Differential effectiveness of the Minnesota Safe Patient Handling Act by health care setting: An exploratory study

BACKGROUND

The Minnesota Safe Patient Handling (MN SPH) Act requires health care facilities to implement comprehensive programs to protect their workers from musculoskeletal injuries caused by lifting and transferring patients. Nursing homes, hospitals, and outpatient facilities each face unique challenges implementing and maintaining SPH programs. The objective of the study was to compare patient handling injuries in these three health care settings and determine whether change in injury rate over time differed by setting following enactment of the law.

METHODS

Workers' compensation data from a Minnesota-based insurer were used to describe worker and claim characteristics in nursing homes, hospitals, and outpatient facilities. Negative binomial models were used to compare claims and estimate mean annual patient handling claim rates by health care setting and time period following enactment of the law.

RESULTS

Consistent with national data, the patient handling claim rate was highest in Minnesota nursing homes (168 claims/$100 million payroll [95% confidence interval: 163-174]) followed by hospitals (35/$100 million payroll [34-37]) and outpatient facilities (2/$100 million payroll [1.8-2.2]). Patient handling claims declined by 38% over 10 years following enactment of the law (vs. 27% for all other claims). The change in claims over time did not differ by health care setting.

CONCLUSIONS

In this single-insurer sample, declines in workers' compensation claims for patient handling injuries were consistent across health care settings following enactment of a state SPH law. Though nursing homes experienced elevated claim rates overall, results suggest they are not lagging hospitals and outpatient facilities in reducing patient handling injuries.

Evaluation of the Minnesota Safe Patient Handling Act: trends in workers' compensation indemnity claims in nursing home workers before and after enactment of the law

OBJECTIVES

The 2007 Minnesota Safe Patient Handling Act aims to protect healthcare workers from injuries caused by lifting and transferring patients. The effectiveness of the law in nursing homes is unknown. This policy evaluation measured changes in patient handling injuries before and after the law was enacted. Additionally, it assessed whether effects of the law were modified by facility levels of staffing and retention.

METHODS

Workers' compensation indemnity claims for years 2005-2016 were matched to annual direct care productive hours and facility characteristics (eg, profit status, hospital affiliation and region) for all Medicaid-certified nursing homes in Minnesota. Trends in patient handling claims were analysed using negative binomial regression with generalised estimating equations. The primary predictors were time period, staff hours per resident day and staff retention.

RESULTS

The patient handling indemnity claim rate declined by 25% in years 4-6 and 38% in years 7-9 following enactment of the law. Claims for all other injuries and illnesses declined by 20% in years 7-9 only. Associations between time period and patient handling claims did not vary by levels of staffing or retention. However, independent of time, facilities with annual retention ≥75% (vs <65%) had a 17% lower patient handling claim rate.

CONCLUSIONS

Results suggest the law reduced patient handling claims in nursing homes. However, claim rates were elevated in facilities with low worker retention and those that were non-profit, not hospital-affiliated or in a non-metro area. Facilities with these characteristics may benefit from targeted state grants and consultation efforts.

Occupational differences in workers' compensation indemnity claims among direct care workers in Minnesota nursing homes, 2005-2016

BACKGROUND

Nursing assistants have one of the highest injury rates in the U.S., but few population-based studies assess differential injury risk by occupation in nursing homes. This statewide study assessed differences in musculoskeletal disorders (MSDs) and patient handling injuries among direct care workers in Minnesota nursing homes.

METHODS

Indemnity claims from the Minnesota workers' compensation database were matched to time at risk from the Minnesota Nursing Home Report Card to estimate 2005 to 2016 injury and illness claim rates for certified nursing assistants (CNAs), licensed practical nurses (LPNs), and registered nurses (RNs). Associations between occupation and claim characteristics were assessed using multivariable regression modeling.

RESULTS

Indemnity claim rates were 3.68, 1.38, and 0.69 per 100 full-time equivalent workers for CNAs, LPNs, and RNs, respectively. Patient handling injuries comprised 62% of claims. Compared to RNs, CNAs had higher odds of an indemnity claim resulting from an MSD (odds ratio [OR] = 1.67; 95% confidence interval [CI], 1.31-2.14) or patient handling injury (OR = 1.89; 95% CI, 1.47-2.45) as opposed to another type of injury or illness. CNAs had lower odds of receiving temporary and permanent partial disability benefits and higher odds of receiving a stipulation settlement.

