Andrea Chambers

Time trends in musculoskeletal disorders attributed to work exposures in Ontario using three independent data sources, 2004-2011

Objective Work-related musculoskeletal disorders (MSDs) are the leading cause of work disability in the developed economies. The objective of this study was to describe trends in the incidence of MSDs attributed to work exposures in Ontario over the period 2004–2011. Methods An observational study of work-related morbidity obtained from three independent sources for a complete population of approximately six million occupationally active adults aged 15–64 in the largest Canadian province. We implemented a conceptually concordant case definition for work-related non-traumatic MSDs in three population-based data sources: emergency department encounter records, lost-time workers’ compensation claims and representative samples of Ontario workers participating in consecutive waves of a national health interview survey. Results Over the 8-year observation period, the annual per cent change (APC) in the incidence of work-related MSDs was −3.4% (95% CI −4.9% to −1.9%) in emergency departments’ administrative records, −7.2% (−8.5% to −5.8%) in lost-time workers’ compensation claims and −5.3% (−7.2% to −3.5%) among participants in the national health interview survey. Corresponding APC measures for all other work-related conditions were −5.4% (−6.6% to −4.2%), −6.0% (−6.7% to −5.3%) and −5.3% (−7.8% to −2.8%), respectively. Incidence rate declines were substantial in the economic recession following the 2008 global financial crisis. Conclusions The three independent population-based data sources used in this study documented an important reduction in the incidence of work-related morbidity attributed to non-traumatic MSDs. The results of this study are consistent with an interpretation that the burden of non-traumatic MSDs arising from work exposures is declining among working-age adults.

Work-attributed Illness Arising From Excess Heat Exposure in Ontario, 2004-2010

ObjectiveTo describe the incidence of occupational heat illness in Ontario.MethodsHeat illness events were identified in two population-based data sources: work-related emergency department (ED) records and lost time claims for the period 2004–2010 in Ontario, Canada. Incidence rates were calculated using denominator estimates from national labour market surveys and estimates were adjusted for workers’ compensation insurance coverage. Proportional morbidity ratios were estimated for industry, occupation and tenure of employment.ResultsThere were 785 heat illness events identified in the ED encounter records (incidence rate 1.6 per 1,000,000 full-time equivalent (FTE) months) and 612 heat illness events identified in the lost time claim records (incidence rate 1.7 per 1,000,000 FTE months) in the seven-year observation period with peak incidence observed in the summer months. The risk of heat illness was elevated for men, young workers, manual workers and those with shorter employment tenure. A higher proportion of lost time claims attributed to heat illness were observed in the government services, agriculture and construction sectors relative to all lost time claims.ConclusionsOccupational heat illnesses are experienced in Ontario’s population and are observed in ED records and lost time claims. The variation of heat illness incidence observed with worker and industry characteristics, and over time, can inform prevention efforts by occupational health services in Ontario.RésuméObjectifDécrire l’incidence des maladies professionnelles liées à la chaleur en Ontario.MéthodeLes épisodes de maladies liées à la chaleur ont été recensés dans deux sources de données populationnelles: les dossiers des services médicaux d’urgence (SMU) concernant les travailleurs et les réclamations avec interruption de travail pour la période de 2004 à 2010 en Ontario (Canada). Les taux d’incidence ont été calculés à l’aide d’estimations dans le dénominateur tirées d’enquêtes nationales sur le marché du travail, et ces estimations ont été ajustées selon la couverture d’assurance indemnisant contre les accidents du travail. Des ratios proportionnels de morbidité ont été estimés par industrie, par profession et par durée d’emploi.RésultatsSur notre période d’observation de sept ans, 785 épisodes de maladies liées à la chaleur ont été recensés dans les dossiers des SMU (taux d’incidence: 1,6 p. 1 000 000 mois équivalents temps plein [ETP]), et 612 épisodes du même type dans les réclamations avec interruption de travail (taux d’incidence: 1,7 p. 1 000 000 mois ETP), avec des pics observés durant les mois d’été. Le risque de maladie liée à la chaleur était élevé chez les hommes, les jeunes travailleurs, les travailleurs manuels et les personnes ayant eu une durée d’emploi plus courte. Une proportion supérieure de réclamations avec interruption de travail imputées aux maladies liées à la chaleur a été observée dans les secteurs des services gouvernementaux, de l’agriculture et du bâtiment comparativement à l’ensemble des réclamations avec interruption de travail.ConclusionsIl y a des cas de maladies professionnelles liées à la chaleur dans la population ontarienne; ils sont observés dans les dossiers des SMU et dans les réclamations avec interruption de travail. On constate des écarts dans l’incidence des maladies liées à la chaleur selon les caractéristiques des travailleurs et des industries; au fil du temps, ces écarts peuvent éclairer les efforts de prévention des services de santé au travail en Ontario.

