozonoff Annals Epidemiology 2008)
Workersrsquo CompensationState Specific Program
Mandatory insurance or if large enough self-insured
Michigan WC Excludesbull Federal employeesbull Interstate railroad workersbull Maritime workersbull Less than 3 employees at any one timebull All employees work less than 35 hoursweek or
if more hours less than 13 weeksbull Self-employed
Not computerizedbull Medical claims only
Proportion of Work-Injured Adults for Whom Treatment was paid by Workersrsquo Compensation by State-BRFSS 10 States 2007
State Injured with Payment by Workersrsquo Compensation
Texas 47 (95 CI 35-59)New York 50 (95 CI 39-60)Michigan 56 (95 CI 41-69)Massachusetts 60 (95 CI 45-75)California 61 (95 CI 55-66)Washington 61 (95 CI 55-67)Oregon 62 (95 CI 50-74)Connecticut 63 (95 CI 53-74)New Jersey 64 (95 CI 51-78)Kentucky 77 (95 CI 65-89)
Excludes self-employed
(Adapted Bonauto et al MMWR 2010)
Percentage Received Workersrsquo Compensation by Condition Michigan
WageReplacement
Medical Only
No CompEmployed
No Comp Self -Employed
Amputations 64 22 17 6Burns 17 48 33 2Skull Fractures 36 32 29 3
Percent Applied for Workersrsquo Comp among 2016 Cases of Work-Related Asthma Michigan
Overall 484
Still ExposedConditions Unchanged 239No Longer Exposed 575
Quit on Doctorrsquos Advice 778Sick Leave 727Fired 621New Controls 589Chemical Substitution 536Quit on Own 431Reassigned 360
Reasons Didnrsquot File a Workersrsquo Compensation Claims for a Repetitive Trauma Michigan
Only 397 (251) of 1598 Filed WC Claim
Injury Not Serious Enough 705 (591)Did Not Expect to Miss Work 694 (583)Expect to Receive Sick Leave or
Disability 337 (283) Medical Expenses Covered by
Other Insurance 427 (359)Did Not Think Injury Work Related 242 (204)
(Rosenman et al JOEM 2000)
Goals of Surveillance Population-Based
bull Assess Magnitude of Problembull NumbersRatesTrends
bull Determine Relative Importance vs Other Health Issuesbull Identify High Risk
bull IndustriesOccupationsWorker Populations
bull Prioritize Interventions bull Evaluate Interventionsbull Generate Hypotheses for Researchbull Identify Emerging Problemsbull Identify Workplaces for Intervention
Case-Based
Reportable Conditions in Michigan
Local Health DepartmentsCommunicable Diseases (83)
ldquoUnusual occurrence outbreak or epidemic of any disease or conditionsrdquoMDHHS
AbortionsBirth DefectsCancerChemical Poisonings including Carbon MonoxideInjuries Nursing Home Abuse
LARAOccupational Illnesses
County Department of Social ServicesChild AbuseAdult Abuse
PoliceInjury from Knife Gun or Deadly WeaponMental Health Patient Abuse
On Request Only
Laboratory Reporting Regulations Michigan
bull Arsenicbull Cadmiumbull Carboxyhemoglobinbull Cholinesterasebull IgE Antibodiesbull Leadbull Mercury
Occupational Illness Reporting Requirement in Michigan
bull LARA ndash MIOSHAPhysician hospital clinic or employer
having a known or suspected occupational disease or health condition aggravated by workplace exposures shall report within 10 days after discovery
Misdemeanor punishable by a fine of not more than $50
Methodology of Multi-Source Surveillance
Amputations 2006- DateHospitalsEDOutpatient ClinicsWorkersrsquo Compensation Wage Replacement
Crushing Injuries 2013- Date+ FACE Program
Skull Fractures 2012-DateBurns 2009-Date
+ Poison Control Center
bull Quarterly Reporting Specified ICD codes -134 Hospitalsbull Quarterly Reporting all Work-related Events ndash Poison Control Centerbull Electronic Data Base All Paid Claims ndash Workersrsquo Compensationbull FACE ndash Death CertificatesOSHA Hot LinePolice Reports
Work-Related Burn Reports ndash By Source Total 1461 Michigan 2009
n=1460 individuals
450
BLS
HOSPITALSEDs (1248)
4501054
BLSMIFACE 1(2) 1
16721
5 PCC (106)
1321 79
WC(306)
(Kica and Rosenman JOEM 2012)
bull UK ERC first responder overdose response exposure pilot project opportunity
bull Multistate or single state applicationsndash Use of survey
ndash development of other first responder-related pilot project
FACE case investigations
bull initiated drug overdose prevention conversations
bull enhanced collaborations
bull provided evidence of need for enhanced multidisciplinary drug overdose prevention efforts1 Interventions
2 Policies
3 Research
Ladder rap
httpswwwyoutubecomwatchv=FsW6eb3aO8gampfeature=youtube
BLS Survey of Employers vs Multi-Source Surveillance of Work-Related Injuries
Kenneth D Rosenman MDProfessor of MedicineMichigan State Universitywwwoemmsuedu
NIOSH Expanding Research Partnerships Conference Denver Colorado June 21-23 2017
Funding NIOSH U60 OH008466
Survey of Occupational Injuries and Illnesses (SOII)
bull Injuries and illnesses (based on OSHArsquos recordkeeping standards) from 230000 establishments (sample by state and NAICS code)
bull Redesigned in 1992 to collect circumstances of injuries and illnesses that lead to days away from work and characteristics of affected workers
bull Scope limitations no small farms private household or self-employed workers (lt 2008 no public sector workers)
NATIONAL ACADEMY OF SCIENCES 1987
New Jersey24 Deaths not covered by OSHA35 Deaths covered by OSHA butemployer had NOT recorded on OSHAlog or did NOT keep OSHA log
TexasNIOSH Fatal Occupational Trauma Surveillance
CENSUS OF FATAL OCCUPATIONAL INJURIES (CFOI) BEGAN IN 1992
Multiple death sourcesDeath certificatesEmployer reportingState PoliceNewspaper Clipping ServiceMedical ExaminersAgricultural Extension Service
Number of deaths doubled from previous BLS estimate
How Much Work-Related Injury and Illness is Missed By the Current National Surveillance System
Rosenman KD Kalush A Reilly MJ Gardiner JC Reeves M Luo Z JOEM 2006 48357-365Funding NIOSH 5 R01 OH004276-03
Summary of Analysis Comparing BLS and Worker Comp data Michigan 2009-2001Days away from workbull BLS estimate
37-41 BLS+ WC31-34 BLS + WC+ CaptureRecapture
1999-2001 Estimates - Michiganbull BLS -281567 vs Our Estimate - 868241
1 in 15 workers vs 1 in 5 workers
(Rosenman et al JOEM 2006)
Simplified Flowchart of Events Necessary to the Documentation of Work-Related Injuries and Illnesses
(Azaroff et al AJPH 2002)
Filters to Identifying Work-Related Injuries and Illnesses
a Filters To Reporting to Supervisorsb Filters To Losing Work Time c Filters to Obtaining Medical Cared Filters to Recognizing Work-Related by Doctore Filters to Workersrsquo Compensation being the Payerf Filters To Recording on OSHA Logg Filters to Reporting by Employers to Workersrsquo
Compensation Agencyh Filters to Reporting by Doctors
(Azaroff et al AJPH 2002)
Capture-Recapture Estimates of Workplace Injury and Illness Reporting by BLS Adjusted for Capture
Heterogeneity Lost-Time Cases 1998-2001
Percent Reported to WA WV OR WI NM MNNo Source Dependence 55 76 56 65 51 68
Source Dependence 52 71 45 53 37 53
(Adapted Boden and Ozonoff Annals Epidemiology 2008)
Workersrsquo CompensationState Specific Program
Mandatory insurance or if large enough self-insured
Michigan WC Excludesbull Federal employeesbull Interstate railroad workersbull Maritime workersbull Less than 3 employees at any one timebull All employees work less than 35 hoursweek or
if more hours less than 13 weeksbull Self-employed
Not computerizedbull Medical claims only
Proportion of Work-Injured Adults for Whom Treatment was paid by Workersrsquo Compensation by State-BRFSS 10 States 2007
State Injured with Payment by Workersrsquo Compensation
Texas 47 (95 CI 35-59)New York 50 (95 CI 39-60)Michigan 56 (95 CI 41-69)Massachusetts 60 (95 CI 45-75)California 61 (95 CI 55-66)Washington 61 (95 CI 55-67)Oregon 62 (95 CI 50-74)Connecticut 63 (95 CI 53-74)New Jersey 64 (95 CI 51-78)Kentucky 77 (95 CI 65-89)
Excludes self-employed
(Adapted Bonauto et al MMWR 2010)
Percentage Received Workersrsquo Compensation by Condition Michigan
WageReplacement
Medical Only
No CompEmployed
No Comp Self -Employed
Amputations 64 22 17 6Burns 17 48 33 2Skull Fractures 36 32 29 3
Percent Applied for Workersrsquo Comp among 2016 Cases of Work-Related Asthma Michigan
Overall 484
Still ExposedConditions Unchanged 239No Longer Exposed 575
Quit on Doctorrsquos Advice 778Sick Leave 727Fired 621New Controls 589Chemical Substitution 536Quit on Own 431Reassigned 360
Reasons Didnrsquot File a Workersrsquo Compensation Claims for a Repetitive Trauma Michigan
Only 397 (251) of 1598 Filed WC Claim
Injury Not Serious Enough 705 (591)Did Not Expect to Miss Work 694 (583)Expect to Receive Sick Leave or
Disability 337 (283) Medical Expenses Covered by
Other Insurance 427 (359)Did Not Think Injury Work Related 242 (204)
(Rosenman et al JOEM 2000)
Goals of Surveillance Population-Based
bull Assess Magnitude of Problembull NumbersRatesTrends
bull Determine Relative Importance vs Other Health Issuesbull Identify High Risk
bull IndustriesOccupationsWorker Populations
bull Prioritize Interventions bull Evaluate Interventionsbull Generate Hypotheses for Researchbull Identify Emerging Problemsbull Identify Workplaces for Intervention
Case-Based
Reportable Conditions in Michigan
Local Health DepartmentsCommunicable Diseases (83)
ldquoUnusual occurrence outbreak or epidemic of any disease or conditionsrdquoMDHHS
AbortionsBirth DefectsCancerChemical Poisonings including Carbon MonoxideInjuries Nursing Home Abuse
LARAOccupational Illnesses
County Department of Social ServicesChild AbuseAdult Abuse
PoliceInjury from Knife Gun or Deadly WeaponMental Health Patient Abuse
On Request Only
Laboratory Reporting Regulations Michigan
bull Arsenicbull Cadmiumbull Carboxyhemoglobinbull Cholinesterasebull IgE Antibodiesbull Leadbull Mercury
Occupational Illness Reporting Requirement in Michigan
bull LARA ndash MIOSHAPhysician hospital clinic or employer
having a known or suspected occupational disease or health condition aggravated by workplace exposures shall report within 10 days after discovery
Misdemeanor punishable by a fine of not more than $50
Methodology of Multi-Source Surveillance
Amputations 2006- DateHospitalsEDOutpatient ClinicsWorkersrsquo Compensation Wage Replacement
Crushing Injuries 2013- Date+ FACE Program
Skull Fractures 2012-DateBurns 2009-Date
+ Poison Control Center
bull Quarterly Reporting Specified ICD codes -134 Hospitalsbull Quarterly Reporting all Work-related Events ndash Poison Control Centerbull Electronic Data Base All Paid Claims ndash Workersrsquo Compensationbull FACE ndash Death CertificatesOSHA Hot LinePolice Reports
Work-Related Burn Reports ndash By Source Total 1461 Michigan 2009
n=1460 individuals
450
BLS
HOSPITALSEDs (1248)
4501054
BLSMIFACE 1(2) 1
16721
5 PCC (106)
1321 79
WC(306)
(Kica and Rosenman JOEM 2012)
FACE case investigations
bull initiated drug overdose prevention conversations
bull enhanced collaborations
bull provided evidence of need for enhanced multidisciplinary drug overdose prevention efforts1 Interventions
2 Policies
3 Research
Ladder rap
httpswwwyoutubecomwatchv=FsW6eb3aO8gampfeature=youtube
BLS Survey of Employers vs Multi-Source Surveillance of Work-Related Injuries
Kenneth D Rosenman MDProfessor of MedicineMichigan State Universitywwwoemmsuedu
NIOSH Expanding Research Partnerships Conference Denver Colorado June 21-23 2017
Funding NIOSH U60 OH008466
Survey of Occupational Injuries and Illnesses (SOII)
bull Injuries and illnesses (based on OSHArsquos recordkeeping standards) from 230000 establishments (sample by state and NAICS code)
bull Redesigned in 1992 to collect circumstances of injuries and illnesses that lead to days away from work and characteristics of affected workers
bull Scope limitations no small farms private household or self-employed workers (lt 2008 no public sector workers)
NATIONAL ACADEMY OF SCIENCES 1987
New Jersey24 Deaths not covered by OSHA35 Deaths covered by OSHA butemployer had NOT recorded on OSHAlog or did NOT keep OSHA log
TexasNIOSH Fatal Occupational Trauma Surveillance
CENSUS OF FATAL OCCUPATIONAL INJURIES (CFOI) BEGAN IN 1992
Multiple death sourcesDeath certificatesEmployer reportingState PoliceNewspaper Clipping ServiceMedical ExaminersAgricultural Extension Service
Number of deaths doubled from previous BLS estimate
How Much Work-Related Injury and Illness is Missed By the Current National Surveillance System
Rosenman KD Kalush A Reilly MJ Gardiner JC Reeves M Luo Z JOEM 2006 48357-365Funding NIOSH 5 R01 OH004276-03
Summary of Analysis Comparing BLS and Worker Comp data Michigan 2009-2001Days away from workbull BLS estimate
37-41 BLS+ WC31-34 BLS + WC+ CaptureRecapture
1999-2001 Estimates - Michiganbull BLS -281567 vs Our Estimate - 868241
1 in 15 workers vs 1 in 5 workers
(Rosenman et al JOEM 2006)
Simplified Flowchart of Events Necessary to the Documentation of Work-Related Injuries and Illnesses
(Azaroff et al AJPH 2002)
Filters to Identifying Work-Related Injuries and Illnesses
a Filters To Reporting to Supervisorsb Filters To Losing Work Time c Filters to Obtaining Medical Cared Filters to Recognizing Work-Related by Doctore Filters to Workersrsquo Compensation being the Payerf Filters To Recording on OSHA Logg Filters to Reporting by Employers to Workersrsquo
Compensation Agencyh Filters to Reporting by Doctors
(Azaroff et al AJPH 2002)
Capture-Recapture Estimates of Workplace Injury and Illness Reporting by BLS Adjusted for Capture
Heterogeneity Lost-Time Cases 1998-2001
Percent Reported to WA WV OR WI NM MNNo Source Dependence 55 76 56 65 51 68
Source Dependence 52 71 45 53 37 53
(Adapted Boden and Ozonoff Annals Epidemiology 2008)
Workersrsquo CompensationState Specific Program
Mandatory insurance or if large enough self-insured
Michigan WC Excludesbull Federal employeesbull Interstate railroad workersbull Maritime workersbull Less than 3 employees at any one timebull All employees work less than 35 hoursweek or
if more hours less than 13 weeksbull Self-employed
Not computerizedbull Medical claims only
Proportion of Work-Injured Adults for Whom Treatment was paid by Workersrsquo Compensation by State-BRFSS 10 States 2007
State Injured with Payment by Workersrsquo Compensation
Texas 47 (95 CI 35-59)New York 50 (95 CI 39-60)Michigan 56 (95 CI 41-69)Massachusetts 60 (95 CI 45-75)California 61 (95 CI 55-66)Washington 61 (95 CI 55-67)Oregon 62 (95 CI 50-74)Connecticut 63 (95 CI 53-74)New Jersey 64 (95 CI 51-78)Kentucky 77 (95 CI 65-89)
Excludes self-employed
(Adapted Bonauto et al MMWR 2010)
Percentage Received Workersrsquo Compensation by Condition Michigan
WageReplacement
Medical Only
No CompEmployed
No Comp Self -Employed
Amputations 64 22 17 6Burns 17 48 33 2Skull Fractures 36 32 29 3
Percent Applied for Workersrsquo Comp among 2016 Cases of Work-Related Asthma Michigan
Overall 484
Still ExposedConditions Unchanged 239No Longer Exposed 575
Quit on Doctorrsquos Advice 778Sick Leave 727Fired 621New Controls 589Chemical Substitution 536Quit on Own 431Reassigned 360
Reasons Didnrsquot File a Workersrsquo Compensation Claims for a Repetitive Trauma Michigan
Only 397 (251) of 1598 Filed WC Claim
Injury Not Serious Enough 705 (591)Did Not Expect to Miss Work 694 (583)Expect to Receive Sick Leave or
Disability 337 (283) Medical Expenses Covered by
Other Insurance 427 (359)Did Not Think Injury Work Related 242 (204)
(Rosenman et al JOEM 2000)
Goals of Surveillance Population-Based
bull Assess Magnitude of Problembull NumbersRatesTrends
bull Determine Relative Importance vs Other Health Issuesbull Identify High Risk
bull IndustriesOccupationsWorker Populations
bull Prioritize Interventions bull Evaluate Interventionsbull Generate Hypotheses for Researchbull Identify Emerging Problemsbull Identify Workplaces for Intervention
Case-Based
Reportable Conditions in Michigan
Local Health DepartmentsCommunicable Diseases (83)
ldquoUnusual occurrence outbreak or epidemic of any disease or conditionsrdquoMDHHS
AbortionsBirth DefectsCancerChemical Poisonings including Carbon MonoxideInjuries Nursing Home Abuse
LARAOccupational Illnesses
County Department of Social ServicesChild AbuseAdult Abuse
PoliceInjury from Knife Gun or Deadly WeaponMental Health Patient Abuse
On Request Only
Laboratory Reporting Regulations Michigan
bull Arsenicbull Cadmiumbull Carboxyhemoglobinbull Cholinesterasebull IgE Antibodiesbull Leadbull Mercury
Occupational Illness Reporting Requirement in Michigan
bull LARA ndash MIOSHAPhysician hospital clinic or employer
having a known or suspected occupational disease or health condition aggravated by workplace exposures shall report within 10 days after discovery
Misdemeanor punishable by a fine of not more than $50
Methodology of Multi-Source Surveillance
Amputations 2006- DateHospitalsEDOutpatient ClinicsWorkersrsquo Compensation Wage Replacement
Crushing Injuries 2013- Date+ FACE Program
Skull Fractures 2012-DateBurns 2009-Date
+ Poison Control Center
bull Quarterly Reporting Specified ICD codes -134 Hospitalsbull Quarterly Reporting all Work-related Events ndash Poison Control Centerbull Electronic Data Base All Paid Claims ndash Workersrsquo Compensationbull FACE ndash Death CertificatesOSHA Hot LinePolice Reports
Work-Related Burn Reports ndash By Source Total 1461 Michigan 2009
n=1460 individuals
450
BLS
HOSPITALSEDs (1248)
4501054
BLSMIFACE 1(2) 1
16721
5 PCC (106)
1321 79
WC(306)
(Kica and Rosenman JOEM 2012)
Ladder rap
httpswwwyoutubecomwatchv=FsW6eb3aO8gampfeature=youtube
BLS Survey of Employers vs Multi-Source Surveillance of Work-Related Injuries
Kenneth D Rosenman MDProfessor of MedicineMichigan State Universitywwwoemmsuedu
NIOSH Expanding Research Partnerships Conference Denver Colorado June 21-23 2017
Funding NIOSH U60 OH008466
Survey of Occupational Injuries and Illnesses (SOII)
bull Injuries and illnesses (based on OSHArsquos recordkeeping standards) from 230000 establishments (sample by state and NAICS code)
bull Redesigned in 1992 to collect circumstances of injuries and illnesses that lead to days away from work and characteristics of affected workers
bull Scope limitations no small farms private household or self-employed workers (lt 2008 no public sector workers)
NATIONAL ACADEMY OF SCIENCES 1987
New Jersey24 Deaths not covered by OSHA35 Deaths covered by OSHA butemployer had NOT recorded on OSHAlog or did NOT keep OSHA log
TexasNIOSH Fatal Occupational Trauma Surveillance
CENSUS OF FATAL OCCUPATIONAL INJURIES (CFOI) BEGAN IN 1992
Multiple death sourcesDeath certificatesEmployer reportingState PoliceNewspaper Clipping ServiceMedical ExaminersAgricultural Extension Service
Number of deaths doubled from previous BLS estimate
How Much Work-Related Injury and Illness is Missed By the Current National Surveillance System
Rosenman KD Kalush A Reilly MJ Gardiner JC Reeves M Luo Z JOEM 2006 48357-365Funding NIOSH 5 R01 OH004276-03
Summary of Analysis Comparing BLS and Worker Comp data Michigan 2009-2001Days away from workbull BLS estimate
37-41 BLS+ WC31-34 BLS + WC+ CaptureRecapture
1999-2001 Estimates - Michiganbull BLS -281567 vs Our Estimate - 868241
1 in 15 workers vs 1 in 5 workers
(Rosenman et al JOEM 2006)
Simplified Flowchart of Events Necessary to the Documentation of Work-Related Injuries and Illnesses
(Azaroff et al AJPH 2002)
Filters to Identifying Work-Related Injuries and Illnesses
a Filters To Reporting to Supervisorsb Filters To Losing Work Time c Filters to Obtaining Medical Cared Filters to Recognizing Work-Related by Doctore Filters to Workersrsquo Compensation being the Payerf Filters To Recording on OSHA Logg Filters to Reporting by Employers to Workersrsquo
Compensation Agencyh Filters to Reporting by Doctors
(Azaroff et al AJPH 2002)
Capture-Recapture Estimates of Workplace Injury and Illness Reporting by BLS Adjusted for Capture
Heterogeneity Lost-Time Cases 1998-2001
Percent Reported to WA WV OR WI NM MNNo Source Dependence 55 76 56 65 51 68
Source Dependence 52 71 45 53 37 53
(Adapted Boden and Ozonoff Annals Epidemiology 2008)
Workersrsquo CompensationState Specific Program
Mandatory insurance or if large enough self-insured
Michigan WC Excludesbull Federal employeesbull Interstate railroad workersbull Maritime workersbull Less than 3 employees at any one timebull All employees work less than 35 hoursweek or
if more hours less than 13 weeksbull Self-employed
Not computerizedbull Medical claims only
Proportion of Work-Injured Adults for Whom Treatment was paid by Workersrsquo Compensation by State-BRFSS 10 States 2007
State Injured with Payment by Workersrsquo Compensation
Texas 47 (95 CI 35-59)New York 50 (95 CI 39-60)Michigan 56 (95 CI 41-69)Massachusetts 60 (95 CI 45-75)California 61 (95 CI 55-66)Washington 61 (95 CI 55-67)Oregon 62 (95 CI 50-74)Connecticut 63 (95 CI 53-74)New Jersey 64 (95 CI 51-78)Kentucky 77 (95 CI 65-89)
Excludes self-employed
(Adapted Bonauto et al MMWR 2010)
Percentage Received Workersrsquo Compensation by Condition Michigan
WageReplacement
Medical Only
No CompEmployed
No Comp Self -Employed
Amputations 64 22 17 6Burns 17 48 33 2Skull Fractures 36 32 29 3
Percent Applied for Workersrsquo Comp among 2016 Cases of Work-Related Asthma Michigan
Overall 484
Still ExposedConditions Unchanged 239No Longer Exposed 575
Quit on Doctorrsquos Advice 778Sick Leave 727Fired 621New Controls 589Chemical Substitution 536Quit on Own 431Reassigned 360
Reasons Didnrsquot File a Workersrsquo Compensation Claims for a Repetitive Trauma Michigan
Only 397 (251) of 1598 Filed WC Claim
Injury Not Serious Enough 705 (591)Did Not Expect to Miss Work 694 (583)Expect to Receive Sick Leave or
Disability 337 (283) Medical Expenses Covered by
Other Insurance 427 (359)Did Not Think Injury Work Related 242 (204)
(Rosenman et al JOEM 2000)
Goals of Surveillance Population-Based
bull Assess Magnitude of Problembull NumbersRatesTrends
bull Determine Relative Importance vs Other Health Issuesbull Identify High Risk
bull IndustriesOccupationsWorker Populations
bull Prioritize Interventions bull Evaluate Interventionsbull Generate Hypotheses for Researchbull Identify Emerging Problemsbull Identify Workplaces for Intervention
Case-Based
Reportable Conditions in Michigan
Local Health DepartmentsCommunicable Diseases (83)
ldquoUnusual occurrence outbreak or epidemic of any disease or conditionsrdquoMDHHS
AbortionsBirth DefectsCancerChemical Poisonings including Carbon MonoxideInjuries Nursing Home Abuse
LARAOccupational Illnesses
County Department of Social ServicesChild AbuseAdult Abuse
PoliceInjury from Knife Gun or Deadly WeaponMental Health Patient Abuse
On Request Only
Laboratory Reporting Regulations Michigan
bull Arsenicbull Cadmiumbull Carboxyhemoglobinbull Cholinesterasebull IgE Antibodiesbull Leadbull Mercury
Occupational Illness Reporting Requirement in Michigan
bull LARA ndash MIOSHAPhysician hospital clinic or employer
having a known or suspected occupational disease or health condition aggravated by workplace exposures shall report within 10 days after discovery
Misdemeanor punishable by a fine of not more than $50
Methodology of Multi-Source Surveillance
Amputations 2006- DateHospitalsEDOutpatient ClinicsWorkersrsquo Compensation Wage Replacement