CONCLUSIONS

CNAs in Minnesota nursing homes are at heightened risk for lost time MSDs and patient handling injuries. Claims filed by CNAs are more frequently settled outside the regular workers' compensation benefit structure, an indication that the workers' compensation system is not providing adequate and timely benefits to these workers.

The need for data harmonization--a response to Boden and Ozonoff

Boden and Ozonoff's undercount estimates in their recent Commentary rely on three assumptions for which no quantitative literature references are provided. Alternatively, we show that findings in both studies and published data indicate lower upper-bound estimates for the undercount range. Am. J. Ind. Med. 53:854-855, 2010. (c) 2010 Wiley-Liss, Inc.

The law and incomplete database information as confounders in epidemiologic research on occupational injuries and illnesses

BACKGROUND

Capture-recapture studies report undercounting of work injuries/illnesses with days away from work (DAFW) in the Bureau of Labor Statistics annual Survey of Occupational Injuries and Illnesses (BLS SOII) by 25-68% depending on the state and undercounting by various state workers' compensation (WC) systems of eligible claims by 5-35%.

METHODS

Statutory/regulatory criteria defining eligible cases are used to adjust counts in the 1998-2001 Minnesota's WC system and the BLS SOII to permit comparison and to evaluate the recent studies. Missing information in the employer database used in the capture-recapture studies is tabulated. An attempt is made to harmonize results with two additional databases counting work injuries.

RESULTS

Counts in the BLS SOII moderately undercount by 10-16% the number of WC cases. We believe that matching in capture-recapture studies is adversely affected by misperceptions regarding the application of statutory/regulatory eligibility criteria and by missing data. The result is that the reported undercounts in both the BLS SOII and several state WC databases are overstated in the capture-recapture studies. Although three of four databases can be approximately harmonized, the fourth cannot.

CONCLUSIONS

More precisely targeted information is needed before decisions regarding redesign of the BLS survey are made or before legislative or administrative changes in the WC are contemplated.

Methodologic issues in the use of workers' compensation databases for the study of work injuries with days away from work. I. Sensitivity of case ascertainment

BACKGROUND

Case ascertainment costs vary substantially between primary and secondary data sources. This review summarizes information on the sensitivity of state administrative databases in workers' compensation systems for the ascertainment of days-away-from-work (DAFW) work injuries for use in modeling studies.

METHODS

Review of the literature supplemented by data from governmental or organizational reports or produced for this report.

RESULTS

Employers currently appear to provide workers' compensation insurance coverage for 98.9% of wage and salary workers. Wage and salary jobs account for approximately 90% of jobs in the United States. In industries such as manufacturing, the fraction of covered jobs is probably closer to 98%. In Minnesota, the number of DAFW cases ascertained by the Bureau of Labor Statistics' annual survey of occupational injuries and illnesses is approximately 92-97% concordant with the number of wage compensation claims for injuries producing DAFW over the period 1992-2000, once adjustments are made to permit direct comparisons of the numbers. The workers' compensation databases provide information for more than 95% of the total DAFW resulting from work injuries. Covariate estimates are unaffected by this less than 5% loss because effects appear dependent on time from injury.

CONCLUSIONS

Statewide workers' compensation administrative databases can have substantial utility for epidemiologic study of work injuries with DAFW because of their size, using high sensitivity for case ascertainment as the evaluative criterion.

Why does workers' compensation pay more for health care?

An analysis shows that health care providers charged substantially larger amounts for treatment of workers' compensation cases than for the treatment of similar patients insured by Blue Cross.

The cost of work-related physical assaults in Minnesota

OBJECTIVE

To describe the long-term productivity costs of occupational assaults.

DATA SOURCES/STUDY SETTING

All incidents of physical assaults that resulted in indemnity payments, identified from the Minnesota Department of Labor and Industry (DLI) Workers' Compensation system in 1992. Medical expenditures were obtained from insurers, and data on lost wages, legal fees, and permanency ratings were collected from DLI records. Insurance administrative expenses were estimated. Lost fringe benefits and household production losses were imputed.

