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International Review of Methods and Systems Used to Measure and Monitor Occupational Disease and Injury

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International Review of Methods and Systems Used to Measure and Monitor Occupational Disease and Injury INTERNATIONAL REVIEW OF METHODS AND SYSTEMS USED TO MEASURE AND MONITOR OCCUPATIONAL DISEASE AND INJURY NOHSAC TECHNICAL REPORT 3 DR NICHOLAS KENDALL AUTHOR ACKNOWLEDGEMENTS Dr Nicholas Kendall This work was funded by NOHSAC. NOHSAC MEMBERS NOHSAC Neil Pearce (Chair) Telephone: (04) 915 4463 Fax: (04) 915 4329 Centre for Public Health Research, Massey University Email: [email protected] Website: www.nohsac.govt.nz Evan Dryson Postal address: PO Box 3705, Wellington Occupational Medical Specialists Ltd, Auckland Centre for Public Health Research, Massey University Anne-Marie Feyer Director, Health Advisory Practice. PricewaterhouseCoopers, Sydney. Adjunct Professorial Research Fellow, Department of Preventive and Social Medicine, University of Otago Philippa Gander Sleep/Wake Research Centre, Massey University Selwyn McCracken Injury Prevention Research Unit, University of Otago NOHSAC SECRETARIAT Mark Wagstaffe (Project Manager) Stephanie Kerruish (Administrative Support Officer) ISBN 0-478-28028-9 This document is available on NOHSAC’s website www.nohsac.govt.nz. It can be freely quoted, copied and circulated with appropriate acknowledgement. The suggested citation is: Kendall N. International Review of Methods and Systems Used to Measure and Monitor Occupational Disease and Injury: NOHSAC Technical Report 3: Wellington, 2005. Table of Contents Executive summary 3 1. Introduction and overview 5 1.1 Objectives of the review 7 1.2 Scope of the review 7 2. Occupational health surveillance 9 2.1 Introduction 10 2.2 Design of surveillance systems 11 2.3 Issues specific to occupational disease 13 2.4 Issues specific to occupational injuries 15 2.5 Uses and limitations of surveillance systems 15 2.6 Occupational surveillance methods 17 2.7 Evaluating surveillance systems 21 2.8 Systems to rate strength of scientific evidence 24 3. Review methodology 27 Semi-structured interview 28 4. Literature review 31 5. International review 37 Canada 38 France 44 Finland 51 Sweden 66 United States 72 United Kingdom 89 Review rating table 103 European occupational surveillance and monitoring systems 104 6. Conclusions and recommendations 115 7. Appendices 121 7.1 Search strings used for literature review 122 7.2 List of useful resources discovered while conducting review 122 8. Definitions and terminology 123 9. References 131 INTERNATIONAL REVIEW OF METHODS AND SYSTEMS USED TO MEASURE AND MONITOR OCCUPATIONAL DISEASE AND INJURY: 1 NOHSAC TECHNICAL REPORT 3 List of Tables Table 1 OSH monitoring systems 22 Table 2 Checklist for evaluating public health surveillance systems 23 Table 3 Rating surveillance systems 103 Table 4 European occupational surveillance and monitoring systems 104 Table 5 Health and safety resources 122 List of Figures Figure 1 Data-driven Model 18 Figure 2 Concept-driven Model 19 Figure 3 Occupational Safety and Health system 52 Figure 4 Data flows into the Finnish register of occupational diseases 60 2 INTERNATIONAL REVIEW OF METHODS AND SYSTEMS USED TO MEASURE AND MONITOR OCCUPATIONAL DISEASE AND INJURY: NOHSAC TECHNICAL REPORT 3 Executive summary This review provides a comprehensive international evidence-based review of methods and systems used to measure occupational disease and injury (excluding New Zealand) and assess the ability of surveillance systems to measure changes in work methods and work organisation. The method involved a literature review and survey of existing approaches. The workplace is a significant and consistent contributor to injuries and illness and associated fatalities. Worker health is therefore fundamental to public health and to a healthy and productive society. Tracking systems form the cornerstone of injury and illness surveillance. Surveillance systems involve the ongoing and systematic collection, analysis, and interpretation of information so that appropriate preventive action may be taken. Occupational surveillance systems have undeniable value and hold considerable potential for prevention approaches. However, most current systems rely on an unsatisfactory patchwork of data and systems. The utility of any surveillance system rests on its ability to capture data from the largest possible proportion of the target population, and for that data to incorporate the widest possible range of potentially relevant variables. Data-driven systems have been built to take opportunistic advantage of information collected for other purposes. Concept-driven systems are rare, but stand as beacons of success for others to aspire to. Integrated occupational surveillance systems are based on sound theoretical principles and have high data capture rates. They use multiple