Crushing Injuries 2013- Date+ FACE Program
Skull Fractures 2012-DateBurns 2009-Date
+ Poison Control Center
bull Quarterly Reporting Specified ICD codes -134 Hospitalsbull Quarterly Reporting all Work-related Events ndash Poison Control Centerbull Electronic Data Base All Paid Claims ndash Workersrsquo Compensationbull FACE ndash Death CertificatesOSHA Hot LinePolice Reports
Work-Related Burn Reports ndash By Source Total 1461 Michigan 2009
n=1460 individuals
450
BLS
HOSPITALSEDs (1248)
4501054
BLSMIFACE 1(2) 1
16721
5 PCC (106)
1321 79
WC(306)
(Kica and Rosenman JOEM 2012)
BLS Survey of Employers vs Multi-Source Surveillance of Work-Related Injuries
Kenneth D Rosenman MDProfessor of MedicineMichigan State Universitywwwoemmsuedu
NIOSH Expanding Research Partnerships Conference Denver Colorado June 21-23 2017
Funding NIOSH U60 OH008466
Survey of Occupational Injuries and Illnesses (SOII)
bull Injuries and illnesses (based on OSHArsquos recordkeeping standards) from 230000 establishments (sample by state and NAICS code)
bull Redesigned in 1992 to collect circumstances of injuries and illnesses that lead to days away from work and characteristics of affected workers
bull Scope limitations no small farms private household or self-employed workers (lt 2008 no public sector workers)
NATIONAL ACADEMY OF SCIENCES 1987
New Jersey24 Deaths not covered by OSHA35 Deaths covered by OSHA butemployer had NOT recorded on OSHAlog or did NOT keep OSHA log
TexasNIOSH Fatal Occupational Trauma Surveillance
CENSUS OF FATAL OCCUPATIONAL INJURIES (CFOI) BEGAN IN 1992
Multiple death sourcesDeath certificatesEmployer reportingState PoliceNewspaper Clipping ServiceMedical ExaminersAgricultural Extension Service
Number of deaths doubled from previous BLS estimate
How Much Work-Related Injury and Illness is Missed By the Current National Surveillance System
Rosenman KD Kalush A Reilly MJ Gardiner JC Reeves M Luo Z JOEM 2006 48357-365Funding NIOSH 5 R01 OH004276-03
Summary of Analysis Comparing BLS and Worker Comp data Michigan 2009-2001Days away from workbull BLS estimate
37-41 BLS+ WC31-34 BLS + WC+ CaptureRecapture
1999-2001 Estimates - Michiganbull BLS -281567 vs Our Estimate - 868241
1 in 15 workers vs 1 in 5 workers
(Rosenman et al JOEM 2006)
Simplified Flowchart of Events Necessary to the Documentation of Work-Related Injuries and Illnesses
(Azaroff et al AJPH 2002)
Filters to Identifying Work-Related Injuries and Illnesses
a Filters To Reporting to Supervisorsb Filters To Losing Work Time c Filters to Obtaining Medical Cared Filters to Recognizing Work-Related by Doctore Filters to Workersrsquo Compensation being the Payerf Filters To Recording on OSHA Logg Filters to Reporting by Employers to Workersrsquo
Compensation Agencyh Filters to Reporting by Doctors
(Azaroff et al AJPH 2002)
Capture-Recapture Estimates of Workplace Injury and Illness Reporting by BLS Adjusted for Capture
Heterogeneity Lost-Time Cases 1998-2001
Percent Reported to WA WV OR WI NM MNNo Source Dependence 55 76 56 65 51 68
Source Dependence 52 71 45 53 37 53
(Adapted Boden and Ozonoff Annals Epidemiology 2008)
Workersrsquo CompensationState Specific Program
Mandatory insurance or if large enough self-insured
Michigan WC Excludesbull Federal employeesbull Interstate railroad workersbull Maritime workersbull Less than 3 employees at any one timebull All employees work less than 35 hoursweek or
if more hours less than 13 weeksbull Self-employed
Not computerizedbull Medical claims only
Proportion of Work-Injured Adults for Whom Treatment was paid by Workersrsquo Compensation by State-BRFSS 10 States 2007
State Injured with Payment by Workersrsquo Compensation
Texas 47 (95 CI 35-59)New York 50 (95 CI 39-60)Michigan 56 (95 CI 41-69)Massachusetts 60 (95 CI 45-75)California 61 (95 CI 55-66)Washington 61 (95 CI 55-67)Oregon 62 (95 CI 50-74)Connecticut 63 (95 CI 53-74)New Jersey 64 (95 CI 51-78)Kentucky 77 (95 CI 65-89)
Excludes self-employed
(Adapted Bonauto et al MMWR 2010)
Percentage Received Workersrsquo Compensation by Condition Michigan
WageReplacement
Medical Only
No CompEmployed
No Comp Self -Employed
Amputations 64 22 17 6Burns 17 48 33 2Skull Fractures 36 32 29 3
Percent Applied for Workersrsquo Comp among 2016 Cases of Work-Related Asthma Michigan
Overall 484
Still ExposedConditions Unchanged 239No Longer Exposed 575
Quit on Doctorrsquos Advice 778Sick Leave 727Fired 621New Controls 589Chemical Substitution 536Quit on Own 431Reassigned 360
Reasons Didnrsquot File a Workersrsquo Compensation Claims for a Repetitive Trauma Michigan
Only 397 (251) of 1598 Filed WC Claim
Injury Not Serious Enough 705 (591)Did Not Expect to Miss Work 694 (583)Expect to Receive Sick Leave or
Disability 337 (283) Medical Expenses Covered by
Other Insurance 427 (359)Did Not Think Injury Work Related 242 (204)
(Rosenman et al JOEM 2000)
Goals of Surveillance Population-Based
bull Assess Magnitude of Problembull NumbersRatesTrends
bull Determine Relative Importance vs Other Health Issuesbull Identify High Risk
bull IndustriesOccupationsWorker Populations
bull Prioritize Interventions bull Evaluate Interventionsbull Generate Hypotheses for Researchbull Identify Emerging Problemsbull Identify Workplaces for Intervention
Case-Based
Reportable Conditions in Michigan
Local Health DepartmentsCommunicable Diseases (83)
ldquoUnusual occurrence outbreak or epidemic of any disease or conditionsrdquoMDHHS
AbortionsBirth DefectsCancerChemical Poisonings including Carbon MonoxideInjuries Nursing Home Abuse
LARAOccupational Illnesses
County Department of Social ServicesChild AbuseAdult Abuse
PoliceInjury from Knife Gun or Deadly WeaponMental Health Patient Abuse
On Request Only
Laboratory Reporting Regulations Michigan
bull Arsenicbull Cadmiumbull Carboxyhemoglobinbull Cholinesterasebull IgE Antibodiesbull Leadbull Mercury
Occupational Illness Reporting Requirement in Michigan
bull LARA ndash MIOSHAPhysician hospital clinic or employer
having a known or suspected occupational disease or health condition aggravated by workplace exposures shall report within 10 days after discovery
Misdemeanor punishable by a fine of not more than $50
Methodology of Multi-Source Surveillance
Amputations 2006- DateHospitalsEDOutpatient ClinicsWorkersrsquo Compensation Wage Replacement
Crushing Injuries 2013- Date+ FACE Program
Skull Fractures 2012-DateBurns 2009-Date
+ Poison Control Center
bull Quarterly Reporting Specified ICD codes -134 Hospitalsbull Quarterly Reporting all Work-related Events ndash Poison Control Centerbull Electronic Data Base All Paid Claims ndash Workersrsquo Compensationbull FACE ndash Death CertificatesOSHA Hot LinePolice Reports
Work-Related Burn Reports ndash By Source Total 1461 Michigan 2009
n=1460 individuals
450
BLS
HOSPITALSEDs (1248)
4501054
BLSMIFACE 1(2) 1
16721
5 PCC (106)
1321 79
WC(306)
(Kica and Rosenman JOEM 2012)
Survey of Occupational Injuries and Illnesses (SOII)
bull Injuries and illnesses (based on OSHArsquos recordkeeping standards) from 230000 establishments (sample by state and NAICS code)
bull Redesigned in 1992 to collect circumstances of injuries and illnesses that lead to days away from work and characteristics of affected workers
bull Scope limitations no small farms private household or self-employed workers (lt 2008 no public sector workers)
NATIONAL ACADEMY OF SCIENCES 1987
New Jersey24 Deaths not covered by OSHA35 Deaths covered by OSHA butemployer had NOT recorded on OSHAlog or did NOT keep OSHA log
TexasNIOSH Fatal Occupational Trauma Surveillance
CENSUS OF FATAL OCCUPATIONAL INJURIES (CFOI) BEGAN IN 1992
Multiple death sourcesDeath certificatesEmployer reportingState PoliceNewspaper Clipping ServiceMedical ExaminersAgricultural Extension Service
Number of deaths doubled from previous BLS estimate
How Much Work-Related Injury and Illness is Missed By the Current National Surveillance System
Rosenman KD Kalush A Reilly MJ Gardiner JC Reeves M Luo Z JOEM 2006 48357-365Funding NIOSH 5 R01 OH004276-03
Summary of Analysis Comparing BLS and Worker Comp data Michigan 2009-2001Days away from workbull BLS estimate
37-41 BLS+ WC31-34 BLS + WC+ CaptureRecapture
1999-2001 Estimates - Michiganbull BLS -281567 vs Our Estimate - 868241
1 in 15 workers vs 1 in 5 workers
(Rosenman et al JOEM 2006)
Simplified Flowchart of Events Necessary to the Documentation of Work-Related Injuries and Illnesses
(Azaroff et al AJPH 2002)
Filters to Identifying Work-Related Injuries and Illnesses
a Filters To Reporting to Supervisorsb Filters To Losing Work Time c Filters to Obtaining Medical Cared Filters to Recognizing Work-Related by Doctore Filters to Workersrsquo Compensation being the Payerf Filters To Recording on OSHA Logg Filters to Reporting by Employers to Workersrsquo
Compensation Agencyh Filters to Reporting by Doctors
(Azaroff et al AJPH 2002)
Capture-Recapture Estimates of Workplace Injury and Illness Reporting by BLS Adjusted for Capture
Heterogeneity Lost-Time Cases 1998-2001
Percent Reported to WA WV OR WI NM MNNo Source Dependence 55 76 56 65 51 68
Source Dependence 52 71 45 53 37 53
(Adapted Boden and Ozonoff Annals Epidemiology 2008)
Workersrsquo CompensationState Specific Program
Mandatory insurance or if large enough self-insured
Michigan WC Excludesbull Federal employeesbull Interstate railroad workersbull Maritime workersbull Less than 3 employees at any one timebull All employees work less than 35 hoursweek or
if more hours less than 13 weeksbull Self-employed
Not computerizedbull Medical claims only
Proportion of Work-Injured Adults for Whom Treatment was paid by Workersrsquo Compensation by State-BRFSS 10 States 2007
State Injured with Payment by Workersrsquo Compensation
Texas 47 (95 CI 35-59)New York 50 (95 CI 39-60)Michigan 56 (95 CI 41-69)Massachusetts 60 (95 CI 45-75)California 61 (95 CI 55-66)Washington 61 (95 CI 55-67)Oregon 62 (95 CI 50-74)Connecticut 63 (95 CI 53-74)New Jersey 64 (95 CI 51-78)Kentucky 77 (95 CI 65-89)
Excludes self-employed
(Adapted Bonauto et al MMWR 2010)
Percentage Received Workersrsquo Compensation by Condition Michigan
WageReplacement
Medical Only
No CompEmployed
No Comp Self -Employed
Amputations 64 22 17 6Burns 17 48 33 2Skull Fractures 36 32 29 3
Percent Applied for Workersrsquo Comp among 2016 Cases of Work-Related Asthma Michigan
Overall 484
Still ExposedConditions Unchanged 239No Longer Exposed 575
Quit on Doctorrsquos Advice 778Sick Leave 727Fired 621New Controls 589Chemical Substitution 536Quit on Own 431Reassigned 360
Reasons Didnrsquot File a Workersrsquo Compensation Claims for a Repetitive Trauma Michigan
Only 397 (251) of 1598 Filed WC Claim
Injury Not Serious Enough 705 (591)Did Not Expect to Miss Work 694 (583)Expect to Receive Sick Leave or
Disability 337 (283) Medical Expenses Covered by
Other Insurance 427 (359)Did Not Think Injury Work Related 242 (204)
(Rosenman et al JOEM 2000)
Goals of Surveillance Population-Based
bull Assess Magnitude of Problembull NumbersRatesTrends
bull Determine Relative Importance vs Other Health Issuesbull Identify High Risk
bull IndustriesOccupationsWorker Populations
bull Prioritize Interventions bull Evaluate Interventionsbull Generate Hypotheses for Researchbull Identify Emerging Problemsbull Identify Workplaces for Intervention
Case-Based
Reportable Conditions in Michigan
Local Health DepartmentsCommunicable Diseases (83)
ldquoUnusual occurrence outbreak or epidemic of any disease or conditionsrdquoMDHHS
AbortionsBirth DefectsCancerChemical Poisonings including Carbon MonoxideInjuries Nursing Home Abuse
LARAOccupational Illnesses
County Department of Social ServicesChild AbuseAdult Abuse
PoliceInjury from Knife Gun or Deadly WeaponMental Health Patient Abuse
On Request Only
Laboratory Reporting Regulations Michigan
bull Arsenicbull Cadmiumbull Carboxyhemoglobinbull Cholinesterasebull IgE Antibodiesbull Leadbull Mercury
Occupational Illness Reporting Requirement in Michigan
bull LARA ndash MIOSHAPhysician hospital clinic or employer
having a known or suspected occupational disease or health condition aggravated by workplace exposures shall report within 10 days after discovery
Misdemeanor punishable by a fine of not more than $50
Methodology of Multi-Source Surveillance
Amputations 2006- DateHospitalsEDOutpatient ClinicsWorkersrsquo Compensation Wage Replacement
Crushing Injuries 2013- Date+ FACE Program
Skull Fractures 2012-DateBurns 2009-Date
+ Poison Control Center
bull Quarterly Reporting Specified ICD codes -134 Hospitalsbull Quarterly Reporting all Work-related Events ndash Poison Control Centerbull Electronic Data Base All Paid Claims ndash Workersrsquo Compensationbull FACE ndash Death CertificatesOSHA Hot LinePolice Reports
Work-Related Burn Reports ndash By Source Total 1461 Michigan 2009
n=1460 individuals
450
BLS
HOSPITALSEDs (1248)
4501054
BLSMIFACE 1(2) 1
16721
5 PCC (106)
1321 79
WC(306)
(Kica and Rosenman JOEM 2012)
NATIONAL ACADEMY OF SCIENCES 1987
New Jersey24 Deaths not covered by OSHA35 Deaths covered by OSHA butemployer had NOT recorded on OSHAlog or did NOT keep OSHA log
TexasNIOSH Fatal Occupational Trauma Surveillance
CENSUS OF FATAL OCCUPATIONAL INJURIES (CFOI) BEGAN IN 1992
Multiple death sourcesDeath certificatesEmployer reportingState PoliceNewspaper Clipping ServiceMedical ExaminersAgricultural Extension Service
Number of deaths doubled from previous BLS estimate
How Much Work-Related Injury and Illness is Missed By the Current National Surveillance System
Rosenman KD Kalush A Reilly MJ Gardiner JC Reeves M Luo Z JOEM 2006 48357-365Funding NIOSH 5 R01 OH004276-03
Summary of Analysis Comparing BLS and Worker Comp data Michigan 2009-2001Days away from workbull BLS estimate
37-41 BLS+ WC31-34 BLS + WC+ CaptureRecapture
1999-2001 Estimates - Michiganbull BLS -281567 vs Our Estimate - 868241
1 in 15 workers vs 1 in 5 workers
(Rosenman et al JOEM 2006)
Simplified Flowchart of Events Necessary to the Documentation of Work-Related Injuries and Illnesses
(Azaroff et al AJPH 2002)
Filters to Identifying Work-Related Injuries and Illnesses
a Filters To Reporting to Supervisorsb Filters To Losing Work Time c Filters to Obtaining Medical Cared Filters to Recognizing Work-Related by Doctore Filters to Workersrsquo Compensation being the Payerf Filters To Recording on OSHA Logg Filters to Reporting by Employers to Workersrsquo
Compensation Agencyh Filters to Reporting by Doctors
(Azaroff et al AJPH 2002)
Capture-Recapture Estimates of Workplace Injury and Illness Reporting by BLS Adjusted for Capture
Heterogeneity Lost-Time Cases 1998-2001
Percent Reported to WA WV OR WI NM MNNo Source Dependence 55 76 56 65 51 68
Source Dependence 52 71 45 53 37 53
(Adapted Boden and Ozonoff Annals Epidemiology 2008)
Workersrsquo CompensationState Specific Program
Mandatory insurance or if large enough self-insured
Michigan WC Excludesbull Federal employeesbull Interstate railroad workersbull Maritime workersbull Less than 3 employees at any one timebull All employees work less than 35 hoursweek or
if more hours less than 13 weeksbull Self-employed
Not computerizedbull Medical claims only
Proportion of Work-Injured Adults for Whom Treatment was paid by Workersrsquo Compensation by State-BRFSS 10 States 2007
State Injured with Payment by Workersrsquo Compensation
Texas 47 (95 CI 35-59)New York 50 (95 CI 39-60)Michigan 56 (95 CI 41-69)Massachusetts 60 (95 CI 45-75)California 61 (95 CI 55-66)Washington 61 (95 CI 55-67)Oregon 62 (95 CI 50-74)Connecticut 63 (95 CI 53-74)New Jersey 64 (95 CI 51-78)Kentucky 77 (95 CI 65-89)
Excludes self-employed
(Adapted Bonauto et al MMWR 2010)
Percentage Received Workersrsquo Compensation by Condition Michigan
WageReplacement
Medical Only
No CompEmployed
No Comp Self -Employed
Amputations 64 22 17 6Burns 17 48 33 2Skull Fractures 36 32 29 3
Percent Applied for Workersrsquo Comp among 2016 Cases of Work-Related Asthma Michigan
Overall 484
Still ExposedConditions Unchanged 239No Longer Exposed 575
Quit on Doctorrsquos Advice 778Sick Leave 727Fired 621New Controls 589Chemical Substitution 536Quit on Own 431Reassigned 360
Reasons Didnrsquot File a Workersrsquo Compensation Claims for a Repetitive Trauma Michigan
Only 397 (251) of 1598 Filed WC Claim
Injury Not Serious Enough 705 (591)Did Not Expect to Miss Work 694 (583)Expect to Receive Sick Leave or
Disability 337 (283) Medical Expenses Covered by
Other Insurance 427 (359)Did Not Think Injury Work Related 242 (204)
(Rosenman et al JOEM 2000)
Goals of Surveillance Population-Based
bull Assess Magnitude of Problembull NumbersRatesTrends
bull Determine Relative Importance vs Other Health Issuesbull Identify High Risk
bull IndustriesOccupationsWorker Populations
bull Prioritize Interventions bull Evaluate Interventionsbull Generate Hypotheses for Researchbull Identify Emerging Problemsbull Identify Workplaces for Intervention
Case-Based
Reportable Conditions in Michigan
Local Health DepartmentsCommunicable Diseases (83)
ldquoUnusual occurrence outbreak or epidemic of any disease or conditionsrdquoMDHHS
AbortionsBirth DefectsCancerChemical Poisonings including Carbon MonoxideInjuries Nursing Home Abuse
LARAOccupational Illnesses
County Department of Social ServicesChild AbuseAdult Abuse
PoliceInjury from Knife Gun or Deadly WeaponMental Health Patient Abuse
On Request Only
Laboratory Reporting Regulations Michigan
bull Arsenicbull Cadmiumbull Carboxyhemoglobinbull Cholinesterasebull IgE Antibodiesbull Leadbull Mercury
Occupational Illness Reporting Requirement in Michigan
bull LARA ndash MIOSHAPhysician hospital clinic or employer
having a known or suspected occupational disease or health condition aggravated by workplace exposures shall report within 10 days after discovery
Misdemeanor punishable by a fine of not more than $50
Methodology of Multi-Source Surveillance
Amputations 2006- DateHospitalsEDOutpatient ClinicsWorkersrsquo Compensation Wage Replacement
Crushing Injuries 2013- Date+ FACE Program
Skull Fractures 2012-DateBurns 2009-Date
+ Poison Control Center
bull Quarterly Reporting Specified ICD codes -134 Hospitalsbull Quarterly Reporting all Work-related Events ndash Poison Control Centerbull Electronic Data Base All Paid Claims ndash Workersrsquo Compensationbull FACE ndash Death CertificatesOSHA Hot LinePolice Reports
Work-Related Burn Reports ndash By Source Total 1461 Michigan 2009
n=1460 individuals
450
BLS
HOSPITALSEDs (1248)
4501054
BLSMIFACE 1(2) 1
16721
5 PCC (106)
1321 79
WC(306)
(Kica and Rosenman JOEM 2012)
CENSUS OF FATAL OCCUPATIONAL INJURIES (CFOI) BEGAN IN 1992
Multiple death sourcesDeath certificatesEmployer reportingState PoliceNewspaper Clipping ServiceMedical ExaminersAgricultural Extension Service
Number of deaths doubled from previous BLS estimate
How Much Work-Related Injury and Illness is Missed By the Current National Surveillance System
Rosenman KD Kalush A Reilly MJ Gardiner JC Reeves M Luo Z JOEM 2006 48357-365Funding NIOSH 5 R01 OH004276-03
Summary of Analysis Comparing BLS and Worker Comp data Michigan 2009-2001Days away from workbull BLS estimate
37-41 BLS+ WC31-34 BLS + WC+ CaptureRecapture
1999-2001 Estimates - Michiganbull BLS -281567 vs Our Estimate - 868241
1 in 15 workers vs 1 in 5 workers
(Rosenman et al JOEM 2006)
Simplified Flowchart of Events Necessary to the Documentation of Work-Related Injuries and Illnesses
(Azaroff et al AJPH 2002)
Filters to Identifying Work-Related Injuries and Illnesses
a Filters To Reporting to Supervisorsb Filters To Losing Work Time c Filters to Obtaining Medical Cared Filters to Recognizing Work-Related by Doctore Filters to Workersrsquo Compensation being the Payerf Filters To Recording on OSHA Logg Filters to Reporting by Employers to Workersrsquo
Compensation Agencyh Filters to Reporting by Doctors
(Azaroff et al AJPH 2002)
Capture-Recapture Estimates of Workplace Injury and Illness Reporting by BLS Adjusted for Capture
Heterogeneity Lost-Time Cases 1998-2001
Percent Reported to WA WV OR WI NM MNNo Source Dependence 55 76 56 65 51 68
Source Dependence 52 71 45 53 37 53
(Adapted Boden and Ozonoff Annals Epidemiology 2008)
Workersrsquo CompensationState Specific Program
Mandatory insurance or if large enough self-insured
Michigan WC Excludesbull Federal employeesbull Interstate railroad workersbull Maritime workersbull Less than 3 employees at any one timebull All employees work less than 35 hoursweek or
if more hours less than 13 weeksbull Self-employed
Not computerizedbull Medical claims only
Proportion of Work-Injured Adults for Whom Treatment was paid by Workersrsquo Compensation by State-BRFSS 10 States 2007
State Injured with Payment by Workersrsquo Compensation
Texas 47 (95 CI 35-59)New York 50 (95 CI 39-60)Michigan 56 (95 CI 41-69)Massachusetts 60 (95 CI 45-75)California 61 (95 CI 55-66)Washington 61 (95 CI 55-67)Oregon 62 (95 CI 50-74)Connecticut 63 (95 CI 53-74)New Jersey 64 (95 CI 51-78)Kentucky 77 (95 CI 65-89)
Excludes self-employed
(Adapted Bonauto et al MMWR 2010)
Percentage Received Workersrsquo Compensation by Condition Michigan
WageReplacement
Medical Only
No CompEmployed
No Comp Self -Employed
Amputations 64 22 17 6Burns 17 48 33 2Skull Fractures 36 32 29 3
Percent Applied for Workersrsquo Comp among 2016 Cases of Work-Related Asthma Michigan
Overall 484
Still ExposedConditions Unchanged 239No Longer Exposed 575
Quit on Doctorrsquos Advice 778Sick Leave 727Fired 621New Controls 589Chemical Substitution 536Quit on Own 431Reassigned 360
Reasons Didnrsquot File a Workersrsquo Compensation Claims for a Repetitive Trauma Michigan
Only 397 (251) of 1598 Filed WC Claim
Injury Not Serious Enough 705 (591)Did Not Expect to Miss Work 694 (583)Expect to Receive Sick Leave or
Disability 337 (283) Medical Expenses Covered by
Other Insurance 427 (359)Did Not Think Injury Work Related 242 (204)
(Rosenman et al JOEM 2000)
Goals of Surveillance Population-Based
bull Assess Magnitude of Problembull NumbersRatesTrends
bull Determine Relative Importance vs Other Health Issuesbull Identify High Risk
bull IndustriesOccupationsWorker Populations
bull Prioritize Interventions bull Evaluate Interventionsbull Generate Hypotheses for Researchbull Identify Emerging Problemsbull Identify Workplaces for Intervention
Case-Based
Reportable Conditions in Michigan
Local Health DepartmentsCommunicable Diseases (83)
ldquoUnusual occurrence outbreak or epidemic of any disease or conditionsrdquoMDHHS
AbortionsBirth DefectsCancerChemical Poisonings including Carbon MonoxideInjuries Nursing Home Abuse
LARAOccupational Illnesses
County Department of Social ServicesChild AbuseAdult Abuse
PoliceInjury from Knife Gun or Deadly WeaponMental Health Patient Abuse
On Request Only
Laboratory Reporting Regulations Michigan
bull Arsenicbull Cadmiumbull Carboxyhemoglobinbull Cholinesterasebull IgE Antibodiesbull Leadbull Mercury
Occupational Illness Reporting Requirement in Michigan
bull LARA ndash MIOSHAPhysician hospital clinic or employer
