Browsing by Subject "injury prevention"

Now showing 1 - 3 of 3
  • Thumbnail Image
    Item
    Protecting the Protectors: Violence-Related Injuries to Hospital Security Personnel and the Use of Conducted Electrical Weapons
    (2017-04) Gramling, Joshua
    Healthcare workers suffer high rates of violence-related injuries compared to other industries, with wide variances in risk dependent upon location and role. Hospital security guards, demonstrated to have high risk levels, are tasked with protecting the safety of healthcare personnel, visitors, and patients, and are called on to help control violent situations, but little is known about their protective and risk factors for violence-related injuries. Two separate and complementary investigations were undertaken to learn more about the risk and protective factors and to find whether one intervention, carriage of conducted electrical weapons, decreases the rates of violence-related injuries or injury severity. The first study was a mixed-methods design investigating the violence-related injuries and other violent events experienced by hospital security workers over the course of 1 year at an urban level 1 trauma center. Qualitative and quantitative analyses were performed on three existing data sources: the security officer narratives, occupational injury reports, and patient health records. There were 19 reported injuries over the course of a year, with an additional 300 violent incidents in 7 months. Most of the violent incidents involving security officers occurred at night, with most of the officer injuries taking place in the psychiatric departments. Qualitative analyses found that hospital policies may increase risk for violence. The second study was a retrospective cohort analysis of all security and ED nursing staff violence-related injuries at the same institution for the time period 4 years prior and 7 years after security workers were armed with conducted electrical weapons. A violence-related injury rate was calculated as all violence-related injuries incurred by each employee for the numerator and the productive hours worked by each individual during the study period of each model for the denominator. The hospital employed 98 security officers and 468 nursing staff over the 11 years of study. Security officers’ injury rate was 13 times higher than nursing staff. The risk ratio was 1.0 (95% CI 0.7-1.4) between the 2 examination periods for security officers, with similar results for nurses. However, among security workers the severity of injuries may have decreased in the post-implementation period.
  • Thumbnail Image
    Item
    Risk Factors And Decision-Making In Potentially Injurious Motor Vehicle Activities
    (2023-08) Jacobs, Sam
    Objective: Driving a motor vehicle can be a dangerous experience. Motor vehicle crashes were the leading cause of unintentional injury death for individuals aged 5-29 in the United States in 2020. The pursuit of a fleeing motor vehicle and the use of a motor vehicle crash as a method of suicide are two specific driving activities that have the potential to lead to injury; in the case of the latter, an intentional injury to the driver can result in the unintentional injury of a bystander. Previous research has examined several risk factors of both these activities, but further exploration remains. This research aims to approach these activities through the lens of hermeneutic phenomenology to mold the research questions and methods to greater explore how the world experiences or lifeworlds of individuals involved in pursuits and motor vehicle suicides may impact the decisions made leading to and during the event. Methods: Each of the three studies in this research addresses potential risk factors or influence on the phenomena of pursuits or motor vehicle crashes as a method of suicide through different methods. Semi-structured interviews with law enforcement officers (n=9), public defenders(n=9), and individuals who had fled from the police (n=20) were analyzed with a previously utilized framework to incorporate hermeneutical phenomenological analysis to identify essential themes of influences that influenced decision-making prior to and during a pursuit. A survey on perceived restrictiveness of pursuit policy was sent to the law enforcement agencies across Minnesota to be used in concert with data from the Uniform Crime Report (UCR) from the Minnesota Bureau of Criminal Apprehension (BCA) to understand further the relationship between perceived restrictions of a policy and the number of reported pursuits by the agency. Collected policy data for State Patrol was utilized with their incident level data to understand further the association between increased policy restrictions and the outcome of pursuits. The final study of this research utilized data from the National Violent Death Reporting System (NVDRS) to analyze the prevalence of different demographics and psychosocial circumstances that may differ within suicides utilizing motor vehicle crashes as compared to another method. Results: Findings from the interviews with officers found how policy and personal experience drive officers' decision-making when deciding to pursue and actions during the pursuit. Likewise, interviews with public defenders and offenders showed prior experience with law enforcement and their current legal situation drive the decision to flee officers, and the desired outcome of pursuits influences the decisions during the pursuit. Within pursuit policy, only policies perceived to discourage pursuits outright resulted in an impact on reported pursuits. State Patrol's policy update remained the same proportion of pursuits ending in non-initiation or law enforcement disengagement.Criminal/legal problems along with a history of suicidal attempts or thoughts and disclosure of suicidal intent were all circumstances that had a higher prevalence in motor vehicle crashes than in non-motor vehicle crash methods. History of mental health disorders, substance use/alcohol abuse, physical health problems, family/friend death, and job/financial problems all were more prevalent in non-motor vehicle crash suicides compared to motor vehicle crash suicides. Conclusion: Each study of this research showed how addressing traffic safety and injury prevention topics through the lens of phenomenology and lifeworlds can provide a new way to address research questions and the context of findings. While not mutually exclusive to phenomenology, this way of thinking may help guide future research questions to bring a more integrated approach to understanding risk factors and injuries.
