Browsing by Subject "occupational injury"

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    Caring for our Caregivers: an Evaluation of the Minnesota Safe Patient Handling Act
    (2020-05) Rosebush, Christina
    Background Minnesota is one of 12 states to pass safe patient handling legislation aimed at reducing high rates of musculoskeletal disorders (MSDs) in health care workers.1 MSD rates are 2- and 3- times higher in U.S. hospitals and nursing homes, respectively, compared to the private sector average.2 Further, MSDs comprise almost half of all reportable injuries in these settings.2 State safe patient handling (SPH) laws generally require health care facilities to implement multicomponent safe patient handling programs. Studies of multicomponent programs in large health care systems show substantial reductions in reportable injuries and workers’ compensation claims, but few evaluations of statewide mandates have been conducted. The 2007 Minnesota Safe Patient Handling (MN SPH) Act requires each health care facility to obtain adequate assistive lifting equipment and create a written safe patient handling plan and committee. The effectiveness of the law in nursing homes is of particular interest due to the frequency of patient handling tasks, challenging physical environment, and unique workforce comprised largely of certified nursing assistants (CNAs). To evaluate the MN SPH Act and better protect Minnesota nursing home workers, studies are needed to characterize patient handling injuries by occupation, assess temporal trends in injuries following enactment of the MN SPH Act, and compare Minnesota’s experience to states without SPH legislation. Objective The overall objectives of this research are to provide a profile of patient handling injuries in Minnesota nursing home workers and to evaluate the effectiveness of the MN SPH Act in reducing workers’ compensation claims. Results will be used to inform future safe patient handling policymaking and to identify groups of Minnesota workers and types of facilities in need of additional state outreach and support. Manuscript 1: Aim: Compare workers’ compensation indemnity claim rates and severity among occupational groups in Minnesota nursing homes. Methods: Negative binomial and linear regression models with generalized estimating equations were used with 2005-2016 data from the statewide workers’ compensation database to model the effect of occupation on type of workers’ compensation indemnity claim. Minnesota Nursing Home Report Card data were used to calculate claim rates by occupation. Results: Claim rates were 3.68, 1.38, and 0.69 per 100 full-time equivalent workers in CNAs, licensed practical nurses (LPNs), and registered nurses (RNs), respectively. CNAs were more likely to experience musculoskeletal and patient handling injuries than RNs. However, their claims were less likely to result in temporary total disability or permanent partial disability benefits and more likely to result in stipulation settlements. Manuscript 2: Aim: Compare pre- and post-MN SPH Act trends in patient handling injury claim rates among Minnesota nursing homes and assess whether temporal trends are modified by facility-level staffing and retention. Methods: Negative binomial regression models with generalized estimating equations were used with 2005-2016 statewide workers’ compensation data matched to Centers for Medicare and Medicaid Services data to evaluate the impacts of time, staffing, and retention on patient handling injuries. Results: Compared to 3 pre-law years, the patient handling indemnity claim rate declined by 38% in years 7-9 following enactment of the MN SPH Act. Claims for all other injuries and illnesses declined by 20%. The association between time and patient handling claims was not modified by staffing or retention. However, across time, nursing homes with annual staff retention ≥75% (vs. <65%) had a 17% lower patient handling injury claim rate. Manuscript 3: Aim: Compare injury trends in Minnesota nursing homes, hospitals, and outpatient facilities to Wisconsin, a state without safe patient handling legislation. Methods: Mixed effects negative binomial regression models were used with 2005-2017 workers’ compensation data from a single large insurer. The effects of the MN SPH Act were evaluated by assessing the interaction between state and time period on workers’ compensation claim outcomes. Results: In both Minnesota and Wisconsin, patient handling injuries comprised the largest proportion of claims in nursing homes (54% and 45%, respectively) and smallest proportion in outpatient facilities (6% for both states). The change in mean annual facility-level patient handling claims from pre-law (2005-2007) to second post-implementation (2014-2017) did not differ between states. Further, changes in patient handling claims over time did not differ by healthcare setting. Conclusion Temporal trends in workers’ compensation indemnity claims suggest that the MN SPH Act may have successfully reduced patient handling injuries in Minnesota nursing homes. However, among health care facilities enrolled with a single large insurer, the change in indemnity and medical only workers’ compensation claims from pre-law to post-implementation did not differ between Minnesota and Wisconsin, a state without SPH legislation. Due to data limitations, including a small Wisconsin sample size, more research comparing Minnesota to states without legislation is needed. In Minnesota, state support of the law should target nursing homes with elevated claim rates, including those that have low staff retention, are non-profit, not affiliated with a hospital, or outside the Twin Cities metropolitan area. Further, additional support is needed to prevent and accommodate patient handling injuries among nursing home CNAs, an occupation with high patient handling and MSD injury rates and adverse workers’ compensation claim outcomes.
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    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.