having a known or suspected occupational disease or health condition aggravated by workplace exposures shall report within 10 days after discovery
Misdemeanor punishable by a fine of not more than $50
Methodology of Multi-Source Surveillance
Amputations 2006- DateHospitalsEDOutpatient ClinicsWorkersrsquo Compensation Wage Replacement
Crushing Injuries 2013- Date+ FACE Program
Skull Fractures 2012-DateBurns 2009-Date
+ Poison Control Center
bull Quarterly Reporting Specified ICD codes -134 Hospitalsbull Quarterly Reporting all Work-related Events ndash Poison Control Centerbull Electronic Data Base All Paid Claims ndash Workersrsquo Compensationbull FACE ndash Death CertificatesOSHA Hot LinePolice Reports
Work-Related Burn Reports ndash By Source Total 1461 Michigan 2009
n=1460 individuals
450
BLS
HOSPITALSEDs (1248)
4501054
BLSMIFACE 1(2) 1
16721
5 PCC (106)
1321 79
WC(306)
(Kica and Rosenman JOEM 2012)
How Much Work-Related Injury and Illness is Missed By the Current National Surveillance System
Rosenman KD Kalush A Reilly MJ Gardiner JC Reeves M Luo Z JOEM 2006 48357-365Funding NIOSH 5 R01 OH004276-03
Summary of Analysis Comparing BLS and Worker Comp data Michigan 2009-2001Days away from workbull BLS estimate
37-41 BLS+ WC31-34 BLS + WC+ CaptureRecapture
1999-2001 Estimates - Michiganbull BLS -281567 vs Our Estimate - 868241
1 in 15 workers vs 1 in 5 workers
(Rosenman et al JOEM 2006)
Simplified Flowchart of Events Necessary to the Documentation of Work-Related Injuries and Illnesses
(Azaroff et al AJPH 2002)
Filters to Identifying Work-Related Injuries and Illnesses
a Filters To Reporting to Supervisorsb Filters To Losing Work Time c Filters to Obtaining Medical Cared Filters to Recognizing Work-Related by Doctore Filters to Workersrsquo Compensation being the Payerf Filters To Recording on OSHA Logg Filters to Reporting by Employers to Workersrsquo
Compensation Agencyh Filters to Reporting by Doctors
(Azaroff et al AJPH 2002)
Capture-Recapture Estimates of Workplace Injury and Illness Reporting by BLS Adjusted for Capture
Heterogeneity Lost-Time Cases 1998-2001
Percent Reported to WA WV OR WI NM MNNo Source Dependence 55 76 56 65 51 68
Source Dependence 52 71 45 53 37 53
(Adapted Boden and Ozonoff Annals Epidemiology 2008)
Workersrsquo CompensationState Specific Program
Mandatory insurance or if large enough self-insured
Michigan WC Excludesbull Federal employeesbull Interstate railroad workersbull Maritime workersbull Less than 3 employees at any one timebull All employees work less than 35 hoursweek or
if more hours less than 13 weeksbull Self-employed
Not computerizedbull Medical claims only
Proportion of Work-Injured Adults for Whom Treatment was paid by Workersrsquo Compensation by State-BRFSS 10 States 2007
State Injured with Payment by Workersrsquo Compensation
Texas 47 (95 CI 35-59)New York 50 (95 CI 39-60)Michigan 56 (95 CI 41-69)Massachusetts 60 (95 CI 45-75)California 61 (95 CI 55-66)Washington 61 (95 CI 55-67)Oregon 62 (95 CI 50-74)Connecticut 63 (95 CI 53-74)New Jersey 64 (95 CI 51-78)Kentucky 77 (95 CI 65-89)
Excludes self-employed
(Adapted Bonauto et al MMWR 2010)
Percentage Received Workersrsquo Compensation by Condition Michigan
WageReplacement
Medical Only
No CompEmployed
No Comp Self -Employed
Amputations 64 22 17 6Burns 17 48 33 2Skull Fractures 36 32 29 3
Percent Applied for Workersrsquo Comp among 2016 Cases of Work-Related Asthma Michigan
Overall 484
Still ExposedConditions Unchanged 239No Longer Exposed 575
Quit on Doctorrsquos Advice 778Sick Leave 727Fired 621New Controls 589Chemical Substitution 536Quit on Own 431Reassigned 360
Reasons Didnrsquot File a Workersrsquo Compensation Claims for a Repetitive Trauma Michigan
Only 397 (251) of 1598 Filed WC Claim
Injury Not Serious Enough 705 (591)Did Not Expect to Miss Work 694 (583)Expect to Receive Sick Leave or
Disability 337 (283) Medical Expenses Covered by
Other Insurance 427 (359)Did Not Think Injury Work Related 242 (204)
(Rosenman et al JOEM 2000)
Goals of Surveillance Population-Based
bull Assess Magnitude of Problembull NumbersRatesTrends
bull Determine Relative Importance vs Other Health Issuesbull Identify High Risk
bull IndustriesOccupationsWorker Populations
bull Prioritize Interventions bull Evaluate Interventionsbull Generate Hypotheses for Researchbull Identify Emerging Problemsbull Identify Workplaces for Intervention
Case-Based
Reportable Conditions in Michigan
Local Health DepartmentsCommunicable Diseases (83)
ldquoUnusual occurrence outbreak or epidemic of any disease or conditionsrdquoMDHHS
AbortionsBirth DefectsCancerChemical Poisonings including Carbon MonoxideInjuries Nursing Home Abuse
LARAOccupational Illnesses
County Department of Social ServicesChild AbuseAdult Abuse
PoliceInjury from Knife Gun or Deadly WeaponMental Health Patient Abuse
On Request Only
Laboratory Reporting Regulations Michigan
bull Arsenicbull Cadmiumbull Carboxyhemoglobinbull Cholinesterasebull IgE Antibodiesbull Leadbull Mercury
Occupational Illness Reporting Requirement in Michigan
bull LARA ndash MIOSHAPhysician hospital clinic or employer
having a known or suspected occupational disease or health condition aggravated by workplace exposures shall report within 10 days after discovery
Misdemeanor punishable by a fine of not more than $50
Methodology of Multi-Source Surveillance
Amputations 2006- DateHospitalsEDOutpatient ClinicsWorkersrsquo Compensation Wage Replacement
Crushing Injuries 2013- Date+ FACE Program
Skull Fractures 2012-DateBurns 2009-Date
+ Poison Control Center
bull Quarterly Reporting Specified ICD codes -134 Hospitalsbull Quarterly Reporting all Work-related Events ndash Poison Control Centerbull Electronic Data Base All Paid Claims ndash Workersrsquo Compensationbull FACE ndash Death CertificatesOSHA Hot LinePolice Reports
Work-Related Burn Reports ndash By Source Total 1461 Michigan 2009
n=1460 individuals
450
BLS
HOSPITALSEDs (1248)
4501054
BLSMIFACE 1(2) 1
16721
5 PCC (106)
1321 79
WC(306)
(Kica and Rosenman JOEM 2012)
Summary of Analysis Comparing BLS and Worker Comp data Michigan 2009-2001Days away from workbull BLS estimate
37-41 BLS+ WC31-34 BLS + WC+ CaptureRecapture
1999-2001 Estimates - Michiganbull BLS -281567 vs Our Estimate - 868241
1 in 15 workers vs 1 in 5 workers
(Rosenman et al JOEM 2006)
Simplified Flowchart of Events Necessary to the Documentation of Work-Related Injuries and Illnesses
(Azaroff et al AJPH 2002)
Filters to Identifying Work-Related Injuries and Illnesses
a Filters To Reporting to Supervisorsb Filters To Losing Work Time c Filters to Obtaining Medical Cared Filters to Recognizing Work-Related by Doctore Filters to Workersrsquo Compensation being the Payerf Filters To Recording on OSHA Logg Filters to Reporting by Employers to Workersrsquo
Compensation Agencyh Filters to Reporting by Doctors
(Azaroff et al AJPH 2002)
Capture-Recapture Estimates of Workplace Injury and Illness Reporting by BLS Adjusted for Capture
Heterogeneity Lost-Time Cases 1998-2001
Percent Reported to WA WV OR WI NM MNNo Source Dependence 55 76 56 65 51 68
Source Dependence 52 71 45 53 37 53
(Adapted Boden and Ozonoff Annals Epidemiology 2008)
Workersrsquo CompensationState Specific Program
Mandatory insurance or if large enough self-insured
Michigan WC Excludesbull Federal employeesbull Interstate railroad workersbull Maritime workersbull Less than 3 employees at any one timebull All employees work less than 35 hoursweek or
if more hours less than 13 weeksbull Self-employed
Not computerizedbull Medical claims only
Proportion of Work-Injured Adults for Whom Treatment was paid by Workersrsquo Compensation by State-BRFSS 10 States 2007
State Injured with Payment by Workersrsquo Compensation
Texas 47 (95 CI 35-59)New York 50 (95 CI 39-60)Michigan 56 (95 CI 41-69)Massachusetts 60 (95 CI 45-75)California 61 (95 CI 55-66)Washington 61 (95 CI 55-67)Oregon 62 (95 CI 50-74)Connecticut 63 (95 CI 53-74)New Jersey 64 (95 CI 51-78)Kentucky 77 (95 CI 65-89)
Excludes self-employed
(Adapted Bonauto et al MMWR 2010)
Percentage Received Workersrsquo Compensation by Condition Michigan
WageReplacement
Medical Only
No CompEmployed
No Comp Self -Employed
Amputations 64 22 17 6Burns 17 48 33 2Skull Fractures 36 32 29 3
Percent Applied for Workersrsquo Comp among 2016 Cases of Work-Related Asthma Michigan
Overall 484
Still ExposedConditions Unchanged 239No Longer Exposed 575
Quit on Doctorrsquos Advice 778Sick Leave 727Fired 621New Controls 589Chemical Substitution 536Quit on Own 431Reassigned 360
Reasons Didnrsquot File a Workersrsquo Compensation Claims for a Repetitive Trauma Michigan
Only 397 (251) of 1598 Filed WC Claim
Injury Not Serious Enough 705 (591)Did Not Expect to Miss Work 694 (583)Expect to Receive Sick Leave or
Disability 337 (283) Medical Expenses Covered by
Other Insurance 427 (359)Did Not Think Injury Work Related 242 (204)
(Rosenman et al JOEM 2000)
Goals of Surveillance Population-Based
bull Assess Magnitude of Problembull NumbersRatesTrends
bull Determine Relative Importance vs Other Health Issuesbull Identify High Risk
bull IndustriesOccupationsWorker Populations
bull Prioritize Interventions bull Evaluate Interventionsbull Generate Hypotheses for Researchbull Identify Emerging Problemsbull Identify Workplaces for Intervention
Case-Based
Reportable Conditions in Michigan
Local Health DepartmentsCommunicable Diseases (83)
ldquoUnusual occurrence outbreak or epidemic of any disease or conditionsrdquoMDHHS
AbortionsBirth DefectsCancerChemical Poisonings including Carbon MonoxideInjuries Nursing Home Abuse
LARAOccupational Illnesses
County Department of Social ServicesChild AbuseAdult Abuse
PoliceInjury from Knife Gun or Deadly WeaponMental Health Patient Abuse
On Request Only
Laboratory Reporting Regulations Michigan
bull Arsenicbull Cadmiumbull Carboxyhemoglobinbull Cholinesterasebull IgE Antibodiesbull Leadbull Mercury
Occupational Illness Reporting Requirement in Michigan
bull LARA ndash MIOSHAPhysician hospital clinic or employer
having a known or suspected occupational disease or health condition aggravated by workplace exposures shall report within 10 days after discovery
Misdemeanor punishable by a fine of not more than $50
Methodology of Multi-Source Surveillance
Amputations 2006- DateHospitalsEDOutpatient ClinicsWorkersrsquo Compensation Wage Replacement
Crushing Injuries 2013- Date+ FACE Program
Skull Fractures 2012-DateBurns 2009-Date
+ Poison Control Center
bull Quarterly Reporting Specified ICD codes -134 Hospitalsbull Quarterly Reporting all Work-related Events ndash Poison Control Centerbull Electronic Data Base All Paid Claims ndash Workersrsquo Compensationbull FACE ndash Death CertificatesOSHA Hot LinePolice Reports
Work-Related Burn Reports ndash By Source Total 1461 Michigan 2009
n=1460 individuals
450
BLS
HOSPITALSEDs (1248)
4501054
BLSMIFACE 1(2) 1
16721
5 PCC (106)
1321 79
WC(306)
(Kica and Rosenman JOEM 2012)
Simplified Flowchart of Events Necessary to the Documentation of Work-Related Injuries and Illnesses
(Azaroff et al AJPH 2002)
Filters to Identifying Work-Related Injuries and Illnesses
a Filters To Reporting to Supervisorsb Filters To Losing Work Time c Filters to Obtaining Medical Cared Filters to Recognizing Work-Related by Doctore Filters to Workersrsquo Compensation being the Payerf Filters To Recording on OSHA Logg Filters to Reporting by Employers to Workersrsquo
Compensation Agencyh Filters to Reporting by Doctors
(Azaroff et al AJPH 2002)
Capture-Recapture Estimates of Workplace Injury and Illness Reporting by BLS Adjusted for Capture
Heterogeneity Lost-Time Cases 1998-2001
Percent Reported to WA WV OR WI NM MNNo Source Dependence 55 76 56 65 51 68
Source Dependence 52 71 45 53 37 53
(Adapted Boden and Ozonoff Annals Epidemiology 2008)
Workersrsquo CompensationState Specific Program
Mandatory insurance or if large enough self-insured
Michigan WC Excludesbull Federal employeesbull Interstate railroad workersbull Maritime workersbull Less than 3 employees at any one timebull All employees work less than 35 hoursweek or
if more hours less than 13 weeksbull Self-employed
Not computerizedbull Medical claims only
Proportion of Work-Injured Adults for Whom Treatment was paid by Workersrsquo Compensation by State-BRFSS 10 States 2007
State Injured with Payment by Workersrsquo Compensation
Texas 47 (95 CI 35-59)New York 50 (95 CI 39-60)Michigan 56 (95 CI 41-69)Massachusetts 60 (95 CI 45-75)California 61 (95 CI 55-66)Washington 61 (95 CI 55-67)Oregon 62 (95 CI 50-74)Connecticut 63 (95 CI 53-74)New Jersey 64 (95 CI 51-78)Kentucky 77 (95 CI 65-89)
Excludes self-employed
(Adapted Bonauto et al MMWR 2010)
Percentage Received Workersrsquo Compensation by Condition Michigan
WageReplacement
Medical Only
No CompEmployed
No Comp Self -Employed
Amputations 64 22 17 6Burns 17 48 33 2Skull Fractures 36 32 29 3
Percent Applied for Workersrsquo Comp among 2016 Cases of Work-Related Asthma Michigan
Overall 484
Still ExposedConditions Unchanged 239No Longer Exposed 575
Quit on Doctorrsquos Advice 778Sick Leave 727Fired 621New Controls 589Chemical Substitution 536Quit on Own 431Reassigned 360
Reasons Didnrsquot File a Workersrsquo Compensation Claims for a Repetitive Trauma Michigan
Only 397 (251) of 1598 Filed WC Claim
Injury Not Serious Enough 705 (591)Did Not Expect to Miss Work 694 (583)Expect to Receive Sick Leave or
Disability 337 (283) Medical Expenses Covered by
Other Insurance 427 (359)Did Not Think Injury Work Related 242 (204)
(Rosenman et al JOEM 2000)
Goals of Surveillance Population-Based
bull Assess Magnitude of Problembull NumbersRatesTrends
bull Determine Relative Importance vs Other Health Issuesbull Identify High Risk
bull IndustriesOccupationsWorker Populations
bull Prioritize Interventions bull Evaluate Interventionsbull Generate Hypotheses for Researchbull Identify Emerging Problemsbull Identify Workplaces for Intervention
Case-Based
Reportable Conditions in Michigan
Local Health DepartmentsCommunicable Diseases (83)
ldquoUnusual occurrence outbreak or epidemic of any disease or conditionsrdquoMDHHS
AbortionsBirth DefectsCancerChemical Poisonings including Carbon MonoxideInjuries Nursing Home Abuse
LARAOccupational Illnesses
County Department of Social ServicesChild AbuseAdult Abuse
PoliceInjury from Knife Gun or Deadly WeaponMental Health Patient Abuse
On Request Only
Laboratory Reporting Regulations Michigan
bull Arsenicbull Cadmiumbull Carboxyhemoglobinbull Cholinesterasebull IgE Antibodiesbull Leadbull Mercury
Occupational Illness Reporting Requirement in Michigan
bull LARA ndash MIOSHAPhysician hospital clinic or employer
having a known or suspected occupational disease or health condition aggravated by workplace exposures shall report within 10 days after discovery
Misdemeanor punishable by a fine of not more than $50
Methodology of Multi-Source Surveillance
Amputations 2006- DateHospitalsEDOutpatient ClinicsWorkersrsquo Compensation Wage Replacement
Crushing Injuries 2013- Date+ FACE Program
Skull Fractures 2012-DateBurns 2009-Date
+ Poison Control Center
bull Quarterly Reporting Specified ICD codes -134 Hospitalsbull Quarterly Reporting all Work-related Events ndash Poison Control Centerbull Electronic Data Base All Paid Claims ndash Workersrsquo Compensationbull FACE ndash Death CertificatesOSHA Hot LinePolice Reports
Work-Related Burn Reports ndash By Source Total 1461 Michigan 2009
n=1460 individuals
450
BLS
HOSPITALSEDs (1248)
4501054
BLSMIFACE 1(2) 1
16721
5 PCC (106)
1321 79
WC(306)
(Kica and Rosenman JOEM 2012)
Filters to Identifying Work-Related Injuries and Illnesses
a Filters To Reporting to Supervisorsb Filters To Losing Work Time c Filters to Obtaining Medical Cared Filters to Recognizing Work-Related by Doctore Filters to Workersrsquo Compensation being the Payerf Filters To Recording on OSHA Logg Filters to Reporting by Employers to Workersrsquo
Compensation Agencyh Filters to Reporting by Doctors
(Azaroff et al AJPH 2002)
Capture-Recapture Estimates of Workplace Injury and Illness Reporting by BLS Adjusted for Capture
Heterogeneity Lost-Time Cases 1998-2001
Percent Reported to WA WV OR WI NM MNNo Source Dependence 55 76 56 65 51 68
Source Dependence 52 71 45 53 37 53
(Adapted Boden and Ozonoff Annals Epidemiology 2008)
Workersrsquo CompensationState Specific Program
Mandatory insurance or if large enough self-insured
Michigan WC Excludesbull Federal employeesbull Interstate railroad workersbull Maritime workersbull Less than 3 employees at any one timebull All employees work less than 35 hoursweek or
if more hours less than 13 weeksbull Self-employed
Not computerizedbull Medical claims only
Proportion of Work-Injured Adults for Whom Treatment was paid by Workersrsquo Compensation by State-BRFSS 10 States 2007
State Injured with Payment by Workersrsquo Compensation
Texas 47 (95 CI 35-59)New York 50 (95 CI 39-60)Michigan 56 (95 CI 41-69)Massachusetts 60 (95 CI 45-75)California 61 (95 CI 55-66)Washington 61 (95 CI 55-67)Oregon 62 (95 CI 50-74)Connecticut 63 (95 CI 53-74)New Jersey 64 (95 CI 51-78)Kentucky 77 (95 CI 65-89)
Excludes self-employed
(Adapted Bonauto et al MMWR 2010)
Percentage Received Workersrsquo Compensation by Condition Michigan
WageReplacement
Medical Only
No CompEmployed
No Comp Self -Employed
Amputations 64 22 17 6Burns 17 48 33 2Skull Fractures 36 32 29 3
Percent Applied for Workersrsquo Comp among 2016 Cases of Work-Related Asthma Michigan
Overall 484
Still ExposedConditions Unchanged 239No Longer Exposed 575
Quit on Doctorrsquos Advice 778Sick Leave 727Fired 621New Controls 589Chemical Substitution 536Quit on Own 431Reassigned 360
Reasons Didnrsquot File a Workersrsquo Compensation Claims for a Repetitive Trauma Michigan
Only 397 (251) of 1598 Filed WC Claim
Injury Not Serious Enough 705 (591)Did Not Expect to Miss Work 694 (583)Expect to Receive Sick Leave or
Disability 337 (283) Medical Expenses Covered by
Other Insurance 427 (359)Did Not Think Injury Work Related 242 (204)
(Rosenman et al JOEM 2000)
Goals of Surveillance Population-Based
bull Assess Magnitude of Problembull NumbersRatesTrends
bull Determine Relative Importance vs Other Health Issuesbull Identify High Risk
bull IndustriesOccupationsWorker Populations
bull Prioritize Interventions bull Evaluate Interventionsbull Generate Hypotheses for Researchbull Identify Emerging Problemsbull Identify Workplaces for Intervention
Case-Based
Reportable Conditions in Michigan
Local Health DepartmentsCommunicable Diseases (83)
ldquoUnusual occurrence outbreak or epidemic of any disease or conditionsrdquoMDHHS
AbortionsBirth DefectsCancerChemical Poisonings including Carbon MonoxideInjuries Nursing Home Abuse
LARAOccupational Illnesses
County Department of Social ServicesChild AbuseAdult Abuse
PoliceInjury from Knife Gun or Deadly WeaponMental Health Patient Abuse
On Request Only
Laboratory Reporting Regulations Michigan
bull Arsenicbull Cadmiumbull Carboxyhemoglobinbull Cholinesterasebull IgE Antibodiesbull Leadbull Mercury
Occupational Illness Reporting Requirement in Michigan
bull LARA ndash MIOSHAPhysician hospital clinic or employer
having a known or suspected occupational disease or health condition aggravated by workplace exposures shall report within 10 days after discovery
Misdemeanor punishable by a fine of not more than $50
Methodology of Multi-Source Surveillance
Amputations 2006- DateHospitalsEDOutpatient ClinicsWorkersrsquo Compensation Wage Replacement
Crushing Injuries 2013- Date+ FACE Program
Skull Fractures 2012-DateBurns 2009-Date
+ Poison Control Center
bull Quarterly Reporting Specified ICD codes -134 Hospitalsbull Quarterly Reporting all Work-related Events ndash Poison Control Centerbull Electronic Data Base All Paid Claims ndash Workersrsquo Compensationbull FACE ndash Death CertificatesOSHA Hot LinePolice Reports
Work-Related Burn Reports ndash By Source Total 1461 Michigan 2009
n=1460 individuals
450
BLS
HOSPITALSEDs (1248)
4501054
BLSMIFACE 1(2) 1
16721
5 PCC (106)
1321 79
WC(306)
(Kica and Rosenman JOEM 2012)
Capture-Recapture Estimates of Workplace Injury and Illness Reporting by BLS Adjusted for Capture
Heterogeneity Lost-Time Cases 1998-2001
Percent Reported to WA WV OR WI NM MNNo Source Dependence 55 76 56 65 51 68
Source Dependence 52 71 45 53 37 53
(Adapted Boden and Ozonoff Annals Epidemiology 2008)
Workersrsquo CompensationState Specific Program
Mandatory insurance or if large enough self-insured
Michigan WC Excludesbull Federal employeesbull Interstate railroad workersbull Maritime workersbull Less than 3 employees at any one timebull All employees work less than 35 hoursweek or
if more hours less than 13 weeksbull Self-employed
Not computerizedbull Medical claims only
Proportion of Work-Injured Adults for Whom Treatment was paid by Workersrsquo Compensation by State-BRFSS 10 States 2007
State Injured with Payment by Workersrsquo Compensation
Texas 47 (95 CI 35-59)New York 50 (95 CI 39-60)Michigan 56 (95 CI 41-69)Massachusetts 60 (95 CI 45-75)California 61 (95 CI 55-66)Washington 61 (95 CI 55-67)Oregon 62 (95 CI 50-74)Connecticut 63 (95 CI 53-74)New Jersey 64 (95 CI 51-78)Kentucky 77 (95 CI 65-89)
Excludes self-employed
(Adapted Bonauto et al MMWR 2010)
Percentage Received Workersrsquo Compensation by Condition Michigan
WageReplacement
Medical Only
No CompEmployed
No Comp Self -Employed
Amputations 64 22 17 6Burns 17 48 33 2Skull Fractures 36 32 29 3
Percent Applied for Workersrsquo Comp among 2016 Cases of Work-Related Asthma Michigan
Overall 484
Still ExposedConditions Unchanged 239No Longer Exposed 575
Quit on Doctorrsquos Advice 778Sick Leave 727Fired 621New Controls 589Chemical Substitution 536Quit on Own 431Reassigned 360
Reasons Didnrsquot File a Workersrsquo Compensation Claims for a Repetitive Trauma Michigan
Only 397 (251) of 1598 Filed WC Claim
Injury Not Serious Enough 705 (591)Did Not Expect to Miss Work 694 (583)Expect to Receive Sick Leave or
Disability 337 (283) Medical Expenses Covered by
Other Insurance 427 (359)Did Not Think Injury Work Related 242 (204)
(Rosenman et al JOEM 2000)
Goals of Surveillance Population-Based
bull Assess Magnitude of Problembull NumbersRatesTrends
bull Determine Relative Importance vs Other Health Issuesbull Identify High Risk
bull IndustriesOccupationsWorker Populations
bull Prioritize Interventions bull Evaluate Interventionsbull Generate Hypotheses for Researchbull Identify Emerging Problemsbull Identify Workplaces for Intervention
Case-Based
Reportable Conditions in Michigan
Local Health DepartmentsCommunicable Diseases (83)
ldquoUnusual occurrence outbreak or epidemic of any disease or conditionsrdquoMDHHS
AbortionsBirth DefectsCancerChemical Poisonings including Carbon MonoxideInjuries Nursing Home Abuse
LARAOccupational Illnesses
County Department of Social ServicesChild AbuseAdult Abuse
PoliceInjury from Knife Gun or Deadly WeaponMental Health Patient Abuse
On Request Only
Laboratory Reporting Regulations Michigan
bull Arsenicbull Cadmiumbull Carboxyhemoglobinbull Cholinesterasebull IgE Antibodiesbull Leadbull Mercury