Work injury risk by time of day in two population-based data sources.

Objective To estimate the rate of work injury over the 24 h clock in Ontario workers over 5 years (2004–2008). Methods A cross-sectional, observational study of work-related injury and illness was conducted for a population of occupationally active adults using two independent data sources (lost-time compensation claims and emergency department encounter records). Hours worked annually by the Ontario labour force by time of day, age, gender and occupation were estimated from population-based surveys. Results There was an approximately 40% higher incidence of emergency department visits for work-related conditions than of lost-time workers’ compensation claims (707 933 emergency department records and 457 141 lost-time claims). For men and women and across all age groups, there was an elevated risk of work-related injury or illness in the evening, night and early morning periods in both administrative data sources. This elevated risk was consistently observed across manual, mixed and non-manual occupational groups. The fraction of lost-time compensation claims that can be attributed to elevated risk of work injury in evening or night work schedules is 12.5% for women and 5.8% for men. Conclusions Despite the high prevalence of employment in non-daytime work schedules in developed economies, the work injury hazards associated with evening and night schedules remain relatively invisible. This study has demonstrated the feasibility of using administrative data sources to enhance capacity to conduct surveillance of work injury risk by time of day. More sophisticated aetiological research is needed to understand the specific mechanisms of hazards associated with non-regular work hours.

Evaluating the implementation of health and safety innovations under a regulatory context: A collective case study of Ontario’s safer needle regulation

BackgroundImplementation effectiveness models have identified important factors that can promote the successful implementation of an innovation; however, these models have been examined within contexts where innovations are adopted voluntarily and often ignore the socio-political and environmental context. In the field of occupational health and safety, there are circumstances where organizations must adopt innovations to comply with a regulatory standard. Examining how the external environment can facilitate or challenge an organization’s change process may add to our understanding of implementation effectiveness. The objective of this study is to describe implementation facilitators and barriers in the context of a regulation designed to promote the uptake of safer engineered medical devices in healthcare.MethodsThe proposed study will focus on Ontario’s safer needle regulation (2007) which requires healthcare organizations to transition to the use of safer engineered medical devices for the prevention of needlestick injuries. A collective case study design will be used to learn from the experiences of three acute care hospitals in the province of Ontario, Canada. Interviews with management and front-line healthcare workers and analysis of supporting documents will be used to describe the implementation experience and examine issues associated with the integration of these devices. The data collection and analysis process will be influenced by a conceptual framework that draws from implementation science and the occupational health and safety literature.DiscussionThe focus of this study in addition to the methodology creates a unique opportunity to contribute to the field of implementation science. First, the study will explore implementation experiences under circumstances where regulatory pressures are influencing the organizations change process. Second, the timing of this study provides an opportunity to focus on issues that arise during later stages of implementation, a phase during the implementation cycle that has been understudied. This study also provides the opportunity to examine the relevance and utility of current implementation science models in the field of occupational health where the adoption of an innovation is meant to enhance the health and safety of workers. Previous work has tended to focus almost exclusively on innovations that are designed to enhance an organization’s productivity or competitive advantage.