data capture methods that are integrated into the workplace, healthcare, and compensation/insurance and social security systems. Equal focus is placed on occupational disease and injury, thereby avoiding arbitrary divisions. Work environment is monitored, in addition to cases or incidents. Standardised definitions are used, allowing comparisons within and between systems. Comprehensive sets of indicators are used, with free text fields to augment. Bias is minimised. Data capture emphasises core attributes of sensitivity, specificity, representativeness, timeliness, simplicity, flexibility and acceptability, and includes reliability checks. The most effective occupational surveillance systems have two unique characteristics. They are run within independent units or services, with the principal mission to provide epidemiological excellence. They also use independent oversight and expert advice. It is vital to separate the collection and interpretation of data from the commercial, political, or social agendas of organisations or groups that may collect it. The most important conclusion is that we need to do better at occupational surveillance in order to realise the potential of these systems. None of the existing occupational surveillance systems in use around the world stands out as a shining example, but the ones that most closely approach the ideal are those with dedicated services that are independent, and charged with the mission to champion this cause. However, this alone is not sufficient. The system must also be comprehensive and emphasise occupational illness in addition to occupational injury. Of the systems reviewed, the Finnish approach is the one that currently most nearly attains these criteria, and it seems that New Zealand could learn a substantial amount from this model. The following recommendations are offered by the reviewer, while acknowledging that some of these have resource implications. These recommendations outline a high-quality occupational surveillance system. RECOMMENDATION 1. ESTABLISH AN INDEPENDENT EPIDEMIOLOGY BUREAU There should be an independent unit providing an epidemiology department with overall responsibility for surveillance systems. This epidemiology bureau should have an appropriate management structure that is entirely independent of any stakeholders or organisations that may hold their own agendas in order to avoid bias. It should be funded by contributions from stakeholders, including but not limited to the Ministry of Health, the Ministry of Social Development, the Accident Compensation Corporation, and private health insurers or underwriters. INTERNATIONAL REVIEW OF METHODS AND SYSTEMS USED TO MEASURE AND MONITOR OCCUPATIONAL DISEASE AND INJURY: 3 NOHSAC TECHNICAL REPORT 3 Core tasks would be to: • establish an integrated concept-driven surveillance system that is feasible • vigorously champion data capture • contribute directly to prevention initiatives • function in a cost-effective manner. RECOMMENDATION 2. ESTABLISH AN EXPERT GROUP There should be an expert group, whose principal function is to advise the epidemiology bureau. Membership should be time-limited, allowing staged turnover to maximise fresh ideas. This group would advise the epidemiology bureau on key topics, including: • case definitions, coding, categories, and key indicators • data capture techniques, including those that might be mandatory • analysis, especially of narrative fields • priorities. In addition, the expert group would function as an expert panel in the development of guidance on specific occupational health topics RECOMMENDATION 3. ESTABLISH AN INTEGRATED CONCEPT-DRIVEN SURVEILLANCE SYSTEM The core of this should be a national database that includes all occupational injuries and disease. This could be modelled on the Finnish equivalent. The epidemiologist(s) would be required to integrate data capture into the workplace and the ACC and health systems. The core database would be augmented with multiple data capture techniques, with consideration given to using a mixture of techniques, targeted carefully at specific issues. This might include sentinel systems, expert opinion, surveys, and laboratory reports, for example. RECOMMENDATION 4. ADOPT BEST PRACTICE PRINCIPLES FOR SURVEILLANCE The key features of high-quality surveillance systems are outlined in detail in this review. It needs to be emphasised that surveillance systems rapidly deteriorate into ineffective systems when compartmentalised or fragmented. The best practice requires a “systems approach”, without cutting corners. An expert group needs to be consulted to ensure that the surveillance system will result in useful outputs and can be continuously improved. RECOMMENDATION 5. PUBLISH SURVEILLANCE DATA Undertake wide dissemination of information on a regular basis. RECOMMENDATION 6. USE THE SURVEILLANCE SYSTEM TO EVALUATE THE EFFECTIVENESS OF INTERVENTIONS
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