Occupational Illness Reporting Requirement in Michigan
bull LARA ndash MIOSHAPhysician hospital clinic or employer
having a known or suspected occupational disease or health condition aggravated by workplace exposures shall report within 10 days after discovery
Misdemeanor punishable by a fine of not more than $50
Methodology of Multi-Source Surveillance
Amputations 2006- DateHospitalsEDOutpatient ClinicsWorkersrsquo Compensation Wage Replacement
Crushing Injuries 2013- Date+ FACE Program
Skull Fractures 2012-DateBurns 2009-Date
+ Poison Control Center
bull Quarterly Reporting Specified ICD codes -134 Hospitalsbull Quarterly Reporting all Work-related Events ndash Poison Control Centerbull Electronic Data Base All Paid Claims ndash Workersrsquo Compensationbull FACE ndash Death CertificatesOSHA Hot LinePolice Reports
Work-Related Burn Reports ndash By Source Total 1461 Michigan 2009
n=1460 individuals
450
BLS
HOSPITALSEDs (1248)
4501054
BLSMIFACE 1(2) 1
16721
5 PCC (106)
1321 79
WC(306)
(Kica and Rosenman JOEM 2012)
Workersrsquo CompensationState Specific Program
Mandatory insurance or if large enough self-insured
Michigan WC Excludesbull Federal employeesbull Interstate railroad workersbull Maritime workersbull Less than 3 employees at any one timebull All employees work less than 35 hoursweek or
if more hours less than 13 weeksbull Self-employed
Not computerizedbull Medical claims only
Proportion of Work-Injured Adults for Whom Treatment was paid by Workersrsquo Compensation by State-BRFSS 10 States 2007
State Injured with Payment by Workersrsquo Compensation
Texas 47 (95 CI 35-59)New York 50 (95 CI 39-60)Michigan 56 (95 CI 41-69)Massachusetts 60 (95 CI 45-75)California 61 (95 CI 55-66)Washington 61 (95 CI 55-67)Oregon 62 (95 CI 50-74)Connecticut 63 (95 CI 53-74)New Jersey 64 (95 CI 51-78)Kentucky 77 (95 CI 65-89)
Excludes self-employed
(Adapted Bonauto et al MMWR 2010)
Percentage Received Workersrsquo Compensation by Condition Michigan
WageReplacement
Medical Only
No CompEmployed
No Comp Self -Employed
Amputations 64 22 17 6Burns 17 48 33 2Skull Fractures 36 32 29 3
Percent Applied for Workersrsquo Comp among 2016 Cases of Work-Related Asthma Michigan
Overall 484
Still ExposedConditions Unchanged 239No Longer Exposed 575
Quit on Doctorrsquos Advice 778Sick Leave 727Fired 621New Controls 589Chemical Substitution 536Quit on Own 431Reassigned 360
Reasons Didnrsquot File a Workersrsquo Compensation Claims for a Repetitive Trauma Michigan
Only 397 (251) of 1598 Filed WC Claim
Injury Not Serious Enough 705 (591)Did Not Expect to Miss Work 694 (583)Expect to Receive Sick Leave or
Disability 337 (283) Medical Expenses Covered by
Other Insurance 427 (359)Did Not Think Injury Work Related 242 (204)
(Rosenman et al JOEM 2000)
Goals of Surveillance Population-Based
bull Assess Magnitude of Problembull NumbersRatesTrends
bull Determine Relative Importance vs Other Health Issuesbull Identify High Risk
bull IndustriesOccupationsWorker Populations
bull Prioritize Interventions bull Evaluate Interventionsbull Generate Hypotheses for Researchbull Identify Emerging Problemsbull Identify Workplaces for Intervention
Case-Based
Reportable Conditions in Michigan
Local Health DepartmentsCommunicable Diseases (83)
ldquoUnusual occurrence outbreak or epidemic of any disease or conditionsrdquoMDHHS
AbortionsBirth DefectsCancerChemical Poisonings including Carbon MonoxideInjuries Nursing Home Abuse
LARAOccupational Illnesses
County Department of Social ServicesChild AbuseAdult Abuse
PoliceInjury from Knife Gun or Deadly WeaponMental Health Patient Abuse
On Request Only
Laboratory Reporting Regulations Michigan
bull Arsenicbull Cadmiumbull Carboxyhemoglobinbull Cholinesterasebull IgE Antibodiesbull Leadbull Mercury
Occupational Illness Reporting Requirement in Michigan
bull LARA ndash MIOSHAPhysician hospital clinic or employer
having a known or suspected occupational disease or health condition aggravated by workplace exposures shall report within 10 days after discovery
Misdemeanor punishable by a fine of not more than $50
Methodology of Multi-Source Surveillance
Amputations 2006- DateHospitalsEDOutpatient ClinicsWorkersrsquo Compensation Wage Replacement
Crushing Injuries 2013- Date+ FACE Program
Skull Fractures 2012-DateBurns 2009-Date
+ Poison Control Center
bull Quarterly Reporting Specified ICD codes -134 Hospitalsbull Quarterly Reporting all Work-related Events ndash Poison Control Centerbull Electronic Data Base All Paid Claims ndash Workersrsquo Compensationbull FACE ndash Death CertificatesOSHA Hot LinePolice Reports
Work-Related Burn Reports ndash By Source Total 1461 Michigan 2009
n=1460 individuals
450
BLS
HOSPITALSEDs (1248)
4501054
BLSMIFACE 1(2) 1
16721
5 PCC (106)
1321 79
WC(306)
(Kica and Rosenman JOEM 2012)
Proportion of Work-Injured Adults for Whom Treatment was paid by Workersrsquo Compensation by State-BRFSS 10 States 2007
State Injured with Payment by Workersrsquo Compensation
Texas 47 (95 CI 35-59)New York 50 (95 CI 39-60)Michigan 56 (95 CI 41-69)Massachusetts 60 (95 CI 45-75)California 61 (95 CI 55-66)Washington 61 (95 CI 55-67)Oregon 62 (95 CI 50-74)Connecticut 63 (95 CI 53-74)New Jersey 64 (95 CI 51-78)Kentucky 77 (95 CI 65-89)
Excludes self-employed
(Adapted Bonauto et al MMWR 2010)
Percentage Received Workersrsquo Compensation by Condition Michigan
WageReplacement
Medical Only
No CompEmployed
No Comp Self -Employed
Amputations 64 22 17 6Burns 17 48 33 2Skull Fractures 36 32 29 3
Percent Applied for Workersrsquo Comp among 2016 Cases of Work-Related Asthma Michigan
Overall 484
Still ExposedConditions Unchanged 239No Longer Exposed 575
Quit on Doctorrsquos Advice 778Sick Leave 727Fired 621New Controls 589Chemical Substitution 536Quit on Own 431Reassigned 360
Reasons Didnrsquot File a Workersrsquo Compensation Claims for a Repetitive Trauma Michigan
Only 397 (251) of 1598 Filed WC Claim
Injury Not Serious Enough 705 (591)Did Not Expect to Miss Work 694 (583)Expect to Receive Sick Leave or
Disability 337 (283) Medical Expenses Covered by
Other Insurance 427 (359)Did Not Think Injury Work Related 242 (204)
(Rosenman et al JOEM 2000)
Goals of Surveillance Population-Based
bull Assess Magnitude of Problembull NumbersRatesTrends
bull Determine Relative Importance vs Other Health Issuesbull Identify High Risk
bull IndustriesOccupationsWorker Populations
bull Prioritize Interventions bull Evaluate Interventionsbull Generate Hypotheses for Researchbull Identify Emerging Problemsbull Identify Workplaces for Intervention
Case-Based
Reportable Conditions in Michigan
Local Health DepartmentsCommunicable Diseases (83)
ldquoUnusual occurrence outbreak or epidemic of any disease or conditionsrdquoMDHHS
AbortionsBirth DefectsCancerChemical Poisonings including Carbon MonoxideInjuries Nursing Home Abuse
LARAOccupational Illnesses
County Department of Social ServicesChild AbuseAdult Abuse
PoliceInjury from Knife Gun or Deadly WeaponMental Health Patient Abuse
On Request Only
Laboratory Reporting Regulations Michigan
bull Arsenicbull Cadmiumbull Carboxyhemoglobinbull Cholinesterasebull IgE Antibodiesbull Leadbull Mercury
Occupational Illness Reporting Requirement in Michigan
bull LARA ndash MIOSHAPhysician hospital clinic or employer
having a known or suspected occupational disease or health condition aggravated by workplace exposures shall report within 10 days after discovery
Misdemeanor punishable by a fine of not more than $50
Methodology of Multi-Source Surveillance
Amputations 2006- DateHospitalsEDOutpatient ClinicsWorkersrsquo Compensation Wage Replacement
Crushing Injuries 2013- Date+ FACE Program
Skull Fractures 2012-DateBurns 2009-Date
+ Poison Control Center
bull Quarterly Reporting Specified ICD codes -134 Hospitalsbull Quarterly Reporting all Work-related Events ndash Poison Control Centerbull Electronic Data Base All Paid Claims ndash Workersrsquo Compensationbull FACE ndash Death CertificatesOSHA Hot LinePolice Reports
Work-Related Burn Reports ndash By Source Total 1461 Michigan 2009
n=1460 individuals
450
BLS
HOSPITALSEDs (1248)
4501054
BLSMIFACE 1(2) 1
16721
5 PCC (106)
1321 79
WC(306)
(Kica and Rosenman JOEM 2012)
Percentage Received Workersrsquo Compensation by Condition Michigan
WageReplacement
Medical Only
No CompEmployed
No Comp Self -Employed
Amputations 64 22 17 6Burns 17 48 33 2Skull Fractures 36 32 29 3
Percent Applied for Workersrsquo Comp among 2016 Cases of Work-Related Asthma Michigan
Overall 484
Still ExposedConditions Unchanged 239No Longer Exposed 575
Quit on Doctorrsquos Advice 778Sick Leave 727Fired 621New Controls 589Chemical Substitution 536Quit on Own 431Reassigned 360
Reasons Didnrsquot File a Workersrsquo Compensation Claims for a Repetitive Trauma Michigan
Only 397 (251) of 1598 Filed WC Claim
Injury Not Serious Enough 705 (591)Did Not Expect to Miss Work 694 (583)Expect to Receive Sick Leave or
Disability 337 (283) Medical Expenses Covered by
Other Insurance 427 (359)Did Not Think Injury Work Related 242 (204)
(Rosenman et al JOEM 2000)
Goals of Surveillance Population-Based
bull Assess Magnitude of Problembull NumbersRatesTrends
bull Determine Relative Importance vs Other Health Issuesbull Identify High Risk
bull IndustriesOccupationsWorker Populations
bull Prioritize Interventions bull Evaluate Interventionsbull Generate Hypotheses for Researchbull Identify Emerging Problemsbull Identify Workplaces for Intervention
Case-Based
Reportable Conditions in Michigan
Local Health DepartmentsCommunicable Diseases (83)
ldquoUnusual occurrence outbreak or epidemic of any disease or conditionsrdquoMDHHS
AbortionsBirth DefectsCancerChemical Poisonings including Carbon MonoxideInjuries Nursing Home Abuse
LARAOccupational Illnesses
County Department of Social ServicesChild AbuseAdult Abuse
PoliceInjury from Knife Gun or Deadly WeaponMental Health Patient Abuse
On Request Only
Laboratory Reporting Regulations Michigan
bull Arsenicbull Cadmiumbull Carboxyhemoglobinbull Cholinesterasebull IgE Antibodiesbull Leadbull Mercury
Occupational Illness Reporting Requirement in Michigan
bull LARA ndash MIOSHAPhysician hospital clinic or employer
having a known or suspected occupational disease or health condition aggravated by workplace exposures shall report within 10 days after discovery
Misdemeanor punishable by a fine of not more than $50
Methodology of Multi-Source Surveillance
Amputations 2006- DateHospitalsEDOutpatient ClinicsWorkersrsquo Compensation Wage Replacement
Crushing Injuries 2013- Date+ FACE Program
Skull Fractures 2012-DateBurns 2009-Date
+ Poison Control Center
bull Quarterly Reporting Specified ICD codes -134 Hospitalsbull Quarterly Reporting all Work-related Events ndash Poison Control Centerbull Electronic Data Base All Paid Claims ndash Workersrsquo Compensationbull FACE ndash Death CertificatesOSHA Hot LinePolice Reports
Work-Related Burn Reports ndash By Source Total 1461 Michigan 2009
n=1460 individuals
450
BLS
HOSPITALSEDs (1248)
4501054
BLSMIFACE 1(2) 1
16721
5 PCC (106)
1321 79
WC(306)
(Kica and Rosenman JOEM 2012)
Percent Applied for Workersrsquo Comp among 2016 Cases of Work-Related Asthma Michigan
Overall 484
Still ExposedConditions Unchanged 239No Longer Exposed 575
Quit on Doctorrsquos Advice 778Sick Leave 727Fired 621New Controls 589Chemical Substitution 536Quit on Own 431Reassigned 360
Reasons Didnrsquot File a Workersrsquo Compensation Claims for a Repetitive Trauma Michigan
Only 397 (251) of 1598 Filed WC Claim
Injury Not Serious Enough 705 (591)Did Not Expect to Miss Work 694 (583)Expect to Receive Sick Leave or
Disability 337 (283) Medical Expenses Covered by
Other Insurance 427 (359)Did Not Think Injury Work Related 242 (204)
(Rosenman et al JOEM 2000)
Goals of Surveillance Population-Based
bull Assess Magnitude of Problembull NumbersRatesTrends
bull Determine Relative Importance vs Other Health Issuesbull Identify High Risk
bull IndustriesOccupationsWorker Populations
bull Prioritize Interventions bull Evaluate Interventionsbull Generate Hypotheses for Researchbull Identify Emerging Problemsbull Identify Workplaces for Intervention
Case-Based
Reportable Conditions in Michigan
Local Health DepartmentsCommunicable Diseases (83)
ldquoUnusual occurrence outbreak or epidemic of any disease or conditionsrdquoMDHHS
AbortionsBirth DefectsCancerChemical Poisonings including Carbon MonoxideInjuries Nursing Home Abuse
LARAOccupational Illnesses
County Department of Social ServicesChild AbuseAdult Abuse
PoliceInjury from Knife Gun or Deadly WeaponMental Health Patient Abuse
On Request Only
Laboratory Reporting Regulations Michigan
bull Arsenicbull Cadmiumbull Carboxyhemoglobinbull Cholinesterasebull IgE Antibodiesbull Leadbull Mercury
Occupational Illness Reporting Requirement in Michigan
bull LARA ndash MIOSHAPhysician hospital clinic or employer
having a known or suspected occupational disease or health condition aggravated by workplace exposures shall report within 10 days after discovery
Misdemeanor punishable by a fine of not more than $50
Methodology of Multi-Source Surveillance
Amputations 2006- DateHospitalsEDOutpatient ClinicsWorkersrsquo Compensation Wage Replacement
Crushing Injuries 2013- Date+ FACE Program
Skull Fractures 2012-DateBurns 2009-Date
+ Poison Control Center
bull Quarterly Reporting Specified ICD codes -134 Hospitalsbull Quarterly Reporting all Work-related Events ndash Poison Control Centerbull Electronic Data Base All Paid Claims ndash Workersrsquo Compensationbull FACE ndash Death CertificatesOSHA Hot LinePolice Reports
Work-Related Burn Reports ndash By Source Total 1461 Michigan 2009
n=1460 individuals
450
BLS
HOSPITALSEDs (1248)
4501054
BLSMIFACE 1(2) 1
16721
5 PCC (106)
1321 79
WC(306)
(Kica and Rosenman JOEM 2012)
Reasons Didnrsquot File a Workersrsquo Compensation Claims for a Repetitive Trauma Michigan
Only 397 (251) of 1598 Filed WC Claim
Injury Not Serious Enough 705 (591)Did Not Expect to Miss Work 694 (583)Expect to Receive Sick Leave or
Disability 337 (283) Medical Expenses Covered by
Other Insurance 427 (359)Did Not Think Injury Work Related 242 (204)
(Rosenman et al JOEM 2000)
Goals of Surveillance Population-Based
bull Assess Magnitude of Problembull NumbersRatesTrends
bull Determine Relative Importance vs Other Health Issuesbull Identify High Risk
bull IndustriesOccupationsWorker Populations
bull Prioritize Interventions bull Evaluate Interventionsbull Generate Hypotheses for Researchbull Identify Emerging Problemsbull Identify Workplaces for Intervention
Case-Based
Reportable Conditions in Michigan
Local Health DepartmentsCommunicable Diseases (83)
ldquoUnusual occurrence outbreak or epidemic of any disease or conditionsrdquoMDHHS
AbortionsBirth DefectsCancerChemical Poisonings including Carbon MonoxideInjuries Nursing Home Abuse
LARAOccupational Illnesses
County Department of Social ServicesChild AbuseAdult Abuse
PoliceInjury from Knife Gun or Deadly WeaponMental Health Patient Abuse
On Request Only
Laboratory Reporting Regulations Michigan
bull Arsenicbull Cadmiumbull Carboxyhemoglobinbull Cholinesterasebull IgE Antibodiesbull Leadbull Mercury
Occupational Illness Reporting Requirement in Michigan
bull LARA ndash MIOSHAPhysician hospital clinic or employer
having a known or suspected occupational disease or health condition aggravated by workplace exposures shall report within 10 days after discovery
Misdemeanor punishable by a fine of not more than $50
Methodology of Multi-Source Surveillance
Amputations 2006- DateHospitalsEDOutpatient ClinicsWorkersrsquo Compensation Wage Replacement
Crushing Injuries 2013- Date+ FACE Program
Skull Fractures 2012-DateBurns 2009-Date
+ Poison Control Center
bull Quarterly Reporting Specified ICD codes -134 Hospitalsbull Quarterly Reporting all Work-related Events ndash Poison Control Centerbull Electronic Data Base All Paid Claims ndash Workersrsquo Compensationbull FACE ndash Death CertificatesOSHA Hot LinePolice Reports
Work-Related Burn Reports ndash By Source Total 1461 Michigan 2009
n=1460 individuals
450
BLS
HOSPITALSEDs (1248)
4501054
BLSMIFACE 1(2) 1
16721
5 PCC (106)
1321 79
WC(306)
(Kica and Rosenman JOEM 2012)
Goals of Surveillance Population-Based
bull Assess Magnitude of Problembull NumbersRatesTrends
bull Determine Relative Importance vs Other Health Issuesbull Identify High Risk
bull IndustriesOccupationsWorker Populations
bull Prioritize Interventions bull Evaluate Interventionsbull Generate Hypotheses for Researchbull Identify Emerging Problemsbull Identify Workplaces for Intervention
Case-Based
Reportable Conditions in Michigan
Local Health DepartmentsCommunicable Diseases (83)
ldquoUnusual occurrence outbreak or epidemic of any disease or conditionsrdquoMDHHS
AbortionsBirth DefectsCancerChemical Poisonings including Carbon MonoxideInjuries Nursing Home Abuse
LARAOccupational Illnesses
County Department of Social ServicesChild AbuseAdult Abuse
PoliceInjury from Knife Gun or Deadly WeaponMental Health Patient Abuse
On Request Only
Laboratory Reporting Regulations Michigan
bull Arsenicbull Cadmiumbull Carboxyhemoglobinbull Cholinesterasebull IgE Antibodiesbull Leadbull Mercury
Occupational Illness Reporting Requirement in Michigan
bull LARA ndash MIOSHAPhysician hospital clinic or employer
having a known or suspected occupational disease or health condition aggravated by workplace exposures shall report within 10 days after discovery
Misdemeanor punishable by a fine of not more than $50
Methodology of Multi-Source Surveillance
Amputations 2006- DateHospitalsEDOutpatient ClinicsWorkersrsquo Compensation Wage Replacement
Crushing Injuries 2013- Date+ FACE Program
Skull Fractures 2012-DateBurns 2009-Date
+ Poison Control Center
bull Quarterly Reporting Specified ICD codes -134 Hospitalsbull Quarterly Reporting all Work-related Events ndash Poison Control Centerbull Electronic Data Base All Paid Claims ndash Workersrsquo Compensationbull FACE ndash Death CertificatesOSHA Hot LinePolice Reports
Work-Related Burn Reports ndash By Source Total 1461 Michigan 2009
n=1460 individuals
450
BLS
HOSPITALSEDs (1248)
4501054
BLSMIFACE 1(2) 1
16721
5 PCC (106)
1321 79
WC(306)
(Kica and Rosenman JOEM 2012)
Reportable Conditions in Michigan
Local Health DepartmentsCommunicable Diseases (83)
ldquoUnusual occurrence outbreak or epidemic of any disease or conditionsrdquoMDHHS
AbortionsBirth DefectsCancerChemical Poisonings including Carbon MonoxideInjuries Nursing Home Abuse
LARAOccupational Illnesses
County Department of Social ServicesChild AbuseAdult Abuse
PoliceInjury from Knife Gun or Deadly WeaponMental Health Patient Abuse
On Request Only
Laboratory Reporting Regulations Michigan
bull Arsenicbull Cadmiumbull Carboxyhemoglobinbull Cholinesterasebull IgE Antibodiesbull Leadbull Mercury
Occupational Illness Reporting Requirement in Michigan
bull LARA ndash MIOSHAPhysician hospital clinic or employer
having a known or suspected occupational disease or health condition aggravated by workplace exposures shall report within 10 days after discovery
Misdemeanor punishable by a fine of not more than $50
Methodology of Multi-Source Surveillance
Amputations 2006- DateHospitalsEDOutpatient ClinicsWorkersrsquo Compensation Wage Replacement
Crushing Injuries 2013- Date+ FACE Program
Skull Fractures 2012-DateBurns 2009-Date
+ Poison Control Center
bull Quarterly Reporting Specified ICD codes -134 Hospitalsbull Quarterly Reporting all Work-related Events ndash Poison Control Centerbull Electronic Data Base All Paid Claims ndash Workersrsquo Compensationbull FACE ndash Death CertificatesOSHA Hot LinePolice Reports
Work-Related Burn Reports ndash By Source Total 1461 Michigan 2009
n=1460 individuals
450
BLS
HOSPITALSEDs (1248)
4501054
BLSMIFACE 1(2) 1
16721
5 PCC (106)
1321 79
WC(306)
(Kica and Rosenman JOEM 2012)
Laboratory Reporting Regulations Michigan
bull Arsenicbull Cadmiumbull Carboxyhemoglobinbull Cholinesterasebull IgE Antibodiesbull Leadbull Mercury
Occupational Illness Reporting Requirement in Michigan
bull LARA ndash MIOSHAPhysician hospital clinic or employer
having a known or suspected occupational disease or health condition aggravated by workplace exposures shall report within 10 days after discovery
Misdemeanor punishable by a fine of not more than $50
Methodology of Multi-Source Surveillance
Amputations 2006- DateHospitalsEDOutpatient ClinicsWorkersrsquo Compensation Wage Replacement
Crushing Injuries 2013- Date+ FACE Program
Skull Fractures 2012-DateBurns 2009-Date
+ Poison Control Center
bull Quarterly Reporting Specified ICD codes -134 Hospitalsbull Quarterly Reporting all Work-related Events ndash Poison Control Centerbull Electronic Data Base All Paid Claims ndash Workersrsquo Compensationbull FACE ndash Death CertificatesOSHA Hot LinePolice Reports
Work-Related Burn Reports ndash By Source Total 1461 Michigan 2009
n=1460 individuals
450
BLS
HOSPITALSEDs (1248)
4501054
BLSMIFACE 1(2) 1
16721
5 PCC (106)
1321 79
WC(306)
(Kica and Rosenman JOEM 2012)
Occupational Illness Reporting Requirement in Michigan
bull LARA ndash MIOSHAPhysician hospital clinic or employer
having a known or suspected occupational disease or health condition aggravated by workplace exposures shall report within 10 days after discovery
Misdemeanor punishable by a fine of not more than $50
Methodology of Multi-Source Surveillance
Amputations 2006- DateHospitalsEDOutpatient ClinicsWorkersrsquo Compensation Wage Replacement
Crushing Injuries 2013- Date+ FACE Program
Skull Fractures 2012-DateBurns 2009-Date
+ Poison Control Center
bull Quarterly Reporting Specified ICD codes -134 Hospitalsbull Quarterly Reporting all Work-related Events ndash Poison Control Centerbull Electronic Data Base All Paid Claims ndash Workersrsquo Compensationbull FACE ndash Death CertificatesOSHA Hot LinePolice Reports
Work-Related Burn Reports ndash By Source Total 1461 Michigan 2009
n=1460 individuals
450
BLS
HOSPITALSEDs (1248)
4501054
BLSMIFACE 1(2) 1
16721
5 PCC (106)
1321 79
WC(306)
(Kica and Rosenman JOEM 2012)
Methodology of Multi-Source Surveillance
Amputations 2006- DateHospitalsEDOutpatient ClinicsWorkersrsquo Compensation Wage Replacement
Crushing Injuries 2013- Date+ FACE Program
Skull Fractures 2012-DateBurns 2009-Date
+ Poison Control Center
bull Quarterly Reporting Specified ICD codes -134 Hospitalsbull Quarterly Reporting all Work-related Events ndash Poison Control Centerbull Electronic Data Base All Paid Claims ndash Workersrsquo Compensationbull FACE ndash Death CertificatesOSHA Hot LinePolice Reports
Work-Related Burn Reports ndash By Source Total 1461 Michigan 2009
n=1460 individuals
450
BLS
HOSPITALSEDs (1248)
4501054
BLSMIFACE 1(2) 1
16721
5 PCC (106)
1321 79
WC(306)
(Kica and Rosenman JOEM 2012)
Work-Related Burn Reports ndash By Source Total 1461 Michigan 2009
n=1460 individuals
450
BLS
HOSPITALSEDs (1248)
4501054
BLSMIFACE 1(2) 1
16721
5 PCC (106)
1321 79
WC(306)
(Kica and Rosenman JOEM 2012)
Work-Related Burn ndash Case History