  • Thumbnail Image
    Item
    A Study of Work-Related Injuries among Older Medicare Enrollees
    (2023-06) McFalls, Matthew
    Background: Older adults in the US are more often working past the age of 65, typically for financial reasons that prevent retirement. Many older adults still work full-time or physically demanding jobs that could compromise their health and safety. Detecting work-related injuries is challenging in this population, as injuries are less often covered by workers' compensation, a frequent source of surveillance data. This also has implications for the healthcare costs of older workers for whom workers' compensation coverage is inadequate or unavailable. Objective: The overall objective of this research is to further understand the burden of work-related injuries and healthcare costs to older adults, particularly those enrolled in Medicare, as well as understand how retirement barriers contribute to their risk of work-related injuries. Results may help to inform occupational injury research and surveillance methods, further understand the shifting healthcare costs of work-related injuries, and inform work practices to promote safety during the retirement transition. Manuscript 1: Aim: Measure the incidence and characterize the burden of work-related medically treated injuries in the 65 and older Medicare population. Methods: Identifying work-related injuries from 2016-2019 Medicare inpatient and outpatient claims data using payer-related and work-related ICD-10-CM codes to estimate the annual incidence of work-related injuries, describing demographic, injury, and healthcare encounter characteristics. Results: Estimated an average annual incidence of 27.6 work-related injury claims per 100,000 Medicare fee-for-service enrollees aged 65 and older. Overall 19% of injuries were hospitalized, and 72% of outpatient visits were in the emergency department. Falls, transportation, and machinery-related causes each accounted for approximately 20% of injuries, the next most common cause was being struck by/against an object (5%), followed by other causes (17%), or missing causes (18%). Manuscript 2: Aim: Estimate the impact of workers' compensation coverage on out-of-pocket healthcare costs following a work-related injury. Methods: Case-only study of work-related injuries from inpatient and outpatient Medicare claims, from 2016-2019. Followed up on work-related injuries to examine 90-day inpatient, outpatient, and skilled nursing facility costs incurred by enrollees. Used difference-in-differences, time series regression, and quantile regression to explore differences in claim costs and Medicare enrollee coinsurance/deductibles, based on workers' compensation (WC) coverage. Results: Of 13039 aged Medicare enrollees with a work-related injury, 16% had evidence of workers' compensation coverage from Medicare claims. The WC group averaged $452 (95% CI 395, 509) in excess out-of-pocket healthcare costs for inpatient, outpatient, and skilled nursing care following a work-related injury, compared to these costs in the 90 days before the injury. For those without WC coverage, these costs averaged $603 (95% CI 572, 634). At the 90th percentile of out-of-pocket spending, those without workers' compensation coverage incurred $601 in additional costs over the WC group (95% CI 398, 805). Manuscript 3: Aim: Estimate the longitudinal effect of job lock on the occupational injury incidence rate among older workers. Methods: Using 2010-2020 data from the Health and Retirement Study, identified two age-based cohorts of workers – those aged 55-64 and age 65 and older. Used repeated measures negative binomial regression models to estimate the longitudinal effect of job lock on occupational injuries. Explored effect modification of work status and self-employment on the effect of job lock. Results: Job lock increased the incidence rate of occupational injuries in the age 55-64 cohort (IRR 1.59, 95% CI 1.25-2.03), but not in the age 65 and older cohort (IRR 0.87, 95% CI 0.54-1.39). For the age 55-64 cohort, job lock did not have an effect on injuries for those who responded as self-employed or "partly-retired", but these effects were present in full-time (IRR 1.69, 95% CI 1.28-2.25) and part-time workers (IRR 1.89, 95% CI 1.06-3.37), as well as workers who were not self-employed (IRR 1.68, 95% CI 1.29-2.19). Conclusion: Work-related injuries appear to impact the health of older Medicare enrollees, and Medicare claims data can be a useful data source to study occupational injuries in this population, including healthcare costs. When available, workers' compensation seems to protect Medicare enrollees from incurring some out-of-pocket costs, but this coverage is not common. Since many older adults continue working for financial reasons, this raises concern that these healthcare costs may be financially detrimental to workers. Prior to age 65, job lock appears to effect occupational injury risk and can be a useful measure of retirement barriers if stratified on other aspects of the work arrangement. Taken together, the findings of this study provide further points to build on to understand the burden and costs of occupational injuries to older adults in the US, as well as areas of further study to improve both their workforce and retirement outcomes.