Building the capacity of Community Health Centers to collect occupational health data

1. Building the capacity of Community Health Centers to collect occupational health data Letitia Davis, ScD, EdM Occupational Health Surveillance Program Bureau of Health Information, Statistics, Research and Evaluation Massachusetts Department of Public Health Kerry Souza, ScD, MPH Division of Surveillance, Hazard Evaluations, and Field Studies National Institute for Occupational Safety and Health

2. Today’s presentation • Describe why we partnered with community health centers (CHCs) • Describe project to institutionalize collection of occupational health data at CHCs • Discuss lessons learned from 2 CHC projects and next steps

3. What are Community Health Centers? • Providers of health care and other services • located in neighborhood settings • focus on culturally appropriate services to underserved populations • >50 CHCs in Massachusetts -- serve 50% of “medically underserved” people in state • We sought to determine if CHCs could be partners in addressing occupational health of immigrant and minority communities

4. CHC Project # 1 Survey of working CHC patients • Surveyed ~1400 working CHC patients about jobs, occupational health experience and awareness of key OSH resources • Survey administered in waiting rooms at 5 CHCs, in 6 languages • Results • Many CHC patients work, face significant workplace hazards, yet are unaware of key OSH resources • CHCs lack knowledge, skill to address OSH concerns of patients

5. Awareness of OSHA was lowest among foreign born workers aware of OSHA Place of Birth Source: Occupational Health and CHC Patients, MDPH, 2007

6. CHC Project # 2 Building CHCs’ capacity to track occupational health • Pilot the tracking of occupational injuries/illnesses at 4 CHCs • Institutionalize capacity to track patient occupational injuries and illnesses • Enable collection of patient occupation through modification of records systems • Provide occupational health resources to providers and patients • Increase reporting of work-related injuries and illnesses

7. Some early challenges • Should we collect industry and/or occupation? • Occupation • How to ask occupation if patients concerned about work status? • If not working: usual or most recent occupation • Recoding work-relatednessin light of work status • Record possible/suspect work-relatedness

8. Results: CHC Pilot Collection of patients’ occupation is possible.. 3 of 4 CHCs collecting occupation Different CHCs chose to carry out same work in different ways Drop down lists for occupation need to be studied At one CHC, modifications to electronic medical record were technically infeasible CHCs seldom using workers’ compensation Data collection has revealed traumatic work-related injuries treated at CHCs --unexpected Modest increase in case reporting to state

9. Lessons learned Technical issues: Need flexible software to be able to add new fields Leadership: Need commitment from administrative and clinical staff Motivation: Support staff and providers need reasons/motivators to collect/use new fields. i.e., record patient’s occupation Follow-up options: Providers still need to know how to follow up on information collected, where to refer etc. Strategy: May be desirable to fund personnel within the CHC who can gain OH expertise

10. Next steps for CHCs in MA • Spin-off project on workers’ compensation • WC training for clinic staff (social workers) • Feedback to CHC Association on barriers to using workers’ compensation • A more focused OHS project at one CHC network: occupational asthma • Inclusion of occupational fields in the Electronic Health Record (EHR) crucial to collecting data through health care facilities • MA participating in local and national EHR efforts

11. Discussion questions: 1. How can CHCs make use of OSHA to protect workers?2. What is the payoff for clinicians? Barrier and obstacles?3. How can this information be aggregated and used on a national or regional level?

12. How can CHCs make use of OSHA to protect workers? • Patient survey revealed that CHC patients are unaware of OSHA. • Educate patients and their providers • Providers have expressed cautious interest in learning about OSHA and how to help their patients. • Relationships are the key to working with community-based organizations. Working through partners such as COSH groups may be effective.

13. What is the payoff for the clinician? • Improve clinical care/ more accurate diagnoses • Help their patients to access benefits (e.g., wage replacement) • Give providers a role in primary prevention

14. Barriers and obstacles to addressing occupational health with CHCs Barriers: • Medical staff have limited knowledge of occupational health, little training • CHCs do not have information and resources for diagnosis and referral of occupational conditions • Patients may be reluctant to discuss work • Many issues remain surrounding use of workers’ compensation

15. Aggregating data from community sources • Data flow through state programs i.e., existing NIOSH-funded state based surveillance programs • Much data likely to be case-based • Value of data to the CHC must be emphasized

17. Occupations of a Sample of 1400Community Health Center Patients by Race* Source: Occupational Health and CHC Patients, MDPH, 2007

18. Awareness of workers’ compensation varied by place of birth – community health center patients aware of workers’ compensation Place of Birth Source: Occupational Health and CHC Patients, MDPH, 2007

19. From Data to Action - Massachusetts FACE (Fatality Assessment Control and Evaluation) • Investigations of targeted deaths: Hispanic and immigrant worker deaths • Dissemination of alerts in relevant languages • Community task force