Diverging Trends in the Incidence of Occupational and Nonoccupational Injury in Ontario, 2004–2011

OBJECTIVES We describe trends in occupational and nonoccupational injury among working-age adults in Ontario. METHODS We conducted an observational study of adults aged 15 to 64 over the period 2004 through 2011, estimating the incidence of occupational and nonoccupational injury from emergency department (ED) records and, separately, from survey responses to 5 waves of a national health interview survey. RESULTS Over the observation period, the annual percentage change (APC) in the incidence of work-related injury was -5.9% (95% confidence interval [CI] = -7.3, -4.6) in ED records and -7.4% (95% CI=-11.1, -3.5) among survey participants. In contrast, the APC in the incidence of nonoccupational injury was -0.3% (95% CI=-0.4, 0.0) in ED records and 1.0% (95% CI=0.4, 1.6) among survey participants. Among working-age adults, the percentage of all injuries attributed to work exposures declined from 20.0% in 2004 to 15.2% in 2011 in ED records and from 27.7% in 2001 to 16.9% in 2010 among survey participants. CONCLUSIONS Among working-age adults in Ontario, nearly all of the observed decline in injury incidence over the period 2004 through 2011 is attributed to reductions in occupational injury.

Implementation of a disability management policy in a large healthcare employer: a quasi-experimental, mixed-methods evaluation

Objective This study describes the process and outcomes of the implementation of a strengthened disability management policy in a large Canadian healthcare employer. Key elements of the strengthened policy included an emphasis on early contact, the training of supervisors and the integration of union representatives in return-to-work (RTW) planning. Design The study applied mixed methods, combining a process evaluation within the employer and a quasi-experimental outcome evaluation between employers for a 3-year period prior to and following policy implementation in January 2012. Participants Staff in the implementation organisation (n=4000) and staff in a peer group of 29 large hospitals (n=1 19 000). Outcomes Work disability episode incidence and duration. Results Both qualitative and quantitative measures of the implementation process were predominantly positive. Over the 6-year observation period, there were 624 work disability episodes in the organisation and 8604 in the comparison group of 29 large hospitals. The annual per cent change in episode incidence in the organisation was −5.6 (95% CI −9.9 to −1.1) comparable to the annual per cent change in the comparison group: −6.2 (-7.2 to –5.3). Disability episode durations also declined in the organisation, from a mean of 19.4 days (16.5, 22.3) in the preintervention period to 10.9 days (8.7, 13.2) in the postintervention period. Reductions in disability durations were also observed in the comparison group: from a mean of 13.5 days (12.9, 14.1) in the 2009–2011 period to 10.5 days (9.9, 11.1) in the 2012–2014 period. Conclusion The incidence of work disability episodes and the durations of work disability declined strongly in this hospital sector over the 6-year observation period. The implementation of the organisation’s RTW policy was associated with larger reductions in disability durations than observed in the comparison group.

The development of a framework to integrate evidence into a national injury prevention strategy

BACKGROUND Injury is the leading cause of death from birth to age 34 in Canada (Statistics Canada, 2008). In 2013, a national injury prevention organization in Canada initiated a research-practitioner collaboration to establish a framework for incorporating evidence in the organizations decision-making. In this study, we outline the development process and provide an overview of the framework. METHODS The process of development of the evidence-synthesis framework included consultation with national and international injury prevention experts, a review of the research literature to identify existing models for incorporating research evidence into public health practice and extensive interactions with the organizations leadership and staff. RESULTS A framework emphasizing four types of research evidence was recommended: (i) epidemiologic evidence describing the burden and cause of injury, (ii) evidence concerning the effectiveness of interventions, (iii) evidence on effective methods for implementing promising interventions at a population level, and (iv) evidence and theory from the behavioral sciences. Through the evidence-synthesis process the framework prioritizes highly synthesized evidence-based strategies and draws attention to important research gaps. CONCLUSIONS This study describes a novel opportunity to operationalize an organizations commitment to integrate evidence into practice. The framework provides guidance on how to use evidence strategically to maximize the potential impact of prevention efforts. Opportunities for further evaluation and dissemination are discussed.