John Mendeloff

Validation of TRISS and ASCOT using a non-MTOS trauma registry.

OBJECTIVES To validate the Trauma and Injury Severity Score (TRISS) and A Severity Characterization of Trauma (ASCOT) models for patients with blunt injuries using an independent trauma registry, and to develop new TRISS and ASCOT models for types of patients with blunt injuries and examine their fit. DESIGN Retrospective analysis of clinical data from the Institute for Trauma and Emergency Care (ITEC). MATERIALS AND METHODS Statistical models were developed using TRISS and ASCOT variables applied to ITEC data for patients with blunt injuries. These models were compared to Major Trauma Outcome Study (MTOS) models with regard to the resulting coefficients and hospital quality assessments. Also, separate models were developed for different groups of blunt injuries, and these models were compared with one another and tested for adequacy of fit. MEASUREMENTS AND MAIN RESULTS ASCOT performed acceptably well when new coefficients were derived using ITEC data, but TRISS did not. Although the models developed from MTOS and from ITEC coefficients generally yielded similar hospital quality assessments, there were some notable exceptions. Some TRISS and ASCOT variables were not significantly related to survival for some subgroups of blunt injuries, and neither the TRISS nor the ASCOT model was an adequate predictor of survival for patients suffering from low falls. CONCLUSIONS New TRISS and ASCOT coefficients should be derived if survival for patients with blunt injuries is to be predicted accurately in independent trauma registries. Also, it may be wise to consider developing separate models for subgroups of patients, particularly if hospitals in the registry have different mixes of patient types.

The Declining Effects of Osha Inspections on Manufacturing Injuries: 1979 to 1998

This study examines the impact of OSHA inspections on injuries in manufacturing plants. The authors use the same model and some of the same plant-level data employed by several earlier studies that found large effects of OSHA inspections on injuries for 1979–85. These new estimates indicate that an OSHA inspection imposing a penalty reduced lost-workday injuries by about 19% in 1979–85, but that this effect fell to 11% in 1987–91, and to a statistically insignificant 1% in 1992–98. The authors cannot fully explain this overall decline, which they find for nearly all subgroups they examine—by inspection type, establishment size, and industry, for example. Among other findings are that, across the years studied, inspections with penalties were more effective than those without, and the effects on injury rates were greater in smaller plants and nonunion plants than in large plants and union plants.

What kinds of injuries do OSHA inspections prevent

OBJECTIVE OSHAs enforcement program is one of the major public efforts to protect American workers. We examine both the scope of injury prevention that inspections can contribute and the types of standards that contribute the most. METHODS We linked Pennsylvania Department of Labor and Industry files for lost-time injuries and employment to calculate injury rates for 1998-2005 for all single-establishment manufacturing firms. We linked these to OSHA inspection records. RESULTS Inspections with penalties did affect injury types unrelated to standards as well as those related. We also found again that citations for violations of the standard requiring personal protective equipment had the largest impact on preventing injuries. IMPACT ON INDUSTRY Programs requiring protective equipment use deserve added attention from consultants and inspectors. In addition, some inspections spur managers to undertake safety measures that go beyond compliance with standards.

Small Businesses and Workplace Fatality Risk: An Exploratory Analysis

6 Jump down to document THE ARTS CHILD POLICY CIVIL JUSTICE EDUCATION ENERGY AND ENVIRONMENT HEALTH AND HEALTH CARE INTERNATIONAL AFFAIRS NATIONAL SECURITY POPULATION AND AGING PUBLIC SAFETY SCIENCE AND TECHNOLOGY SUBSTANCE ABUSE TERRORISM AND HOMELAND SECURITY TRANSPORTATION AND INFRASTRUCTURE WORKFORCE AND WORKPLACE The RAND Corporation is a nonprofit research organization providing objective analysis and effective solutions that address the challenges facing the public and private sectors around the world.

A national view of workplace injuries in nursing homes.

Objectives: Data from a large sample of nursing homes were used to examine the cross-sectional association between workplace injuries and organizational factors, caregiver staffing levels, and quality. Methods: Three sources of data were used, the Occupational Safety and Health Administration data initiative for 2004, the Online Survey Certification and Recording system representing 2004, and the 2004 Area Resource File. Results: For the organizational characteristics of interest, the results show that for-profit facilities were less likely to report high injury rates and that facilities with a higher average occupancy and belonging to a chain were more likely to report high injury rates. For the staffing characteristics of interest, facilities with high staffing levels of registered nurses were more likely to report high injury rates, whereas those with high staffing levels of nurse aides were less likely to report high injury rates. For the quality characteristic of interest, facilities of low quality (as measured by quality-of-care deficiency citations) were more likely to report high injury rates. Conclusions: Workplace injuries are associated with organizational, caregiver, and quality characteristics of nursing homes. This may present an opportunity to reduce high injury rates.

Measuring elusive benefits: on the value of health.

Can analysts provide better guidance to policymakers about the valuation of health effects? This paper argues that valuation questions usually cannot be easily sidestepped by the use of cost-effectiveness analysis. Valuations are implicit in the measures of program outcome that we use, as illustrated by an examination of a policy of maximizing discounted quality-adjusted life-years (QALYs). The paper concludes that surveys focused directly on the questions that health and safety policymakers face could be a most fruitful source of guidance.

Is Occupational Injury Risk Higher at New Firms

This paper studies whether newly created firms have higher injury rates than established firms. We use data on a large sample of single‐establishment firms in Pennsylvania from 2001–2005 to examine the relationship between firm age and the risk of lost workday injuries. Using the full set of firms, there appears to be little overall correlation between firm age and risk. If anything, newer firms appear less likely to have lost workday injuries. When we condition on having at least one injury reported in 2000, however, we find that in later years the injury risk of firms declines with age. This pattern is consistent with systematic underreporting of injuries by new firms.

A Quantitative Analysis of Factors Affecting PELs and TLVs for Carcinogens

For carcinogens, this paper provides a quantitative examination of the roles of potency and weight-of-evidence (WOE) in setting permissible exposure limits (PELs) at the U.S. Occupational Safety and Health Administration (OSHA) and threshold limit values (TLVs) at the private American Conference of Governmental Industrial Hygienists (ACGIH). On normative grounds, both of these factors should influence choices about the acceptable level of exposures. Our major objective is to examine whether and in what ways these factors have been considered by these organizations. A lesser objective is to identify outliers, which might be candidates for further regulatory scrutiny. Our sample (N = 48) includes chemicals for which EPA has estimated a unit risk as a measure of carcinogenic potency and for which OSHA or the ACGIH has a PEL or TLV. Different assessments of the strength of the evidence of carcinogenicity were obtained from EPA, ACGIH, and the International Agency for Research on Cancer. We found that potency alone explains 49% of the variation in PELs and 62% of the variation in TLVs. For the ACGIH, WOE plays a much smaller role than potency. TLVs set by the ACGIH since 1989 appear to be stricter than earlier TLVs. We suggest that this change represents evidence that the ACGIH had responded to criticisms leveled at it in the late 1980s for failing to adopt sufficiently protective standards. The models developed here identify 2-nitropropane, ethylene dibromide, and chromium as having OSHA PELs significantly higher than predicted on the basis of potency and WOE.