bull Electroplating industrybull 39-year-old malebull Second degree thermal burns to
right footbull Temperature of chemicals 150ordmFbull Inadequate fall protectionbull No barrier(s)bull of Violations 20bull Penalty $19200
Work-Related Crushing Injuryndash Case History
bull Ice Cream Manufacturerbull Woman mid-fortiesbull Crushing injury to her left
wrist laceration that needed sutures and a burn from the heated element used to seal packaging
bull No Guardbull of Serious Violations 1bull Penalty $ 4000
Michigan OSHA Inspections Violations and Penalties by Work-Related Injuries
CONDITION TIME PERIOD
ENFORCEMENT INSPECTIONS
VIOLATIONS
TOTAL PENALTIES ASSESSED
Amputations 2006 - 2013 184 1575 $674255
Crush Injuries 2013 - 2015 77 212 $276425
Burns 2009 - 2013 213 539 $954590
Skull Fractures 2010 - 2013 28 66 $78050
TOTAL 502 2392 $1983320
Percent Inspections Hazard Causing the Injury is Still Present - 60 - 94
Severity of Burns within Specific Industries Michigan 2013
Industry Classification (NAICS)Degree of Burn
1deg 2deg 3deg Fatal Total () () () ()
Accommodation and Food Svcs (72) 176 (37) 288 (61) 8 (2) 0 (-) 472
Health Care and Social Assist (62) 78 (53) 66 (45) 2 (2) 0 (-) 146
Primary Metal Manufacturing (33) 33 (27) 75 (61) 15 (12) 0 (-) 123
Retail Trade (44) 27 (38) 39 (54) 6 (8) 0 (-) 72
Construction (23) 23 (29) 48 (61) 6 (8) 2 (2) 79
Work-Related Burns Among Young Workers (14-24) by Top 5 Industries Michigan 2013
Industry Classification (NAICS)2013
Number PercentAccommodation and Food Services (72) 251 53Health Care and Social Assistance (62) 28 19Primary Metal Manufacturing (33) 25 20Retail Trade (44) 25 35Construction (23) 14 18
Work-Related Burn SummaryMichigan 2009-2012
0
200
400
600
800
1000
1200
1400
1600
WC BLS MI Surveillance
2680
6909
1228
(Kica and Rosenman JOEM 2012)
410
600
250
9471080 1110
2225 25
0
5
10
15
20
25
30
0
200
400
600
800
1000
1200
2013 2014 2015
Rate
Num
ber
BLS Estimate MI Surveillance Number
BLS Rate MI Surveillance Rate
Number and Rate of Work-Related Crushing Injuries ComparingBLS and MI Surveillance Michigan 2013-2015
Number of Work-Related Amputations by year Michigan 2006-2012 by data source
0
100
200
300
400
500
600
700
800
2006 2007 2008 2009 2010 2011 2012
Num
ber o
f am
puta
tions
Incident Year
Michigan Multi-source
Workers Compensation
BLS SOII
(Largo and Rosenman OEM 2014)
Comparison of Multi-Source Date Surveillance in Michigan vs the Bureau of Labor Statistics Employer Based Survey for Work-Related Amputations Burns
Crushing Injuries and Skull Fractures
2380
5673
3220
8737
1110
3137
310 648
Num
ber o
f W
ork-
Rela
ted
Inju
ries
(420)
(369)
(354) (478)
Amputations2006-2015
Burns2009-2013
Crushing Injuries2013-2015
Skull Fractures 2012-2013
Summary Statistics of Work-Related Farm Injuries Michigan 2015
678 work-related farm injuries treated in Michiganrsquos hospitals or Emergency Room departments for work-related farm injuries
Types of medical encounterED visits ndash 594 (876)Hospitalizations ndash 70 (103)Outpatient visits ndash 14 (21)
9 individuals were identified as migrant workers
There were an additional 16 agricultural fatalities and 1408 non work-related farm injuries
Work-Related Farm Injury NarrativeExamples - AgrAbility Letter Follow-up
bull A 68-year-old male farmer was using a tractor on his grain farm when he exited it while it was still running He was run over by the tractor when it slipped into gear He sustained multiple traumatic crush injuries right multiple rib fractures pelvic fractures and a left lower extremity injury He was hospitalized for seven days
bull A 26-year-old male was working on a dairy farm when his right lower extremity was caught in an auger attached to a power takeoff unit He sustained a traumatic above-the-knee amputation of the right lower extremity up to the hip joint He was hospitalized
Injury Source ndash Work-Related Farm Injuries Michigan 2015
bull Information on injury source available 650 (959)
03
03
37
55
63
68
85
92
95
197
302
0 5 10 15 20 25 30 35
Poultry
Chemical
Tool
Tractor
Fall at Ground Level
Horse
Livestock
Other Machinery (than Tractor)
Fall from Height
Other
Cow
BLS Undercount ndash Possible Explanations (Burn data)
Self employed ndash only 11 Farms ndash only 5 Includes only one or more days away from
work Employer reporting Statistical Samplingextrapolation Codingmiscoding
WC Undercount ndash Possible Explanations (Burn Data)
bull Includes only 7 consecutive days away from work
bull Self employed ndash only 11bull Codingmiscoding bull Handled unofficially directly with company
Number of Patients with Inpatient Hospitalizations Primary Diagnosis with Workersrsquo Compensation Expected Payer Michigan 2014
This table does not include another 15 diagnosis with 281 patients
SummaryCurrent Employer Based Systembull Undercount - Miss 29 - 69 of casesbull Undercount Not Consistent Across IndustryCondition
What is Neededbull Multi-Source System like CFOI
Cost Prohibitive to do in Every Statebull System that Allows Follow UpInterventionbull System that Extrapolates from Multi-Source Surveillance
Systemsbull Better Presentation of Data
- Californiarsquos Workersrsquo Compensation Surveillance
- Aims
- How do we calculate rates in occupational health
- Calculating injury rates with four data sources
- 1 Workersrsquo Compensation Information System (WCIS)
- 2 Base Wage File (BWF)
- 3 Quarterly Census of Employment and Wages (QCEW)
- Multi Establishment Car Manufacturing
- Rules for Multi-establishment Firms
- 4 American Community Survey (ACS)
- Pilot Project
- Rate Results
- Employers
- Match Results
- Match Results
- Match Results
- Match Results
- Private Sector Rate of InjuryJanuary-June 2016
- Slide Number 19
- Slide Number 20
- Slide Number 21
- Slide Number 22
- Slide Number 23
- Rates of Injury by IndustryPrivate sector
- Rates of Injury by IndustryPrivate sector
- How great is this
- Milestones
- What are we missing
- Next Steps
- Collaborators
- Concurrent 3I-June 22 ndash Rosenmanpdf
-
- Slide Number 1
- BLS Survey of Employers vs Multi-Source Surveillance of Work-Related Injuries
- Survey of Occupational Injuries and Illnesses (SOII)
- NATIONAL ACADEMY OF SCIENCES 1987
- CENSUS OF FATAL OCCUPATIONAL INJURIES (CFOI) BEGAN IN 1992
- How Much Work-Related Injury and Illness is Missed By the Current National Surveillance System
- Slide Number 7
- Summary of Analysis Comparing BLS and Worker Comp data Michigan 2009-2001
- Simplified Flowchart of Events Necessary to the Documentation of Work-Related Injuries and Illnesses
- Filters to Identifying Work-Related Injuries and Illnesses
- Capture-Recapture Estimates of Workplace Injury and Illness Reporting by BLS Adjusted for Capture Heterogeneity Lost-Time Cases 1998-2001
- Workersrsquo Compensation
- Proportion of Work-Injured Adults for Whom Treatment was paid by Workersrsquo Compensation by State-BRFSS 10 States 2007
- Percentage Received Workersrsquo Compensation by Condition Michigan
- Slide Number 15
- Reasons Didnrsquot File a Workersrsquo Compensation Claims for a Repetitive Trauma Michigan
- Goals of Surveillance
- Reportable Conditions in Michigan
- Laboratory Reporting Regulations Michigan
- Occupational Illness Reporting Requirement in Michigan
- Methodology of Multi-Source Surveillance
- Work-Related Burn Reports ndash By Source Total 1461 Michigan 2009
- Work-Related Burn ndash Case History
- Slide Number 24
- Michigan OSHA Inspections Violations and Penalties by Work-Related Injuries
- Severity of Burns within Specific Industries Michigan 2013
- Work-Related Burns Among Young Workers (14-24) by Top 5 Industries Michigan 2013
- Work-Related Burn SummaryMichigan 2009-2012
- Slide Number 29
- Slide Number 30
- Slide Number 31
- Slide Number 32
- Slide Number 33
- Slide Number 34
- BLS Undercount ndash Possible Explanations (Burn data)
- WC Undercount ndash Possible Explanations (Burn Data)
- Slide Number 37
- Slide Number 38
- Slide Number 39
- Summary
- Slide Number 41
-
Work-Related Crushing Injuryndash Case History
bull Ice Cream Manufacturerbull Woman mid-fortiesbull Crushing injury to her left
wrist laceration that needed sutures and a burn from the heated element used to seal packaging
bull No Guardbull of Serious Violations 1bull Penalty $ 4000
Michigan OSHA Inspections Violations and Penalties by Work-Related Injuries
CONDITION TIME PERIOD
ENFORCEMENT INSPECTIONS
VIOLATIONS
TOTAL PENALTIES ASSESSED
Amputations 2006 - 2013 184 1575 $674255
Crush Injuries 2013 - 2015 77 212 $276425
Burns 2009 - 2013 213 539 $954590
Skull Fractures 2010 - 2013 28 66 $78050
TOTAL 502 2392 $1983320
Percent Inspections Hazard Causing the Injury is Still Present - 60 - 94
Severity of Burns within Specific Industries Michigan 2013
Industry Classification (NAICS)Degree of Burn
1deg 2deg 3deg Fatal Total () () () ()
Accommodation and Food Svcs (72) 176 (37) 288 (61) 8 (2) 0 (-) 472
Health Care and Social Assist (62) 78 (53) 66 (45) 2 (2) 0 (-) 146
Primary Metal Manufacturing (33) 33 (27) 75 (61) 15 (12) 0 (-) 123
Retail Trade (44) 27 (38) 39 (54) 6 (8) 0 (-) 72
Construction (23) 23 (29) 48 (61) 6 (8) 2 (2) 79
Work-Related Burns Among Young Workers (14-24) by Top 5 Industries Michigan 2013
Industry Classification (NAICS)2013
Number PercentAccommodation and Food Services (72) 251 53Health Care and Social Assistance (62) 28 19Primary Metal Manufacturing (33) 25 20Retail Trade (44) 25 35Construction (23) 14 18
Work-Related Burn SummaryMichigan 2009-2012
0
200
400
600
800
1000
1200
1400
1600
WC BLS MI Surveillance
2680
6909
1228
(Kica and Rosenman JOEM 2012)
410
600
250
9471080 1110
2225 25
0
5
10
15
20
25
30
0
200
400
600
800
1000
1200
2013 2014 2015
Rate
Num
ber
BLS Estimate MI Surveillance Number
BLS Rate MI Surveillance Rate
Number and Rate of Work-Related Crushing Injuries ComparingBLS and MI Surveillance Michigan 2013-2015
Number of Work-Related Amputations by year Michigan 2006-2012 by data source
0
100
200
300
400
500
600
700
800
2006 2007 2008 2009 2010 2011 2012
Num
ber o
f am
puta
tions
Incident Year
Michigan Multi-source
Workers Compensation
BLS SOII
(Largo and Rosenman OEM 2014)
Comparison of Multi-Source Date Surveillance in Michigan vs the Bureau of Labor Statistics Employer Based Survey for Work-Related Amputations Burns
Crushing Injuries and Skull Fractures
2380
5673
3220
8737
1110
3137
310 648
Num
ber o
f W
ork-
Rela
ted
Inju
ries
(420)
(369)
(354) (478)
Amputations2006-2015
Burns2009-2013
Crushing Injuries2013-2015
Skull Fractures 2012-2013
Summary Statistics of Work-Related Farm Injuries Michigan 2015
678 work-related farm injuries treated in Michiganrsquos hospitals or Emergency Room departments for work-related farm injuries
Types of medical encounterED visits ndash 594 (876)Hospitalizations ndash 70 (103)Outpatient visits ndash 14 (21)
9 individuals were identified as migrant workers
There were an additional 16 agricultural fatalities and 1408 non work-related farm injuries
Work-Related Farm Injury NarrativeExamples - AgrAbility Letter Follow-up
bull A 68-year-old male farmer was using a tractor on his grain farm when he exited it while it was still running He was run over by the tractor when it slipped into gear He sustained multiple traumatic crush injuries right multiple rib fractures pelvic fractures and a left lower extremity injury He was hospitalized for seven days
bull A 26-year-old male was working on a dairy farm when his right lower extremity was caught in an auger attached to a power takeoff unit He sustained a traumatic above-the-knee amputation of the right lower extremity up to the hip joint He was hospitalized
Injury Source ndash Work-Related Farm Injuries Michigan 2015
bull Information on injury source available 650 (959)
03
03
37
55
63
68
85
92
95
197
302
0 5 10 15 20 25 30 35
Poultry
Chemical
Tool
Tractor
Fall at Ground Level
Horse
Livestock
Other Machinery (than Tractor)
Fall from Height
Other
Cow
BLS Undercount ndash Possible Explanations (Burn data)
Self employed ndash only 11 Farms ndash only 5 Includes only one or more days away from
work Employer reporting Statistical Samplingextrapolation Codingmiscoding
WC Undercount ndash Possible Explanations (Burn Data)
bull Includes only 7 consecutive days away from work
bull Self employed ndash only 11bull Codingmiscoding bull Handled unofficially directly with company
Number of Patients with Inpatient Hospitalizations Primary Diagnosis with Workersrsquo Compensation Expected Payer Michigan 2014
This table does not include another 15 diagnosis with 281 patients
SummaryCurrent Employer Based Systembull Undercount - Miss 29 - 69 of casesbull Undercount Not Consistent Across IndustryCondition
What is Neededbull Multi-Source System like CFOI
Cost Prohibitive to do in Every Statebull System that Allows Follow UpInterventionbull System that Extrapolates from Multi-Source Surveillance
Systemsbull Better Presentation of Data
- Californiarsquos Workersrsquo Compensation Surveillance
- Aims
- How do we calculate rates in occupational health
- Calculating injury rates with four data sources
- 1 Workersrsquo Compensation Information System (WCIS)
- 2 Base Wage File (BWF)
- 3 Quarterly Census of Employment and Wages (QCEW)
- Multi Establishment Car Manufacturing
- Rules for Multi-establishment Firms
- 4 American Community Survey (ACS)
- Pilot Project
- Rate Results
- Employers
- Match Results
- Match Results
- Match Results
- Match Results
- Private Sector Rate of InjuryJanuary-June 2016
- Slide Number 19
- Slide Number 20
- Slide Number 21
- Slide Number 22
- Slide Number 23
- Rates of Injury by IndustryPrivate sector
- Rates of Injury by IndustryPrivate sector
- How great is this
- Milestones
- What are we missing
- Next Steps
- Collaborators
- Concurrent 3I-June 22 ndash Rosenmanpdf
-
- Slide Number 1
- BLS Survey of Employers vs Multi-Source Surveillance of Work-Related Injuries
- Survey of Occupational Injuries and Illnesses (SOII)
- NATIONAL ACADEMY OF SCIENCES 1987
- CENSUS OF FATAL OCCUPATIONAL INJURIES (CFOI) BEGAN IN 1992
- How Much Work-Related Injury and Illness is Missed By the Current National Surveillance System
- Slide Number 7
- Summary of Analysis Comparing BLS and Worker Comp data Michigan 2009-2001
- Simplified Flowchart of Events Necessary to the Documentation of Work-Related Injuries and Illnesses
- Filters to Identifying Work-Related Injuries and Illnesses
- Capture-Recapture Estimates of Workplace Injury and Illness Reporting by BLS Adjusted for Capture Heterogeneity Lost-Time Cases 1998-2001
- Workersrsquo Compensation
- Proportion of Work-Injured Adults for Whom Treatment was paid by Workersrsquo Compensation by State-BRFSS 10 States 2007
- Percentage Received Workersrsquo Compensation by Condition Michigan
- Slide Number 15
- Reasons Didnrsquot File a Workersrsquo Compensation Claims for a Repetitive Trauma Michigan
- Goals of Surveillance
- Reportable Conditions in Michigan
- Laboratory Reporting Regulations Michigan
- Occupational Illness Reporting Requirement in Michigan
- Methodology of Multi-Source Surveillance
- Work-Related Burn Reports ndash By Source Total 1461 Michigan 2009
- Work-Related Burn ndash Case History
- Slide Number 24
- Michigan OSHA Inspections Violations and Penalties by Work-Related Injuries
- Severity of Burns within Specific Industries Michigan 2013
- Work-Related Burns Among Young Workers (14-24) by Top 5 Industries Michigan 2013
- Work-Related Burn SummaryMichigan 2009-2012
- Slide Number 29
- Slide Number 30
- Slide Number 31
- Slide Number 32
- Slide Number 33
- Slide Number 34
- BLS Undercount ndash Possible Explanations (Burn data)
- WC Undercount ndash Possible Explanations (Burn Data)
- Slide Number 37
- Slide Number 38
- Slide Number 39
- Summary
- Slide Number 41
-
Michigan OSHA Inspections Violations and Penalties by Work-Related Injuries
CONDITION TIME PERIOD
ENFORCEMENT INSPECTIONS
VIOLATIONS
TOTAL PENALTIES ASSESSED
Amputations 2006 - 2013 184 1575 $674255
Crush Injuries 2013 - 2015 77 212 $276425
Burns 2009 - 2013 213 539 $954590
Skull Fractures 2010 - 2013 28 66 $78050
TOTAL 502 2392 $1983320
Percent Inspections Hazard Causing the Injury is Still Present - 60 - 94
Severity of Burns within Specific Industries Michigan 2013
Industry Classification (NAICS)Degree of Burn
1deg 2deg 3deg Fatal Total () () () ()
Accommodation and Food Svcs (72) 176 (37) 288 (61) 8 (2) 0 (-) 472
Health Care and Social Assist (62) 78 (53) 66 (45) 2 (2) 0 (-) 146
Primary Metal Manufacturing (33) 33 (27) 75 (61) 15 (12) 0 (-) 123
Retail Trade (44) 27 (38) 39 (54) 6 (8) 0 (-) 72
Construction (23) 23 (29) 48 (61) 6 (8) 2 (2) 79
Work-Related Burns Among Young Workers (14-24) by Top 5 Industries Michigan 2013
Industry Classification (NAICS)2013
Number PercentAccommodation and Food Services (72) 251 53Health Care and Social Assistance (62) 28 19Primary Metal Manufacturing (33) 25 20Retail Trade (44) 25 35Construction (23) 14 18
Work-Related Burn SummaryMichigan 2009-2012
0
200
400
600
800
1000
1200
1400
1600
WC BLS MI Surveillance
2680
6909
1228
(Kica and Rosenman JOEM 2012)
410
600
250
9471080 1110
2225 25
0
5
10
15
20
25
30
0
200
400
600
800
1000
1200
2013 2014 2015
Rate
Num
ber
BLS Estimate MI Surveillance Number
BLS Rate MI Surveillance Rate
Number and Rate of Work-Related Crushing Injuries ComparingBLS and MI Surveillance Michigan 2013-2015
Number of Work-Related Amputations by year Michigan 2006-2012 by data source
0
100
200
300
400
500
600
700
800
2006 2007 2008 2009 2010 2011 2012
Num
ber o
f am
puta
tions
Incident Year
Michigan Multi-source
Workers Compensation
BLS SOII
(Largo and Rosenman OEM 2014)
Comparison of Multi-Source Date Surveillance in Michigan vs the Bureau of Labor Statistics Employer Based Survey for Work-Related Amputations Burns
Crushing Injuries and Skull Fractures
2380
5673
3220
8737
1110
3137
310 648
Num
ber o
f W
ork-
Rela
ted
Inju
ries
(420)
(369)
(354) (478)
Amputations2006-2015
Burns2009-2013
Crushing Injuries2013-2015
Skull Fractures 2012-2013
Summary Statistics of Work-Related Farm Injuries Michigan 2015
678 work-related farm injuries treated in Michiganrsquos hospitals or Emergency Room departments for work-related farm injuries
Types of medical encounterED visits ndash 594 (876)Hospitalizations ndash 70 (103)Outpatient visits ndash 14 (21)
9 individuals were identified as migrant workers
There were an additional 16 agricultural fatalities and 1408 non work-related farm injuries
Work-Related Farm Injury NarrativeExamples - AgrAbility Letter Follow-up
bull A 68-year-old male farmer was using a tractor on his grain farm when he exited it while it was still running He was run over by the tractor when it slipped into gear He sustained multiple traumatic crush injuries right multiple rib fractures pelvic fractures and a left lower extremity injury He was hospitalized for seven days
bull A 26-year-old male was working on a dairy farm when his right lower extremity was caught in an auger attached to a power takeoff unit He sustained a traumatic above-the-knee amputation of the right lower extremity up to the hip joint He was hospitalized
Injury Source ndash Work-Related Farm Injuries Michigan 2015
bull Information on injury source available 650 (959)
03
03
37
55
63
68
85
92
95
197
302
0 5 10 15 20 25 30 35
Poultry
Chemical
Tool
Tractor
Fall at Ground Level
Horse
Livestock
Other Machinery (than Tractor)
Fall from Height
Other
Cow
BLS Undercount ndash Possible Explanations (Burn data)
Self employed ndash only 11 Farms ndash only 5 Includes only one or more days away from
work Employer reporting Statistical Samplingextrapolation Codingmiscoding
WC Undercount ndash Possible Explanations (Burn Data)
bull Includes only 7 consecutive days away from work
bull Self employed ndash only 11bull Codingmiscoding bull Handled unofficially directly with company
Number of Patients with Inpatient Hospitalizations Primary Diagnosis with Workersrsquo Compensation Expected Payer Michigan 2014
This table does not include another 15 diagnosis with 281 patients
SummaryCurrent Employer Based Systembull Undercount - Miss 29 - 69 of casesbull Undercount Not Consistent Across IndustryCondition
What is Neededbull Multi-Source System like CFOI
Cost Prohibitive to do in Every Statebull System that Allows Follow UpInterventionbull System that Extrapolates from Multi-Source Surveillance
Systemsbull Better Presentation of Data
- Californiarsquos Workersrsquo Compensation Surveillance
- Aims
- How do we calculate rates in occupational health
- Calculating injury rates with four data sources
- 1 Workersrsquo Compensation Information System (WCIS)
- 2 Base Wage File (BWF)
- 3 Quarterly Census of Employment and Wages (QCEW)
- Multi Establishment Car Manufacturing
- Rules for Multi-establishment Firms
- 4 American Community Survey (ACS)
- Pilot Project
- Rate Results
- Employers
- Match Results
- Match Results
- Match Results
- Match Results
- Private Sector Rate of InjuryJanuary-June 2016
- Slide Number 19
- Slide Number 20
- Slide Number 21
- Slide Number 22
- Slide Number 23
- Rates of Injury by IndustryPrivate sector
- Rates of Injury by IndustryPrivate sector
- How great is this
- Milestones
- What are we missing
- Next Steps
- Collaborators
- Concurrent 3I-June 22 ndash Rosenmanpdf
-
- Slide Number 1
- BLS Survey of Employers vs Multi-Source Surveillance of Work-Related Injuries
- Survey of Occupational Injuries and Illnesses (SOII)
- NATIONAL ACADEMY OF SCIENCES 1987
- CENSUS OF FATAL OCCUPATIONAL INJURIES (CFOI) BEGAN IN 1992
- How Much Work-Related Injury and Illness is Missed By the Current National Surveillance System
- Slide Number 7
- Summary of Analysis Comparing BLS and Worker Comp data Michigan 2009-2001
- Simplified Flowchart of Events Necessary to the Documentation of Work-Related Injuries and Illnesses
- Filters to Identifying Work-Related Injuries and Illnesses
- Capture-Recapture Estimates of Workplace Injury and Illness Reporting by BLS Adjusted for Capture Heterogeneity Lost-Time Cases 1998-2001
- Workersrsquo Compensation
- Proportion of Work-Injured Adults for Whom Treatment was paid by Workersrsquo Compensation by State-BRFSS 10 States 2007
- Percentage Received Workersrsquo Compensation by Condition Michigan
- Slide Number 15
- Reasons Didnrsquot File a Workersrsquo Compensation Claims for a Repetitive Trauma Michigan
- Goals of Surveillance
- Reportable Conditions in Michigan
- Laboratory Reporting Regulations Michigan
- Occupational Illness Reporting Requirement in Michigan
- Methodology of Multi-Source Surveillance
- Work-Related Burn Reports ndash By Source Total 1461 Michigan 2009
- Work-Related Burn ndash Case History
- Slide Number 24
- Michigan OSHA Inspections Violations and Penalties by Work-Related Injuries
- Severity of Burns within Specific Industries Michigan 2013
- Work-Related Burns Among Young Workers (14-24) by Top 5 Industries Michigan 2013
- Work-Related Burn SummaryMichigan 2009-2012
- Slide Number 29
- Slide Number 30
- Slide Number 31
- Slide Number 32
- Slide Number 33
- Slide Number 34