STUDY DESIGN

The human capital approach was used to describe the long-term costs of occupational assaults. Economic software was used to apply a modified version of Rice, MacKenzie, and Associates' (1989) model for estimating the present value of past losses from 1992 through 1995 for all cases, and the future losses for cases open in 1996.

PRINCIPAL FINDINGS

The total costs for 344 nonfatal work-related assaults were estimated at $5,885,448 (1996 dollars). Calculation of injury incidence and average costs per case and per employee identified populations with an elevated risk of assault. An analysis by industry revealed an elevated risk for workers employed in justice and safety (incidence: 198/100,000; $19,251 per case; $38 per employee), social service (incidence: 127/100,000; $24,210 per case; $31 per employee), and health care (incidence: 76/100,000; $13,197 per case; $10 per employee).

CONCLUSIONS

Identified subgroups warrant attention for risk factor identification and prevention efforts. Cost estimates can serve as the basis for business calculations on the potential value of risk management interventions.

Work-related physical assault

Violence in the workplace is a serious public health problem. Yet, to date, little has been documented relevant to non-fatal events associated with physical assault. The aim of the present study was to identify the magnitude of work-related physical assault in Minnesota and to identify potential risk factors; both fatal and non-fatal cases were included. Minnesota workers' compensation records, relevant to assault, were used to identify 712 cases involving more than three days of lost work time for 1992; six homicide cases were included. Assault rates were calculated by industry and occupation. Women had an assault rate twice that of men (51 versus 26 per 100,000 workers). Workers in industries of social services (340), health services (202), and transportation (914) had the highest rates of assault per 100,000 full-time employees. The fact that in addition to overall workers' compensation costs of $1.6 million, the average lost time for closed compensated cases was 54 days (median, 14 days) and time to reach maximum medical improvement for 44% of the cases reporting was 156 days (median, 83 days), indicates a major problem. The findings suggest that specific groups of workers are at risk for physical assault on the job. Further research is essential to identify specific risk factors that will enable the development of appropriate prevention strategies.

Oral interaction in cooperative learning groups: speaking, listening, and the nature of statements made by high-, medium-, and low-achieving students

Oral interaction within cooperative learning groups was observed for high-, medium-, and low-achieving students. Initially, cooperative and individualistic learning situations were compared on achievement and attitudes. Forty-eight 4th-grade American students were assigned to learning situations on a stratified random basis controlling for ability and sex. They participated in the study for 55 min a day for 15 instructional days. Two observation schemes were used. The results for the cooperative situation were factor analyzed to determine the basic dimensions of oral interaction within cooperative learning groups. Five orthogonal factors were identified: Exchanging Task-Related Information, Elaborating on the Information, Encouraging Each Other to Learn, Disagreeing With Each Other's Conclusions, and Making Nontask Comments and Sharing Personal Feelings. The oral participation of students from different achievement levels was differentially related to achievement. Vocalizing was found to be more strongly related to achievement than was listening to other group members vocalize. Medium and low achievers especially benefited from cooperative learning experiences.

Integrating severely adaptive handicapped seventh-grade students into constructive relationships with nonhandicapped peers in science class

The effects of cooperative and individualistic learning experiences were compared on interactions and relationships between severely adaptive handicapped (not adapting to regular classroom demands) and nonhandicapped seventh-grade students in science classes. We investigated the predictions that (a) requiring cooperation between the two groups of students would result in increased rejection of the severely adaptive handicapped students and (b) cooperation would promote increased interpersonal attraction regardless of the heterogeneity of the students. Forty-eight suburban junior-high-school, seventh-grade students (41 nonhandicapped, 9 severely adaptive handicapped) were assigned to conditions on a stratified random basis controlling for handicap, sex, and ability level. They participated in the study for 10 days, 55 minutes per day. Results indicated that cooperative learning procedures, compared with individualistic ones, promoted more interaction and interpersonal attraction between severely adaptive handicapped and nonhandicapped students.