- BLS Undercount ndash Possible Explanations (Burn data)
- WC Undercount ndash Possible Explanations (Burn Data)
- Slide Number 37
- Slide Number 38
- Slide Number 39
- Summary
- Slide Number 41
-
Severity of Burns within Specific Industries Michigan 2013
Industry Classification (NAICS)Degree of Burn
1deg 2deg 3deg Fatal Total () () () ()
Accommodation and Food Svcs (72) 176 (37) 288 (61) 8 (2) 0 (-) 472
Health Care and Social Assist (62) 78 (53) 66 (45) 2 (2) 0 (-) 146
Primary Metal Manufacturing (33) 33 (27) 75 (61) 15 (12) 0 (-) 123
Retail Trade (44) 27 (38) 39 (54) 6 (8) 0 (-) 72
Construction (23) 23 (29) 48 (61) 6 (8) 2 (2) 79
Work-Related Burns Among Young Workers (14-24) by Top 5 Industries Michigan 2013
Industry Classification (NAICS)2013
Number PercentAccommodation and Food Services (72) 251 53Health Care and Social Assistance (62) 28 19Primary Metal Manufacturing (33) 25 20Retail Trade (44) 25 35Construction (23) 14 18
Work-Related Burn SummaryMichigan 2009-2012
0
200
400
600
800
1000
1200
1400
1600
WC BLS MI Surveillance
2680
6909
1228
(Kica and Rosenman JOEM 2012)
410
600
250
9471080 1110
2225 25
0
5
10
15
20
25
30
0
200
400
600
800
1000
1200
2013 2014 2015
Rate
Num
ber
BLS Estimate MI Surveillance Number
BLS Rate MI Surveillance Rate
Number and Rate of Work-Related Crushing Injuries ComparingBLS and MI Surveillance Michigan 2013-2015
Number of Work-Related Amputations by year Michigan 2006-2012 by data source
0
100
200
300
400
500
600
700
800
2006 2007 2008 2009 2010 2011 2012
Num
ber o
f am
puta
tions
Incident Year
Michigan Multi-source
Workers Compensation
BLS SOII
(Largo and Rosenman OEM 2014)
Comparison of Multi-Source Date Surveillance in Michigan vs the Bureau of Labor Statistics Employer Based Survey for Work-Related Amputations Burns
Crushing Injuries and Skull Fractures
2380
5673
3220
8737
1110
3137
310 648
Num
ber o
f W
ork-
Rela
ted
Inju
ries
(420)
(369)
(354) (478)
Amputations2006-2015
Burns2009-2013
Crushing Injuries2013-2015
Skull Fractures 2012-2013
Summary Statistics of Work-Related Farm Injuries Michigan 2015
678 work-related farm injuries treated in Michiganrsquos hospitals or Emergency Room departments for work-related farm injuries
Types of medical encounterED visits ndash 594 (876)Hospitalizations ndash 70 (103)Outpatient visits ndash 14 (21)
9 individuals were identified as migrant workers
There were an additional 16 agricultural fatalities and 1408 non work-related farm injuries
Work-Related Farm Injury NarrativeExamples - AgrAbility Letter Follow-up
bull A 68-year-old male farmer was using a tractor on his grain farm when he exited it while it was still running He was run over by the tractor when it slipped into gear He sustained multiple traumatic crush injuries right multiple rib fractures pelvic fractures and a left lower extremity injury He was hospitalized for seven days
bull A 26-year-old male was working on a dairy farm when his right lower extremity was caught in an auger attached to a power takeoff unit He sustained a traumatic above-the-knee amputation of the right lower extremity up to the hip joint He was hospitalized
Injury Source ndash Work-Related Farm Injuries Michigan 2015
bull Information on injury source available 650 (959)
03
03
37
55
63
68
85
92
95
197
302
0 5 10 15 20 25 30 35
Poultry
Chemical
Tool
Tractor
Fall at Ground Level
Horse
Livestock
Other Machinery (than Tractor)
Fall from Height
Other
Cow
BLS Undercount ndash Possible Explanations (Burn data)
Self employed ndash only 11 Farms ndash only 5 Includes only one or more days away from
work Employer reporting Statistical Samplingextrapolation Codingmiscoding
WC Undercount ndash Possible Explanations (Burn Data)
bull Includes only 7 consecutive days away from work
bull Self employed ndash only 11bull Codingmiscoding bull Handled unofficially directly with company
Number of Patients with Inpatient Hospitalizations Primary Diagnosis with Workersrsquo Compensation Expected Payer Michigan 2014
This table does not include another 15 diagnosis with 281 patients
SummaryCurrent Employer Based Systembull Undercount - Miss 29 - 69 of casesbull Undercount Not Consistent Across IndustryCondition
What is Neededbull Multi-Source System like CFOI
Cost Prohibitive to do in Every Statebull System that Allows Follow UpInterventionbull System that Extrapolates from Multi-Source Surveillance
Systemsbull Better Presentation of Data
- Californiarsquos Workersrsquo Compensation Surveillance
- Aims
- How do we calculate rates in occupational health
- Calculating injury rates with four data sources
- 1 Workersrsquo Compensation Information System (WCIS)
- 2 Base Wage File (BWF)
- 3 Quarterly Census of Employment and Wages (QCEW)
- Multi Establishment Car Manufacturing
- Rules for Multi-establishment Firms
- 4 American Community Survey (ACS)
- Pilot Project
- Rate Results
- Employers
- Match Results
- Match Results
- Match Results
- Match Results
- Private Sector Rate of InjuryJanuary-June 2016
- Slide Number 19
- Slide Number 20
- Slide Number 21
- Slide Number 22
- Slide Number 23
- Rates of Injury by IndustryPrivate sector
- Rates of Injury by IndustryPrivate sector
- How great is this
- Milestones
- What are we missing
- Next Steps
- Collaborators
- Concurrent 3I-June 22 ndash Rosenmanpdf
-
- Slide Number 1
- BLS Survey of Employers vs Multi-Source Surveillance of Work-Related Injuries
- Survey of Occupational Injuries and Illnesses (SOII)
- NATIONAL ACADEMY OF SCIENCES 1987
- CENSUS OF FATAL OCCUPATIONAL INJURIES (CFOI) BEGAN IN 1992
- How Much Work-Related Injury and Illness is Missed By the Current National Surveillance System
- Slide Number 7
- Summary of Analysis Comparing BLS and Worker Comp data Michigan 2009-2001
- Simplified Flowchart of Events Necessary to the Documentation of Work-Related Injuries and Illnesses
- Filters to Identifying Work-Related Injuries and Illnesses
- Capture-Recapture Estimates of Workplace Injury and Illness Reporting by BLS Adjusted for Capture Heterogeneity Lost-Time Cases 1998-2001
- Workersrsquo Compensation
- Proportion of Work-Injured Adults for Whom Treatment was paid by Workersrsquo Compensation by State-BRFSS 10 States 2007
- Percentage Received Workersrsquo Compensation by Condition Michigan
- Slide Number 15
- Reasons Didnrsquot File a Workersrsquo Compensation Claims for a Repetitive Trauma Michigan
- Goals of Surveillance
- Reportable Conditions in Michigan
- Laboratory Reporting Regulations Michigan
- Occupational Illness Reporting Requirement in Michigan
- Methodology of Multi-Source Surveillance
- Work-Related Burn Reports ndash By Source Total 1461 Michigan 2009
- Work-Related Burn ndash Case History
- Slide Number 24
- Michigan OSHA Inspections Violations and Penalties by Work-Related Injuries
- Severity of Burns within Specific Industries Michigan 2013
- Work-Related Burns Among Young Workers (14-24) by Top 5 Industries Michigan 2013
- Work-Related Burn SummaryMichigan 2009-2012
- Slide Number 29
- Slide Number 30
- Slide Number 31
- Slide Number 32
- Slide Number 33
- Slide Number 34
- BLS Undercount ndash Possible Explanations (Burn data)
- WC Undercount ndash Possible Explanations (Burn Data)
- Slide Number 37
- Slide Number 38
- Slide Number 39
- Summary
- Slide Number 41
-
Work-Related Burns Among Young Workers (14-24) by Top 5 Industries Michigan 2013
Industry Classification (NAICS)2013
Number PercentAccommodation and Food Services (72) 251 53Health Care and Social Assistance (62) 28 19Primary Metal Manufacturing (33) 25 20Retail Trade (44) 25 35Construction (23) 14 18
Work-Related Burn SummaryMichigan 2009-2012
0
200
400
600
800
1000
1200
1400
1600
WC BLS MI Surveillance
2680
6909
1228
(Kica and Rosenman JOEM 2012)
410
600
250
9471080 1110
2225 25
0
5
10
15
20
25
30
0
200
400
600
800
1000
1200
2013 2014 2015
Rate
Num
ber
BLS Estimate MI Surveillance Number
BLS Rate MI Surveillance Rate
Number and Rate of Work-Related Crushing Injuries ComparingBLS and MI Surveillance Michigan 2013-2015
Number of Work-Related Amputations by year Michigan 2006-2012 by data source
0
100
200
300
400
500
600
700
800
2006 2007 2008 2009 2010 2011 2012
Num
ber o
f am
puta
tions
Incident Year
Michigan Multi-source
Workers Compensation
BLS SOII
(Largo and Rosenman OEM 2014)
Comparison of Multi-Source Date Surveillance in Michigan vs the Bureau of Labor Statistics Employer Based Survey for Work-Related Amputations Burns
Crushing Injuries and Skull Fractures
2380
5673
3220
8737
1110
3137
310 648
Num
ber o
f W
ork-
Rela
ted
Inju
ries
(420)
(369)
(354) (478)
Amputations2006-2015
Burns2009-2013
Crushing Injuries2013-2015
Skull Fractures 2012-2013
Summary Statistics of Work-Related Farm Injuries Michigan 2015
678 work-related farm injuries treated in Michiganrsquos hospitals or Emergency Room departments for work-related farm injuries
Types of medical encounterED visits ndash 594 (876)Hospitalizations ndash 70 (103)Outpatient visits ndash 14 (21)
9 individuals were identified as migrant workers
There were an additional 16 agricultural fatalities and 1408 non work-related farm injuries
Work-Related Farm Injury NarrativeExamples - AgrAbility Letter Follow-up
bull A 68-year-old male farmer was using a tractor on his grain farm when he exited it while it was still running He was run over by the tractor when it slipped into gear He sustained multiple traumatic crush injuries right multiple rib fractures pelvic fractures and a left lower extremity injury He was hospitalized for seven days
bull A 26-year-old male was working on a dairy farm when his right lower extremity was caught in an auger attached to a power takeoff unit He sustained a traumatic above-the-knee amputation of the right lower extremity up to the hip joint He was hospitalized
Injury Source ndash Work-Related Farm Injuries Michigan 2015
bull Information on injury source available 650 (959)
03
03
37
55
63
68
85
92
95
197
302
0 5 10 15 20 25 30 35
Poultry
Chemical
Tool
Tractor
Fall at Ground Level
Horse
Livestock
Other Machinery (than Tractor)
Fall from Height
Other
Cow
BLS Undercount ndash Possible Explanations (Burn data)
Self employed ndash only 11 Farms ndash only 5 Includes only one or more days away from
work Employer reporting Statistical Samplingextrapolation Codingmiscoding
WC Undercount ndash Possible Explanations (Burn Data)
bull Includes only 7 consecutive days away from work
bull Self employed ndash only 11bull Codingmiscoding bull Handled unofficially directly with company
Number of Patients with Inpatient Hospitalizations Primary Diagnosis with Workersrsquo Compensation Expected Payer Michigan 2014
This table does not include another 15 diagnosis with 281 patients
SummaryCurrent Employer Based Systembull Undercount - Miss 29 - 69 of casesbull Undercount Not Consistent Across IndustryCondition
What is Neededbull Multi-Source System like CFOI
Cost Prohibitive to do in Every Statebull System that Allows Follow UpInterventionbull System that Extrapolates from Multi-Source Surveillance
Systemsbull Better Presentation of Data
- Californiarsquos Workersrsquo Compensation Surveillance
- Aims
- How do we calculate rates in occupational health
- Calculating injury rates with four data sources
- 1 Workersrsquo Compensation Information System (WCIS)
- 2 Base Wage File (BWF)
- 3 Quarterly Census of Employment and Wages (QCEW)
- Multi Establishment Car Manufacturing
- Rules for Multi-establishment Firms
- 4 American Community Survey (ACS)
- Pilot Project
- Rate Results
- Employers
- Match Results
- Match Results
- Match Results
- Match Results
- Private Sector Rate of InjuryJanuary-June 2016
- Slide Number 19
- Slide Number 20
- Slide Number 21
- Slide Number 22
- Slide Number 23
- Rates of Injury by IndustryPrivate sector
- Rates of Injury by IndustryPrivate sector
- How great is this
- Milestones
- What are we missing
- Next Steps
- Collaborators
- Concurrent 3I-June 22 ndash Rosenmanpdf
-
- Slide Number 1
- BLS Survey of Employers vs Multi-Source Surveillance of Work-Related Injuries
- Survey of Occupational Injuries and Illnesses (SOII)
- NATIONAL ACADEMY OF SCIENCES 1987
- CENSUS OF FATAL OCCUPATIONAL INJURIES (CFOI) BEGAN IN 1992
- How Much Work-Related Injury and Illness is Missed By the Current National Surveillance System
- Slide Number 7
- Summary of Analysis Comparing BLS and Worker Comp data Michigan 2009-2001
- Simplified Flowchart of Events Necessary to the Documentation of Work-Related Injuries and Illnesses
- Filters to Identifying Work-Related Injuries and Illnesses
- Capture-Recapture Estimates of Workplace Injury and Illness Reporting by BLS Adjusted for Capture Heterogeneity Lost-Time Cases 1998-2001
- Workersrsquo Compensation
- Proportion of Work-Injured Adults for Whom Treatment was paid by Workersrsquo Compensation by State-BRFSS 10 States 2007
- Percentage Received Workersrsquo Compensation by Condition Michigan
- Slide Number 15
- Reasons Didnrsquot File a Workersrsquo Compensation Claims for a Repetitive Trauma Michigan
- Goals of Surveillance
- Reportable Conditions in Michigan
- Laboratory Reporting Regulations Michigan
- Occupational Illness Reporting Requirement in Michigan
- Methodology of Multi-Source Surveillance
- Work-Related Burn Reports ndash By Source Total 1461 Michigan 2009
- Work-Related Burn ndash Case History
- Slide Number 24
- Michigan OSHA Inspections Violations and Penalties by Work-Related Injuries
- Severity of Burns within Specific Industries Michigan 2013
- Work-Related Burns Among Young Workers (14-24) by Top 5 Industries Michigan 2013
- Work-Related Burn SummaryMichigan 2009-2012
- Slide Number 29
- Slide Number 30
- Slide Number 31
- Slide Number 32
- Slide Number 33
- Slide Number 34
- BLS Undercount ndash Possible Explanations (Burn data)
- WC Undercount ndash Possible Explanations (Burn Data)
- Slide Number 37
- Slide Number 38
- Slide Number 39
- Summary
- Slide Number 41
-
Work-Related Burn SummaryMichigan 2009-2012
0
200
400
600
800
1000
1200
1400
1600
WC BLS MI Surveillance
2680
6909
1228
(Kica and Rosenman JOEM 2012)
410
600
250
9471080 1110
2225 25
0
5
10
15
20
25
30
0
200
400
600
800
1000
1200
2013 2014 2015
Rate
Num
ber
BLS Estimate MI Surveillance Number
BLS Rate MI Surveillance Rate
Number and Rate of Work-Related Crushing Injuries ComparingBLS and MI Surveillance Michigan 2013-2015
Number of Work-Related Amputations by year Michigan 2006-2012 by data source
0
100
200
300
400
500
600
700
800
2006 2007 2008 2009 2010 2011 2012
Num
ber o
f am
puta
tions
Incident Year
Michigan Multi-source
Workers Compensation
BLS SOII
(Largo and Rosenman OEM 2014)
Comparison of Multi-Source Date Surveillance in Michigan vs the Bureau of Labor Statistics Employer Based Survey for Work-Related Amputations Burns
Crushing Injuries and Skull Fractures
2380
5673
3220
8737
1110
3137
310 648
Num
ber o
f W
ork-
Rela
ted
Inju
ries
(420)
(369)
(354) (478)
Amputations2006-2015
Burns2009-2013
Crushing Injuries2013-2015
Skull Fractures 2012-2013
Summary Statistics of Work-Related Farm Injuries Michigan 2015
678 work-related farm injuries treated in Michiganrsquos hospitals or Emergency Room departments for work-related farm injuries
Types of medical encounterED visits ndash 594 (876)Hospitalizations ndash 70 (103)Outpatient visits ndash 14 (21)
9 individuals were identified as migrant workers
There were an additional 16 agricultural fatalities and 1408 non work-related farm injuries
Work-Related Farm Injury NarrativeExamples - AgrAbility Letter Follow-up
bull A 68-year-old male farmer was using a tractor on his grain farm when he exited it while it was still running He was run over by the tractor when it slipped into gear He sustained multiple traumatic crush injuries right multiple rib fractures pelvic fractures and a left lower extremity injury He was hospitalized for seven days
bull A 26-year-old male was working on a dairy farm when his right lower extremity was caught in an auger attached to a power takeoff unit He sustained a traumatic above-the-knee amputation of the right lower extremity up to the hip joint He was hospitalized
Injury Source ndash Work-Related Farm Injuries Michigan 2015
bull Information on injury source available 650 (959)
03
03
37
55
63
68
85
92
95
197
302
0 5 10 15 20 25 30 35
Poultry
Chemical
Tool
Tractor
Fall at Ground Level
Horse
Livestock
Other Machinery (than Tractor)
Fall from Height
Other
Cow
BLS Undercount ndash Possible Explanations (Burn data)
Self employed ndash only 11 Farms ndash only 5 Includes only one or more days away from
work Employer reporting Statistical Samplingextrapolation Codingmiscoding
WC Undercount ndash Possible Explanations (Burn Data)
bull Includes only 7 consecutive days away from work
bull Self employed ndash only 11bull Codingmiscoding bull Handled unofficially directly with company
Number of Patients with Inpatient Hospitalizations Primary Diagnosis with Workersrsquo Compensation Expected Payer Michigan 2014
This table does not include another 15 diagnosis with 281 patients
SummaryCurrent Employer Based Systembull Undercount - Miss 29 - 69 of casesbull Undercount Not Consistent Across IndustryCondition
What is Neededbull Multi-Source System like CFOI
Cost Prohibitive to do in Every Statebull System that Allows Follow UpInterventionbull System that Extrapolates from Multi-Source Surveillance
Systemsbull Better Presentation of Data
- Californiarsquos Workersrsquo Compensation Surveillance
- Aims
- How do we calculate rates in occupational health
- Calculating injury rates with four data sources
- 1 Workersrsquo Compensation Information System (WCIS)
- 2 Base Wage File (BWF)
- 3 Quarterly Census of Employment and Wages (QCEW)
- Multi Establishment Car Manufacturing
- Rules for Multi-establishment Firms
- 4 American Community Survey (ACS)
- Pilot Project
- Rate Results
- Employers
- Match Results
- Match Results
- Match Results
- Match Results
- Private Sector Rate of InjuryJanuary-June 2016
- Slide Number 19
- Slide Number 20
- Slide Number 21
- Slide Number 22
- Slide Number 23
- Rates of Injury by IndustryPrivate sector
- Rates of Injury by IndustryPrivate sector
- How great is this
- Milestones
- What are we missing
- Next Steps
- Collaborators
- Concurrent 3I-June 22 ndash Rosenmanpdf
-
- Slide Number 1
- BLS Survey of Employers vs Multi-Source Surveillance of Work-Related Injuries
- Survey of Occupational Injuries and Illnesses (SOII)
- NATIONAL ACADEMY OF SCIENCES 1987
- CENSUS OF FATAL OCCUPATIONAL INJURIES (CFOI) BEGAN IN 1992
- How Much Work-Related Injury and Illness is Missed By the Current National Surveillance System
- Slide Number 7
- Summary of Analysis Comparing BLS and Worker Comp data Michigan 2009-2001
- Simplified Flowchart of Events Necessary to the Documentation of Work-Related Injuries and Illnesses
- Filters to Identifying Work-Related Injuries and Illnesses
- Capture-Recapture Estimates of Workplace Injury and Illness Reporting by BLS Adjusted for Capture Heterogeneity Lost-Time Cases 1998-2001
- Workersrsquo Compensation
- Proportion of Work-Injured Adults for Whom Treatment was paid by Workersrsquo Compensation by State-BRFSS 10 States 2007
- Percentage Received Workersrsquo Compensation by Condition Michigan
- Slide Number 15
- Reasons Didnrsquot File a Workersrsquo Compensation Claims for a Repetitive Trauma Michigan
- Goals of Surveillance
- Reportable Conditions in Michigan
- Laboratory Reporting Regulations Michigan
- Occupational Illness Reporting Requirement in Michigan
- Methodology of Multi-Source Surveillance
- Work-Related Burn Reports ndash By Source Total 1461 Michigan 2009
- Work-Related Burn ndash Case History
- Slide Number 24
- Michigan OSHA Inspections Violations and Penalties by Work-Related Injuries
- Severity of Burns within Specific Industries Michigan 2013
- Work-Related Burns Among Young Workers (14-24) by Top 5 Industries Michigan 2013
- Work-Related Burn SummaryMichigan 2009-2012
- Slide Number 29
- Slide Number 30
- Slide Number 31
- Slide Number 32
- Slide Number 33
- Slide Number 34
- BLS Undercount ndash Possible Explanations (Burn data)
- WC Undercount ndash Possible Explanations (Burn Data)
- Slide Number 37
- Slide Number 38
- Slide Number 39
- Summary
- Slide Number 41
-
410
600
250
9471080 1110
2225 25
0
5
10
15
20
25
30
0
200
400
600
800
1000
1200
2013 2014 2015
Rate
Num
ber
BLS Estimate MI Surveillance Number
BLS Rate MI Surveillance Rate
Number and Rate of Work-Related Crushing Injuries ComparingBLS and MI Surveillance Michigan 2013-2015
Number of Work-Related Amputations by year Michigan 2006-2012 by data source
0
100
200
300
400
500
600
700
800
2006 2007 2008 2009 2010 2011 2012
Num
ber o
f am
puta
tions
Incident Year
Michigan Multi-source
Workers Compensation
BLS SOII
(Largo and Rosenman OEM 2014)
Comparison of Multi-Source Date Surveillance in Michigan vs the Bureau of Labor Statistics Employer Based Survey for Work-Related Amputations Burns
Crushing Injuries and Skull Fractures
2380
5673
3220
8737
1110
3137
310 648
Num
ber o
f W
ork-
Rela
ted
Inju
ries
(420)
(369)
(354) (478)
Amputations2006-2015
Burns2009-2013
Crushing Injuries2013-2015
Skull Fractures 2012-2013
Summary Statistics of Work-Related Farm Injuries Michigan 2015
678 work-related farm injuries treated in Michiganrsquos hospitals or Emergency Room departments for work-related farm injuries
Types of medical encounterED visits ndash 594 (876)Hospitalizations ndash 70 (103)Outpatient visits ndash 14 (21)
9 individuals were identified as migrant workers
There were an additional 16 agricultural fatalities and 1408 non work-related farm injuries
Work-Related Farm Injury NarrativeExamples - AgrAbility Letter Follow-up
bull A 68-year-old male farmer was using a tractor on his grain farm when he exited it while it was still running He was run over by the tractor when it slipped into gear He sustained multiple traumatic crush injuries right multiple rib fractures pelvic fractures and a left lower extremity injury He was hospitalized for seven days
bull A 26-year-old male was working on a dairy farm when his right lower extremity was caught in an auger attached to a power takeoff unit He sustained a traumatic above-the-knee amputation of the right lower extremity up to the hip joint He was hospitalized
Injury Source ndash Work-Related Farm Injuries Michigan 2015
bull Information on injury source available 650 (959)
03
03
37
55
63
68
85
92
95
197
302
0 5 10 15 20 25 30 35
Poultry
Chemical
Tool
Tractor
Fall at Ground Level
Horse
Livestock
Other Machinery (than Tractor)
Fall from Height
Other
Cow
BLS Undercount ndash Possible Explanations (Burn data)
Self employed ndash only 11 Farms ndash only 5 Includes only one or more days away from
work Employer reporting Statistical Samplingextrapolation Codingmiscoding
WC Undercount ndash Possible Explanations (Burn Data)
bull Includes only 7 consecutive days away from work
bull Self employed ndash only 11bull Codingmiscoding bull Handled unofficially directly with company
Number of Patients with Inpatient Hospitalizations Primary Diagnosis with Workersrsquo Compensation Expected Payer Michigan 2014
This table does not include another 15 diagnosis with 281 patients
SummaryCurrent Employer Based Systembull Undercount - Miss 29 - 69 of casesbull Undercount Not Consistent Across IndustryCondition
What is Neededbull Multi-Source System like CFOI
Cost Prohibitive to do in Every Statebull System that Allows Follow UpInterventionbull System that Extrapolates from Multi-Source Surveillance
Systemsbull Better Presentation of Data
- Californiarsquos Workersrsquo Compensation Surveillance
- Aims
- How do we calculate rates in occupational health
- Calculating injury rates with four data sources
- 1 Workersrsquo Compensation Information System (WCIS)
- 2 Base Wage File (BWF)
- 3 Quarterly Census of Employment and Wages (QCEW)
- Multi Establishment Car Manufacturing
- Rules for Multi-establishment Firms
- 4 American Community Survey (ACS)
- Pilot Project
- Rate Results
- Employers
- Match Results
- Match Results
- Match Results
- Match Results
- Private Sector Rate of InjuryJanuary-June 2016
- Slide Number 19
- Slide Number 20
- Slide Number 21
- Slide Number 22
- Slide Number 23
- Rates of Injury by IndustryPrivate sector
- Rates of Injury by IndustryPrivate sector
- How great is this
- Milestones
- What are we missing
- Next Steps
- Collaborators
- Concurrent 3I-June 22 ndash Rosenmanpdf
-
- Slide Number 1
- BLS Survey of Employers vs Multi-Source Surveillance of Work-Related Injuries
- Survey of Occupational Injuries and Illnesses (SOII)
- NATIONAL ACADEMY OF SCIENCES 1987
- CENSUS OF FATAL OCCUPATIONAL INJURIES (CFOI) BEGAN IN 1992
- How Much Work-Related Injury and Illness is Missed By the Current National Surveillance System
- Slide Number 7
- Summary of Analysis Comparing BLS and Worker Comp data Michigan 2009-2001
- Simplified Flowchart of Events Necessary to the Documentation of Work-Related Injuries and Illnesses
- Filters to Identifying Work-Related Injuries and Illnesses
- Capture-Recapture Estimates of Workplace Injury and Illness Reporting by BLS Adjusted for Capture Heterogeneity Lost-Time Cases 1998-2001
- Workersrsquo Compensation
- Proportion of Work-Injured Adults for Whom Treatment was paid by Workersrsquo Compensation by State-BRFSS 10 States 2007
- Percentage Received Workersrsquo Compensation by Condition Michigan
- Slide Number 15
- Reasons Didnrsquot File a Workersrsquo Compensation Claims for a Repetitive Trauma Michigan
- Goals of Surveillance
- Reportable Conditions in Michigan
- Laboratory Reporting Regulations Michigan
- Occupational Illness Reporting Requirement in Michigan
- Methodology of Multi-Source Surveillance
- Work-Related Burn Reports ndash By Source Total 1461 Michigan 2009
- Work-Related Burn ndash Case History
- Slide Number 24
- Michigan OSHA Inspections Violations and Penalties by Work-Related Injuries
- Severity of Burns within Specific Industries Michigan 2013
- Work-Related Burns Among Young Workers (14-24) by Top 5 Industries Michigan 2013
- Work-Related Burn SummaryMichigan 2009-2012
- Slide Number 29
- Slide Number 30
- Slide Number 31
- Slide Number 32
- Slide Number 33
- Slide Number 34
- BLS Undercount ndash Possible Explanations (Burn data)
- WC Undercount ndash Possible Explanations (Burn Data)
- Slide Number 37
- Slide Number 38
- Slide Number 39
- Summary
- Slide Number 41
-
Number of Work-Related Amputations by year Michigan 2006-2012 by data source
0
100
200
300
400
500
600
700
800
2006 2007 2008 2009 2010 2011 2012
Num
ber o
f am
puta
tions
Incident Year
Michigan Multi-source
Workers Compensation
BLS SOII
(Largo and Rosenman OEM 2014)
Comparison of Multi-Source Date Surveillance in Michigan vs the Bureau of Labor Statistics Employer Based Survey for Work-Related Amputations Burns
Crushing Injuries and Skull Fractures
2380
5673
3220
8737
1110
3137
310 648
Num
ber o
f W
ork-
Rela
ted
Inju
ries
(420)
(369)
(354) (478)
Amputations2006-2015
Burns2009-2013
Crushing Injuries2013-2015
Skull Fractures 2012-2013
Summary Statistics of Work-Related Farm Injuries Michigan 2015
678 work-related farm injuries treated in Michiganrsquos hospitals or Emergency Room departments for work-related farm injuries
Types of medical encounterED visits ndash 594 (876)Hospitalizations ndash 70 (103)Outpatient visits ndash 14 (21)
9 individuals were identified as migrant workers
There were an additional 16 agricultural fatalities and 1408 non work-related farm injuries
Work-Related Farm Injury NarrativeExamples - AgrAbility Letter Follow-up
bull A 68-year-old male farmer was using a tractor on his grain farm when he exited it while it was still running He was run over by the tractor when it slipped into gear He sustained multiple traumatic crush injuries right multiple rib fractures pelvic fractures and a left lower extremity injury He was hospitalized for seven days
bull A 26-year-old male was working on a dairy farm when his right lower extremity was caught in an auger attached to a power takeoff unit He sustained a traumatic above-the-knee amputation of the right lower extremity up to the hip joint He was hospitalized
Injury Source ndash Work-Related Farm Injuries Michigan 2015
bull Information on injury source available 650 (959)
03
03
37
55
63
68
85
92
95
197
302
0 5 10 15 20 25 30 35
Poultry
Chemical
Tool
Tractor
Fall at Ground Level
Horse
Livestock
Other Machinery (than Tractor)
Fall from Height
Other
Cow
BLS Undercount ndash Possible Explanations (Burn data)
Self employed ndash only 11 Farms ndash only 5 Includes only one or more days away from
work Employer reporting Statistical Samplingextrapolation Codingmiscoding
WC Undercount ndash Possible Explanations (Burn Data)
bull Includes only 7 consecutive days away from work
bull Self employed ndash only 11bull Codingmiscoding bull Handled unofficially directly with company
Number of Patients with Inpatient Hospitalizations Primary Diagnosis with Workersrsquo Compensation Expected Payer Michigan 2014
This table does not include another 15 diagnosis with 281 patients
SummaryCurrent Employer Based Systembull Undercount - Miss 29 - 69 of casesbull Undercount Not Consistent Across IndustryCondition
What is Neededbull Multi-Source System like CFOI
Cost Prohibitive to do in Every Statebull System that Allows Follow UpInterventionbull System that Extrapolates from Multi-Source Surveillance
Systemsbull Better Presentation of Data
- Californiarsquos Workersrsquo Compensation Surveillance
- Aims
- How do we calculate rates in occupational health
- Calculating injury rates with four data sources
- 1 Workersrsquo Compensation Information System (WCIS)
- 2 Base Wage File (BWF)
- 3 Quarterly Census of Employment and Wages (QCEW)
- Multi Establishment Car Manufacturing
- Rules for Multi-establishment Firms
- 4 American Community Survey (ACS)
- Pilot Project
- Rate Results
- Employers
- Match Results
- Match Results
- Match Results
- Match Results
- Private Sector Rate of InjuryJanuary-June 2016
- Slide Number 19
- Slide Number 20
- Slide Number 21
- Slide Number 22
- Slide Number 23
- Rates of Injury by IndustryPrivate sector
- Rates of Injury by IndustryPrivate sector
- How great is this
- Milestones
- What are we missing
- Next Steps
- Collaborators
- Concurrent 3I-June 22 ndash Rosenmanpdf
-
- Slide Number 1
- BLS Survey of Employers vs Multi-Source Surveillance of Work-Related Injuries
- Survey of Occupational Injuries and Illnesses (SOII)
- NATIONAL ACADEMY OF SCIENCES 1987
- CENSUS OF FATAL OCCUPATIONAL INJURIES (CFOI) BEGAN IN 1992
- How Much Work-Related Injury and Illness is Missed By the Current National Surveillance System
- Slide Number 7
- Summary of Analysis Comparing BLS and Worker Comp data Michigan 2009-2001
- Simplified Flowchart of Events Necessary to the Documentation of Work-Related Injuries and Illnesses
- Filters to Identifying Work-Related Injuries and Illnesses
- Capture-Recapture Estimates of Workplace Injury and Illness Reporting by BLS Adjusted for Capture Heterogeneity Lost-Time Cases 1998-2001
- Workersrsquo Compensation
- Proportion of Work-Injured Adults for Whom Treatment was paid by Workersrsquo Compensation by State-BRFSS 10 States 2007
- Percentage Received Workersrsquo Compensation by Condition Michigan
- Slide Number 15
- Reasons Didnrsquot File a Workersrsquo Compensation Claims for a Repetitive Trauma Michigan
- Goals of Surveillance
- Reportable Conditions in Michigan
- Laboratory Reporting Regulations Michigan
- Occupational Illness Reporting Requirement in Michigan
- Methodology of Multi-Source Surveillance
- Work-Related Burn Reports ndash By Source Total 1461 Michigan 2009
- Work-Related Burn ndash Case History
- Slide Number 24
- Michigan OSHA Inspections Violations and Penalties by Work-Related Injuries
- Severity of Burns within Specific Industries Michigan 2013
- Work-Related Burns Among Young Workers (14-24) by Top 5 Industries Michigan 2013
- Work-Related Burn SummaryMichigan 2009-2012
- Slide Number 29
- Slide Number 30
- Slide Number 31
- Slide Number 32
- Slide Number 33
- Slide Number 34
- BLS Undercount ndash Possible Explanations (Burn data)
- WC Undercount ndash Possible Explanations (Burn Data)
- Slide Number 37
- Slide Number 38
- Slide Number 39
- Summary
- Slide Number 41
-
Comparison of Multi-Source Date Surveillance in Michigan vs the Bureau of Labor Statistics Employer Based Survey for Work-Related Amputations Burns
Crushing Injuries and Skull Fractures
2380
5673
3220
8737
1110
3137
310 648
Num
ber o
f W
ork-
Rela
ted
Inju
ries
(420)
(369)
(354) (478)
Amputations2006-2015
Burns2009-2013
Crushing Injuries2013-2015
Skull Fractures 2012-2013
Summary Statistics of Work-Related Farm Injuries Michigan 2015
678 work-related farm injuries treated in Michiganrsquos hospitals or Emergency Room departments for work-related farm injuries
Types of medical encounterED visits ndash 594 (876)Hospitalizations ndash 70 (103)Outpatient visits ndash 14 (21)
9 individuals were identified as migrant workers
There were an additional 16 agricultural fatalities and 1408 non work-related farm injuries
Work-Related Farm Injury NarrativeExamples - AgrAbility Letter Follow-up
bull A 68-year-old male farmer was using a tractor on his grain farm when he exited it while it was still running He was run over by the tractor when it slipped into gear He sustained multiple traumatic crush injuries right multiple rib fractures pelvic fractures and a left lower extremity injury He was hospitalized for seven days
bull A 26-year-old male was working on a dairy farm when his right lower extremity was caught in an auger attached to a power takeoff unit He sustained a traumatic above-the-knee amputation of the right lower extremity up to the hip joint He was hospitalized
Injury Source ndash Work-Related Farm Injuries Michigan 2015
bull Information on injury source available 650 (959)
03
03
37
55
63
68
85
92
95
197
302
0 5 10 15 20 25 30 35
Poultry
Chemical
Tool
Tractor
Fall at Ground Level
Horse
Livestock
Other Machinery (than Tractor)
Fall from Height
Other
Cow
BLS Undercount ndash Possible Explanations (Burn data)
Self employed ndash only 11 Farms ndash only 5 Includes only one or more days away from
work Employer reporting Statistical Samplingextrapolation Codingmiscoding
WC Undercount ndash Possible Explanations (Burn Data)
bull Includes only 7 consecutive days away from work
bull Self employed ndash only 11bull Codingmiscoding bull Handled unofficially directly with company
Number of Patients with Inpatient Hospitalizations Primary Diagnosis with Workersrsquo Compensation Expected Payer Michigan 2014
This table does not include another 15 diagnosis with 281 patients
SummaryCurrent Employer Based Systembull Undercount - Miss 29 - 69 of casesbull Undercount Not Consistent Across IndustryCondition
What is Neededbull Multi-Source System like CFOI
Cost Prohibitive to do in Every Statebull System that Allows Follow UpInterventionbull System that Extrapolates from Multi-Source Surveillance
Systemsbull Better Presentation of Data
- Californiarsquos Workersrsquo Compensation Surveillance
- Aims
- How do we calculate rates in occupational health
- Calculating injury rates with four data sources
- 1 Workersrsquo Compensation Information System (WCIS)
- 2 Base Wage File (BWF)
- 3 Quarterly Census of Employment and Wages (QCEW)
- Multi Establishment Car Manufacturing
- Rules for Multi-establishment Firms
- 4 American Community Survey (ACS)
- Pilot Project
- Rate Results
- Employers
- Match Results
- Match Results
- Match Results
- Match Results
- Private Sector Rate of InjuryJanuary-June 2016
- Slide Number 19
- Slide Number 20
- Slide Number 21
- Slide Number 22
- Slide Number 23
- Rates of Injury by IndustryPrivate sector
- Rates of Injury by IndustryPrivate sector
- How great is this
- Milestones
- What are we missing
- Next Steps
- Collaborators
- Concurrent 3I-June 22 ndash Rosenmanpdf
-
- Slide Number 1
- BLS Survey of Employers vs Multi-Source Surveillance of Work-Related Injuries
- Survey of Occupational Injuries and Illnesses (SOII)
- NATIONAL ACADEMY OF SCIENCES 1987
- CENSUS OF FATAL OCCUPATIONAL INJURIES (CFOI) BEGAN IN 1992
- How Much Work-Related Injury and Illness is Missed By the Current National Surveillance System
- Slide Number 7
- Summary of Analysis Comparing BLS and Worker Comp data Michigan 2009-2001
- Simplified Flowchart of Events Necessary to the Documentation of Work-Related Injuries and Illnesses
- Filters to Identifying Work-Related Injuries and Illnesses
- Capture-Recapture Estimates of Workplace Injury and Illness Reporting by BLS Adjusted for Capture Heterogeneity Lost-Time Cases 1998-2001
- Workersrsquo Compensation
- Proportion of Work-Injured Adults for Whom Treatment was paid by Workersrsquo Compensation by State-BRFSS 10 States 2007
- Percentage Received Workersrsquo Compensation by Condition Michigan
- Slide Number 15
- Reasons Didnrsquot File a Workersrsquo Compensation Claims for a Repetitive Trauma Michigan
- Goals of Surveillance
- Reportable Conditions in Michigan
- Laboratory Reporting Regulations Michigan
- Occupational Illness Reporting Requirement in Michigan
- Methodology of Multi-Source Surveillance
- Work-Related Burn Reports ndash By Source Total 1461 Michigan 2009
- Work-Related Burn ndash Case History
- Slide Number 24
- Michigan OSHA Inspections Violations and Penalties by Work-Related Injuries
- Severity of Burns within Specific Industries Michigan 2013
- Work-Related Burns Among Young Workers (14-24) by Top 5 Industries Michigan 2013
- Work-Related Burn SummaryMichigan 2009-2012
- Slide Number 29
- Slide Number 30
- Slide Number 31
- Slide Number 32
- Slide Number 33
- Slide Number 34
- BLS Undercount ndash Possible Explanations (Burn data)
- WC Undercount ndash Possible Explanations (Burn Data)
- Slide Number 37
- Slide Number 38
- Slide Number 39
- Summary
- Slide Number 41
-
Summary Statistics of Work-Related Farm Injuries Michigan 2015
678 work-related farm injuries treated in Michiganrsquos hospitals or Emergency Room departments for work-related farm injuries
Types of medical encounterED visits ndash 594 (876)Hospitalizations ndash 70 (103)Outpatient visits ndash 14 (21)
9 individuals were identified as migrant workers
There were an additional 16 agricultural fatalities and 1408 non work-related farm injuries
Work-Related Farm Injury NarrativeExamples - AgrAbility Letter Follow-up
bull A 68-year-old male farmer was using a tractor on his grain farm when he exited it while it was still running He was run over by the tractor when it slipped into gear He sustained multiple traumatic crush injuries right multiple rib fractures pelvic fractures and a left lower extremity injury He was hospitalized for seven days
bull A 26-year-old male was working on a dairy farm when his right lower extremity was caught in an auger attached to a power takeoff unit He sustained a traumatic above-the-knee amputation of the right lower extremity up to the hip joint He was hospitalized
Injury Source ndash Work-Related Farm Injuries Michigan 2015
bull Information on injury source available 650 (959)
03
03
37
55
63
68
85
92
95
197
302
0 5 10 15 20 25 30 35
Poultry
Chemical
Tool
Tractor
Fall at Ground Level
Horse
Livestock
Other Machinery (than Tractor)
Fall from Height
Other
Cow
BLS Undercount ndash Possible Explanations (Burn data)
Self employed ndash only 11 Farms ndash only 5 Includes only one or more days away from
work Employer reporting Statistical Samplingextrapolation Codingmiscoding
WC Undercount ndash Possible Explanations (Burn Data)
bull Includes only 7 consecutive days away from work
bull Self employed ndash only 11bull Codingmiscoding bull Handled unofficially directly with company
Number of Patients with Inpatient Hospitalizations Primary Diagnosis with Workersrsquo Compensation Expected Payer Michigan 2014
This table does not include another 15 diagnosis with 281 patients
SummaryCurrent Employer Based Systembull Undercount - Miss 29 - 69 of casesbull Undercount Not Consistent Across IndustryCondition
What is Neededbull Multi-Source System like CFOI
Cost Prohibitive to do in Every Statebull System that Allows Follow UpInterventionbull System that Extrapolates from Multi-Source Surveillance
Systemsbull Better Presentation of Data
- Californiarsquos Workersrsquo Compensation Surveillance
- Aims
- How do we calculate rates in occupational health
- Calculating injury rates with four data sources
- 1 Workersrsquo Compensation Information System (WCIS)
- 2 Base Wage File (BWF)
- 3 Quarterly Census of Employment and Wages (QCEW)
- Multi Establishment Car Manufacturing
- Rules for Multi-establishment Firms
- 4 American Community Survey (ACS)
- Pilot Project
- Rate Results
- Employers
- Match Results
- Match Results
- Match Results
- Match Results
- Private Sector Rate of InjuryJanuary-June 2016
- Slide Number 19
- Slide Number 20
- Slide Number 21
- Slide Number 22
- Slide Number 23
- Rates of Injury by IndustryPrivate sector
- Rates of Injury by IndustryPrivate sector
- How great is this
- Milestones
- What are we missing
- Next Steps
- Collaborators
- Concurrent 3I-June 22 ndash Rosenmanpdf
-
- Slide Number 1
- BLS Survey of Employers vs Multi-Source Surveillance of Work-Related Injuries
- Survey of Occupational Injuries and Illnesses (SOII)
- NATIONAL ACADEMY OF SCIENCES 1987
- CENSUS OF FATAL OCCUPATIONAL INJURIES (CFOI) BEGAN IN 1992
- How Much Work-Related Injury and Illness is Missed By the Current National Surveillance System
- Slide Number 7
- Summary of Analysis Comparing BLS and Worker Comp data Michigan 2009-2001
- Simplified Flowchart of Events Necessary to the Documentation of Work-Related Injuries and Illnesses
- Filters to Identifying Work-Related Injuries and Illnesses
- Capture-Recapture Estimates of Workplace Injury and Illness Reporting by BLS Adjusted for Capture Heterogeneity Lost-Time Cases 1998-2001
- Workersrsquo Compensation
- Proportion of Work-Injured Adults for Whom Treatment was paid by Workersrsquo Compensation by State-BRFSS 10 States 2007
- Percentage Received Workersrsquo Compensation by Condition Michigan
- Slide Number 15
- Reasons Didnrsquot File a Workersrsquo Compensation Claims for a Repetitive Trauma Michigan
- Goals of Surveillance
- Reportable Conditions in Michigan
- Laboratory Reporting Regulations Michigan
- Occupational Illness Reporting Requirement in Michigan
- Methodology of Multi-Source Surveillance
- Work-Related Burn Reports ndash By Source Total 1461 Michigan 2009
- Work-Related Burn ndash Case History
- Slide Number 24
- Michigan OSHA Inspections Violations and Penalties by Work-Related Injuries
- Severity of Burns within Specific Industries Michigan 2013
- Work-Related Burns Among Young Workers (14-24) by Top 5 Industries Michigan 2013
- Work-Related Burn SummaryMichigan 2009-2012
- Slide Number 29
- Slide Number 30
- Slide Number 31
- Slide Number 32
- Slide Number 33
- Slide Number 34
- BLS Undercount ndash Possible Explanations (Burn data)
- WC Undercount ndash Possible Explanations (Burn Data)
- Slide Number 37
- Slide Number 38
- Slide Number 39
- Summary
- Slide Number 41
-
Work-Related Farm Injury NarrativeExamples - AgrAbility Letter Follow-up
bull A 68-year-old male farmer was using a tractor on his grain farm when he exited it while it was still running He was run over by the tractor when it slipped into gear He sustained multiple traumatic crush injuries right multiple rib fractures pelvic fractures and a left lower extremity injury He was hospitalized for seven days
bull A 26-year-old male was working on a dairy farm when his right lower extremity was caught in an auger attached to a power takeoff unit He sustained a traumatic above-the-knee amputation of the right lower extremity up to the hip joint He was hospitalized
Injury Source ndash Work-Related Farm Injuries Michigan 2015
bull Information on injury source available 650 (959)
03
03
37
55
63
68
85
92
95
197
302
0 5 10 15 20 25 30 35
Poultry
Chemical
Tool
Tractor
Fall at Ground Level
Horse
Livestock
Other Machinery (than Tractor)
Fall from Height
Other
Cow
BLS Undercount ndash Possible Explanations (Burn data)
Self employed ndash only 11 Farms ndash only 5 Includes only one or more days away from
work Employer reporting Statistical Samplingextrapolation Codingmiscoding
WC Undercount ndash Possible Explanations (Burn Data)
bull Includes only 7 consecutive days away from work
bull Self employed ndash only 11bull Codingmiscoding bull Handled unofficially directly with company
Number of Patients with Inpatient Hospitalizations Primary Diagnosis with Workersrsquo Compensation Expected Payer Michigan 2014
This table does not include another 15 diagnosis with 281 patients
SummaryCurrent Employer Based Systembull Undercount - Miss 29 - 69 of casesbull Undercount Not Consistent Across IndustryCondition
What is Neededbull Multi-Source System like CFOI
Cost Prohibitive to do in Every Statebull System that Allows Follow UpInterventionbull System that Extrapolates from Multi-Source Surveillance
Systemsbull Better Presentation of Data
- Californiarsquos Workersrsquo Compensation Surveillance
- Aims
- How do we calculate rates in occupational health
- Calculating injury rates with four data sources
- 1 Workersrsquo Compensation Information System (WCIS)
- 2 Base Wage File (BWF)
- 3 Quarterly Census of Employment and Wages (QCEW)
- Multi Establishment Car Manufacturing
- Rules for Multi-establishment Firms
- 4 American Community Survey (ACS)
- Pilot Project
- Rate Results
- Employers
- Match Results
- Match Results
- Match Results
- Match Results
- Private Sector Rate of InjuryJanuary-June 2016
- Slide Number 19
- Slide Number 20
- Slide Number 21
- Slide Number 22
- Slide Number 23
- Rates of Injury by IndustryPrivate sector
- Rates of Injury by IndustryPrivate sector
- How great is this
- Milestones
- What are we missing
- Next Steps
- Collaborators
- Concurrent 3I-June 22 ndash Rosenmanpdf
-
- Slide Number 1
- BLS Survey of Employers vs Multi-Source Surveillance of Work-Related Injuries
- Survey of Occupational Injuries and Illnesses (SOII)
- NATIONAL ACADEMY OF SCIENCES 1987
- CENSUS OF FATAL OCCUPATIONAL INJURIES (CFOI) BEGAN IN 1992
- How Much Work-Related Injury and Illness is Missed By the Current National Surveillance System
- Slide Number 7
- Summary of Analysis Comparing BLS and Worker Comp data Michigan 2009-2001
- Simplified Flowchart of Events Necessary to the Documentation of Work-Related Injuries and Illnesses
- Filters to Identifying Work-Related Injuries and Illnesses
- Capture-Recapture Estimates of Workplace Injury and Illness Reporting by BLS Adjusted for Capture Heterogeneity Lost-Time Cases 1998-2001
- Workersrsquo Compensation
- Proportion of Work-Injured Adults for Whom Treatment was paid by Workersrsquo Compensation by State-BRFSS 10 States 2007
- Percentage Received Workersrsquo Compensation by Condition Michigan
- Slide Number 15
- Reasons Didnrsquot File a Workersrsquo Compensation Claims for a Repetitive Trauma Michigan
- Goals of Surveillance
- Reportable Conditions in Michigan
- Laboratory Reporting Regulations Michigan
- Occupational Illness Reporting Requirement in Michigan
- Methodology of Multi-Source Surveillance
- Work-Related Burn Reports ndash By Source Total 1461 Michigan 2009
- Work-Related Burn ndash Case History
- Slide Number 24
- Michigan OSHA Inspections Violations and Penalties by Work-Related Injuries
- Severity of Burns within Specific Industries Michigan 2013
- Work-Related Burns Among Young Workers (14-24) by Top 5 Industries Michigan 2013
- Work-Related Burn SummaryMichigan 2009-2012
- Slide Number 29
- Slide Number 30
- Slide Number 31
- Slide Number 32
- Slide Number 33
- Slide Number 34
- BLS Undercount ndash Possible Explanations (Burn data)
- WC Undercount ndash Possible Explanations (Burn Data)
- Slide Number 37
- Slide Number 38
- Slide Number 39
- Summary
- Slide Number 41
-
Injury Source ndash Work-Related Farm Injuries Michigan 2015
bull Information on injury source available 650 (959)
03
03
37
55
63
68
85
92
95
197
302
0 5 10 15 20 25 30 35
Poultry
Chemical
Tool
Tractor
Fall at Ground Level
Horse
Livestock
Other Machinery (than Tractor)
Fall from Height
Other
Cow
BLS Undercount ndash Possible Explanations (Burn data)
Self employed ndash only 11 Farms ndash only 5 Includes only one or more days away from
work Employer reporting Statistical Samplingextrapolation Codingmiscoding
WC Undercount ndash Possible Explanations (Burn Data)
bull Includes only 7 consecutive days away from work
bull Self employed ndash only 11bull Codingmiscoding bull Handled unofficially directly with company
Number of Patients with Inpatient Hospitalizations Primary Diagnosis with Workersrsquo Compensation Expected Payer Michigan 2014
This table does not include another 15 diagnosis with 281 patients
SummaryCurrent Employer Based Systembull Undercount - Miss 29 - 69 of casesbull Undercount Not Consistent Across IndustryCondition
What is Neededbull Multi-Source System like CFOI
Cost Prohibitive to do in Every Statebull System that Allows Follow UpInterventionbull System that Extrapolates from Multi-Source Surveillance
Systemsbull Better Presentation of Data
- Californiarsquos Workersrsquo Compensation Surveillance
- Aims
- How do we calculate rates in occupational health
- Calculating injury rates with four data sources
- 1 Workersrsquo Compensation Information System (WCIS)
- 2 Base Wage File (BWF)
- 3 Quarterly Census of Employment and Wages (QCEW)
- Multi Establishment Car Manufacturing
- Rules for Multi-establishment Firms
- 4 American Community Survey (ACS)
- Pilot Project
- Rate Results
- Employers
- Match Results
- Match Results
- Match Results
- Match Results
- Private Sector Rate of InjuryJanuary-June 2016
- Slide Number 19
- Slide Number 20
- Slide Number 21
- Slide Number 22
- Slide Number 23
- Rates of Injury by IndustryPrivate sector
- Rates of Injury by IndustryPrivate sector
- How great is this
- Milestones
- What are we missing
- Next Steps
- Collaborators
- Concurrent 3I-June 22 ndash Rosenmanpdf
-
- Slide Number 1
- BLS Survey of Employers vs Multi-Source Surveillance of Work-Related Injuries
- Survey of Occupational Injuries and Illnesses (SOII)
- NATIONAL ACADEMY OF SCIENCES 1987
- CENSUS OF FATAL OCCUPATIONAL INJURIES (CFOI) BEGAN IN 1992
- How Much Work-Related Injury and Illness is Missed By the Current National Surveillance System
- Slide Number 7
- Summary of Analysis Comparing BLS and Worker Comp data Michigan 2009-2001
- Simplified Flowchart of Events Necessary to the Documentation of Work-Related Injuries and Illnesses
- Filters to Identifying Work-Related Injuries and Illnesses
- Capture-Recapture Estimates of Workplace Injury and Illness Reporting by BLS Adjusted for Capture Heterogeneity Lost-Time Cases 1998-2001
- Workersrsquo Compensation
- Proportion of Work-Injured Adults for Whom Treatment was paid by Workersrsquo Compensation by State-BRFSS 10 States 2007
- Percentage Received Workersrsquo Compensation by Condition Michigan
- Slide Number 15
- Reasons Didnrsquot File a Workersrsquo Compensation Claims for a Repetitive Trauma Michigan
- Goals of Surveillance
- Reportable Conditions in Michigan
- Laboratory Reporting Regulations Michigan
- Occupational Illness Reporting Requirement in Michigan
- Methodology of Multi-Source Surveillance
- Work-Related Burn Reports ndash By Source Total 1461 Michigan 2009
- Work-Related Burn ndash Case History
- Slide Number 24
- Michigan OSHA Inspections Violations and Penalties by Work-Related Injuries
- Severity of Burns within Specific Industries Michigan 2013
- Work-Related Burns Among Young Workers (14-24) by Top 5 Industries Michigan 2013
- Work-Related Burn SummaryMichigan 2009-2012
- Slide Number 29
- Slide Number 30
- Slide Number 31
- Slide Number 32
- Slide Number 33
- Slide Number 34
- BLS Undercount ndash Possible Explanations (Burn data)
- WC Undercount ndash Possible Explanations (Burn Data)
- Slide Number 37
- Slide Number 38
- Slide Number 39
- Summary
- Slide Number 41
-
BLS Undercount ndash Possible Explanations (Burn data)
Self employed ndash only 11 Farms ndash only 5 Includes only one or more days away from
work Employer reporting Statistical Samplingextrapolation Codingmiscoding
WC Undercount ndash Possible Explanations (Burn Data)
bull Includes only 7 consecutive days away from work
bull Self employed ndash only 11bull Codingmiscoding bull Handled unofficially directly with company
Number of Patients with Inpatient Hospitalizations Primary Diagnosis with Workersrsquo Compensation Expected Payer Michigan 2014
This table does not include another 15 diagnosis with 281 patients
SummaryCurrent Employer Based Systembull Undercount - Miss 29 - 69 of casesbull Undercount Not Consistent Across IndustryCondition
What is Neededbull Multi-Source System like CFOI
Cost Prohibitive to do in Every Statebull System that Allows Follow UpInterventionbull System that Extrapolates from Multi-Source Surveillance
Systemsbull Better Presentation of Data
- Californiarsquos Workersrsquo Compensation Surveillance
- Aims
- How do we calculate rates in occupational health
- Calculating injury rates with four data sources
- 1 Workersrsquo Compensation Information System (WCIS)
- 2 Base Wage File (BWF)
- 3 Quarterly Census of Employment and Wages (QCEW)
- Multi Establishment Car Manufacturing
- Rules for Multi-establishment Firms
- 4 American Community Survey (ACS)
- Pilot Project
- Rate Results
- Employers
- Match Results
- Match Results
- Match Results
- Match Results
- Private Sector Rate of InjuryJanuary-June 2016
- Slide Number 19
- Slide Number 20
- Slide Number 21
- Slide Number 22
- Slide Number 23
- Rates of Injury by IndustryPrivate sector
- Rates of Injury by IndustryPrivate sector
- How great is this
- Milestones
- What are we missing
- Next Steps
- Collaborators
- Concurrent 3I-June 22 ndash Rosenmanpdf
-
- Slide Number 1
- BLS Survey of Employers vs Multi-Source Surveillance of Work-Related Injuries
- Survey of Occupational Injuries and Illnesses (SOII)
- NATIONAL ACADEMY OF SCIENCES 1987
- CENSUS OF FATAL OCCUPATIONAL INJURIES (CFOI) BEGAN IN 1992
- How Much Work-Related Injury and Illness is Missed By the Current National Surveillance System
- Slide Number 7
- Summary of Analysis Comparing BLS and Worker Comp data Michigan 2009-2001
- Simplified Flowchart of Events Necessary to the Documentation of Work-Related Injuries and Illnesses
- Filters to Identifying Work-Related Injuries and Illnesses
- Capture-Recapture Estimates of Workplace Injury and Illness Reporting by BLS Adjusted for Capture Heterogeneity Lost-Time Cases 1998-2001
- Workersrsquo Compensation
- Proportion of Work-Injured Adults for Whom Treatment was paid by Workersrsquo Compensation by State-BRFSS 10 States 2007
- Percentage Received Workersrsquo Compensation by Condition Michigan
- Slide Number 15
- Reasons Didnrsquot File a Workersrsquo Compensation Claims for a Repetitive Trauma Michigan
- Goals of Surveillance
- Reportable Conditions in Michigan
- Laboratory Reporting Regulations Michigan
- Occupational Illness Reporting Requirement in Michigan
- Methodology of Multi-Source Surveillance
- Work-Related Burn Reports ndash By Source Total 1461 Michigan 2009
- Work-Related Burn ndash Case History
- Slide Number 24
- Michigan OSHA Inspections Violations and Penalties by Work-Related Injuries
- Severity of Burns within Specific Industries Michigan 2013
- Work-Related Burns Among Young Workers (14-24) by Top 5 Industries Michigan 2013
- Work-Related Burn SummaryMichigan 2009-2012
- Slide Number 29
- Slide Number 30
- Slide Number 31
- Slide Number 32
- Slide Number 33
- Slide Number 34
- BLS Undercount ndash Possible Explanations (Burn data)
- WC Undercount ndash Possible Explanations (Burn Data)
- Slide Number 37
- Slide Number 38
- Slide Number 39
- Summary
- Slide Number 41
-
WC Undercount ndash Possible Explanations (Burn Data)
bull Includes only 7 consecutive days away from work
bull Self employed ndash only 11bull Codingmiscoding bull Handled unofficially directly with company
Number of Patients with Inpatient Hospitalizations Primary Diagnosis with Workersrsquo Compensation Expected Payer Michigan 2014
This table does not include another 15 diagnosis with 281 patients
SummaryCurrent Employer Based Systembull Undercount - Miss 29 - 69 of casesbull Undercount Not Consistent Across IndustryCondition
What is Neededbull Multi-Source System like CFOI
Cost Prohibitive to do in Every Statebull System that Allows Follow UpInterventionbull System that Extrapolates from Multi-Source Surveillance
Systemsbull Better Presentation of Data
- Californiarsquos Workersrsquo Compensation Surveillance
- Aims
- How do we calculate rates in occupational health
- Calculating injury rates with four data sources
- 1 Workersrsquo Compensation Information System (WCIS)
- 2 Base Wage File (BWF)
- 3 Quarterly Census of Employment and Wages (QCEW)
- Multi Establishment Car Manufacturing
- Rules for Multi-establishment Firms
- 4 American Community Survey (ACS)
- Pilot Project
- Rate Results
- Employers
- Match Results
- Match Results
- Match Results
- Match Results
- Private Sector Rate of InjuryJanuary-June 2016
- Slide Number 19
- Slide Number 20
- Slide Number 21
- Slide Number 22
- Slide Number 23
- Rates of Injury by IndustryPrivate sector
- Rates of Injury by IndustryPrivate sector
- How great is this
- Milestones
- What are we missing
- Next Steps
- Collaborators
- Concurrent 3I-June 22 ndash Rosenmanpdf
-
- Slide Number 1
- BLS Survey of Employers vs Multi-Source Surveillance of Work-Related Injuries
- Survey of Occupational Injuries and Illnesses (SOII)
- NATIONAL ACADEMY OF SCIENCES 1987
- CENSUS OF FATAL OCCUPATIONAL INJURIES (CFOI) BEGAN IN 1992
- How Much Work-Related Injury and Illness is Missed By the Current National Surveillance System
- Slide Number 7
- Summary of Analysis Comparing BLS and Worker Comp data Michigan 2009-2001
- Simplified Flowchart of Events Necessary to the Documentation of Work-Related Injuries and Illnesses
- Filters to Identifying Work-Related Injuries and Illnesses
- Capture-Recapture Estimates of Workplace Injury and Illness Reporting by BLS Adjusted for Capture Heterogeneity Lost-Time Cases 1998-2001
- Workersrsquo Compensation
- Proportion of Work-Injured Adults for Whom Treatment was paid by Workersrsquo Compensation by State-BRFSS 10 States 2007
- Percentage Received Workersrsquo Compensation by Condition Michigan
- Slide Number 15
- Reasons Didnrsquot File a Workersrsquo Compensation Claims for a Repetitive Trauma Michigan
- Goals of Surveillance
- Reportable Conditions in Michigan
- Laboratory Reporting Regulations Michigan
- Occupational Illness Reporting Requirement in Michigan
- Methodology of Multi-Source Surveillance
- Work-Related Burn Reports ndash By Source Total 1461 Michigan 2009
- Work-Related Burn ndash Case History
- Slide Number 24
- Michigan OSHA Inspections Violations and Penalties by Work-Related Injuries
- Severity of Burns within Specific Industries Michigan 2013
- Work-Related Burns Among Young Workers (14-24) by Top 5 Industries Michigan 2013
- Work-Related Burn SummaryMichigan 2009-2012
- Slide Number 29
- Slide Number 30
- Slide Number 31
- Slide Number 32
- Slide Number 33
- Slide Number 34
- BLS Undercount ndash Possible Explanations (Burn data)
- WC Undercount ndash Possible Explanations (Burn Data)
- Slide Number 37
- Slide Number 38
- Slide Number 39
- Summary
- Slide Number 41
-
Number of Patients with Inpatient Hospitalizations Primary Diagnosis with Workersrsquo Compensation Expected Payer Michigan 2014
This table does not include another 15 diagnosis with 281 patients
SummaryCurrent Employer Based Systembull Undercount - Miss 29 - 69 of casesbull Undercount Not Consistent Across IndustryCondition
What is Neededbull Multi-Source System like CFOI
Cost Prohibitive to do in Every Statebull System that Allows Follow UpInterventionbull System that Extrapolates from Multi-Source Surveillance
Systemsbull Better Presentation of Data
- Californiarsquos Workersrsquo Compensation Surveillance
- Aims
- How do we calculate rates in occupational health
- Calculating injury rates with four data sources
- 1 Workersrsquo Compensation Information System (WCIS)
- 2 Base Wage File (BWF)
- 3 Quarterly Census of Employment and Wages (QCEW)
- Multi Establishment Car Manufacturing
- Rules for Multi-establishment Firms
- 4 American Community Survey (ACS)
- Pilot Project
- Rate Results
- Employers
- Match Results
- Match Results
- Match Results
- Match Results
- Private Sector Rate of InjuryJanuary-June 2016
- Slide Number 19
- Slide Number 20
- Slide Number 21
- Slide Number 22
- Slide Number 23
- Rates of Injury by IndustryPrivate sector
- Rates of Injury by IndustryPrivate sector
- How great is this
- Milestones
- What are we missing
- Next Steps
- Collaborators
- Concurrent 3I-June 22 ndash Rosenmanpdf
-
- Slide Number 1
- BLS Survey of Employers vs Multi-Source Surveillance of Work-Related Injuries
- Survey of Occupational Injuries and Illnesses (SOII)
- NATIONAL ACADEMY OF SCIENCES 1987
- CENSUS OF FATAL OCCUPATIONAL INJURIES (CFOI) BEGAN IN 1992
- How Much Work-Related Injury and Illness is Missed By the Current National Surveillance System
- Slide Number 7
- Summary of Analysis Comparing BLS and Worker Comp data Michigan 2009-2001
- Simplified Flowchart of Events Necessary to the Documentation of Work-Related Injuries and Illnesses
- Filters to Identifying Work-Related Injuries and Illnesses
- Capture-Recapture Estimates of Workplace Injury and Illness Reporting by BLS Adjusted for Capture Heterogeneity Lost-Time Cases 1998-2001
- Workersrsquo Compensation
- Proportion of Work-Injured Adults for Whom Treatment was paid by Workersrsquo Compensation by State-BRFSS 10 States 2007
- Percentage Received Workersrsquo Compensation by Condition Michigan
- Slide Number 15
- Reasons Didnrsquot File a Workersrsquo Compensation Claims for a Repetitive Trauma Michigan
- Goals of Surveillance
- Reportable Conditions in Michigan
- Laboratory Reporting Regulations Michigan
- Occupational Illness Reporting Requirement in Michigan
- Methodology of Multi-Source Surveillance
- Work-Related Burn Reports ndash By Source Total 1461 Michigan 2009
- Work-Related Burn ndash Case History
- Slide Number 24
- Michigan OSHA Inspections Violations and Penalties by Work-Related Injuries
- Severity of Burns within Specific Industries Michigan 2013
- Work-Related Burns Among Young Workers (14-24) by Top 5 Industries Michigan 2013
- Work-Related Burn SummaryMichigan 2009-2012
- Slide Number 29
- Slide Number 30
- Slide Number 31
- Slide Number 32
- Slide Number 33
- Slide Number 34
- BLS Undercount ndash Possible Explanations (Burn data)
- WC Undercount ndash Possible Explanations (Burn Data)
- Slide Number 37
- Slide Number 38
- Slide Number 39
- Summary
- Slide Number 41
-
SummaryCurrent Employer Based Systembull Undercount - Miss 29 - 69 of casesbull Undercount Not Consistent Across IndustryCondition
What is Neededbull Multi-Source System like CFOI
Cost Prohibitive to do in Every Statebull System that Allows Follow UpInterventionbull System that Extrapolates from Multi-Source Surveillance
Systemsbull Better Presentation of Data
- Californiarsquos Workersrsquo Compensation Surveillance
- Aims
- How do we calculate rates in occupational health
- Calculating injury rates with four data sources
- 1 Workersrsquo Compensation Information System (WCIS)
- 2 Base Wage File (BWF)
- 3 Quarterly Census of Employment and Wages (QCEW)
- Multi Establishment Car Manufacturing
- Rules for Multi-establishment Firms
- 4 American Community Survey (ACS)
- Pilot Project
- Rate Results
- Employers
- Match Results
- Match Results
- Match Results
- Match Results
- Private Sector Rate of InjuryJanuary-June 2016
- Slide Number 19
- Slide Number 20
- Slide Number 21
- Slide Number 22
- Slide Number 23
- Rates of Injury by IndustryPrivate sector
- Rates of Injury by IndustryPrivate sector
- How great is this
- Milestones
- What are we missing
- Next Steps
- Collaborators
- Concurrent 3I-June 22 ndash Rosenmanpdf
-
- Slide Number 1
- BLS Survey of Employers vs Multi-Source Surveillance of Work-Related Injuries
- Survey of Occupational Injuries and Illnesses (SOII)
- NATIONAL ACADEMY OF SCIENCES 1987
- CENSUS OF FATAL OCCUPATIONAL INJURIES (CFOI) BEGAN IN 1992
- How Much Work-Related Injury and Illness is Missed By the Current National Surveillance System
- Slide Number 7
- Summary of Analysis Comparing BLS and Worker Comp data Michigan 2009-2001
- Simplified Flowchart of Events Necessary to the Documentation of Work-Related Injuries and Illnesses
- Filters to Identifying Work-Related Injuries and Illnesses
- Capture-Recapture Estimates of Workplace Injury and Illness Reporting by BLS Adjusted for Capture Heterogeneity Lost-Time Cases 1998-2001
- Workersrsquo Compensation
- Proportion of Work-Injured Adults for Whom Treatment was paid by Workersrsquo Compensation by State-BRFSS 10 States 2007
- Percentage Received Workersrsquo Compensation by Condition Michigan
- Slide Number 15
- Reasons Didnrsquot File a Workersrsquo Compensation Claims for a Repetitive Trauma Michigan
- Goals of Surveillance
- Reportable Conditions in Michigan
- Laboratory Reporting Regulations Michigan
- Occupational Illness Reporting Requirement in Michigan
- Methodology of Multi-Source Surveillance
- Work-Related Burn Reports ndash By Source Total 1461 Michigan 2009
- Work-Related Burn ndash Case History
- Slide Number 24
- Michigan OSHA Inspections Violations and Penalties by Work-Related Injuries
- Severity of Burns within Specific Industries Michigan 2013
- Work-Related Burns Among Young Workers (14-24) by Top 5 Industries Michigan 2013
- Work-Related Burn SummaryMichigan 2009-2012
- Slide Number 29
- Slide Number 30
- Slide Number 31
- Slide Number 32
- Slide Number 33
- Slide Number 34
- BLS Undercount ndash Possible Explanations (Burn data)
- WC Undercount ndash Possible Explanations (Burn Data)
- Slide Number 37
- Slide Number 38
- Slide Number 39
- Summary
- Slide Number 41
-
- Californiarsquos Workersrsquo Compensation Surveillance
- Aims
- How do we calculate rates in occupational health
- Calculating injury rates with four data sources
- 1 Workersrsquo Compensation Information System (WCIS)
- 2 Base Wage File (BWF)
- 3 Quarterly Census of Employment and Wages (QCEW)
- Multi Establishment Car Manufacturing
- Rules for Multi-establishment Firms
- 4 American Community Survey (ACS)
- Pilot Project
- Rate Results
- Employers
- Match Results
- Match Results
- Match Results
- Match Results
- Private Sector Rate of InjuryJanuary-June 2016
- Slide Number 19
- Slide Number 20
- Slide Number 21
- Slide Number 22
- Slide Number 23
- Rates of Injury by IndustryPrivate sector
- Rates of Injury by IndustryPrivate sector
- How great is this
- Milestones
- What are we missing
- Next Steps
- Collaborators
- Concurrent 3I-June 22 ndash Rosenmanpdf
-
- Slide Number 1
- BLS Survey of Employers vs Multi-Source Surveillance of Work-Related Injuries
- Survey of Occupational Injuries and Illnesses (SOII)
- NATIONAL ACADEMY OF SCIENCES 1987
- CENSUS OF FATAL OCCUPATIONAL INJURIES (CFOI) BEGAN IN 1992
- How Much Work-Related Injury and Illness is Missed By the Current National Surveillance System
- Slide Number 7
- Summary of Analysis Comparing BLS and Worker Comp data Michigan 2009-2001
- Simplified Flowchart of Events Necessary to the Documentation of Work-Related Injuries and Illnesses
- Filters to Identifying Work-Related Injuries and Illnesses
- Capture-Recapture Estimates of Workplace Injury and Illness Reporting by BLS Adjusted for Capture Heterogeneity Lost-Time Cases 1998-2001
- Workersrsquo Compensation
- Proportion of Work-Injured Adults for Whom Treatment was paid by Workersrsquo Compensation by State-BRFSS 10 States 2007
- Percentage Received Workersrsquo Compensation by Condition Michigan
- Slide Number 15
- Reasons Didnrsquot File a Workersrsquo Compensation Claims for a Repetitive Trauma Michigan
- Goals of Surveillance
- Reportable Conditions in Michigan
- Laboratory Reporting Regulations Michigan
- Occupational Illness Reporting Requirement in Michigan
- Methodology of Multi-Source Surveillance
- Work-Related Burn Reports ndash By Source Total 1461 Michigan 2009
- Work-Related Burn ndash Case History
- Slide Number 24
- Michigan OSHA Inspections Violations and Penalties by Work-Related Injuries
- Severity of Burns within Specific Industries Michigan 2013
- Work-Related Burns Among Young Workers (14-24) by Top 5 Industries Michigan 2013
- Work-Related Burn SummaryMichigan 2009-2012
- Slide Number 29
- Slide Number 30
- Slide Number 31
- Slide Number 32
- Slide Number 33
- Slide Number 34
- BLS Undercount ndash Possible Explanations (Burn data)
- WC Undercount ndash Possible Explanations (Burn Data)
- Slide Number 37
- Slide Number 38
- Slide Number 39
- Summary
- Slide Number 41
-
