Evaluation of direct workers' compensation costs for musculoskeletal injuries surrounding interventions to reduce patient lifting.

OBJECTIVES: We evaluated costs for workers' compensation (WC) injuries of a musculoskeletal (MS) nature in a large tertiary care hospital and an affiliated community hospital in the 13 years surrounding an institution-wide shift to a 'minimal manual patient-lifting environment' supported with inpatient mechanical lift equipment. METHODS: Negative binomial regression was used to model adjusted and discounted payment rates based on full-time equivalents (FTEs), and payment ratios. The risk of higher cost was assessed based on type of injury (patient-handling vs non-patient-handling), hospital, job, age, gender, institutional tenure and time since the implementation of lift equipment. Lagging was used to evaluate the latency of the intervention effect. RESULTS: Patient-handling injuries (n=1543) were responsible for 72% of MS injuries and 53% of compensation costs among patient care staff. Mean costs per claim were 5 times higher for those over age 45 than those <25 years of age. Physical and occupational therapy aides had the highest cost rates ($578/FTE) followed by nursing aides ($347/FTE) and patient transporters ($185/FTE). There was an immediate, marked decline in mean costs per claim and costs per FTE following the policy change and delivery of lift equipment. CONCLUSIONS: The observed patterns of changes in cost likely reflect the effects of activities other than use of lift equipment, including targeted efforts to close WC claims and an almost simultaneous policy that shifted cost responsibility to the budgets of managers on individual units. Inference was facilitated through the use of longitudinal data on the workgroups and an internal injury comparison.

Musculoskeletal symptoms among poultry processing workers and a community comparison group: Black women in low-wage jobs in the rural South.

BACKGROUND: Poultry processing is characterized by rapid line speed and extreme division of labor. Morbidity associated with this work has been reported by scientists, journalists and workers in this fast growing industry. METHODS: Cross-sectional data from baseline measures of a cohort of black women employed in poultry processing (n = 291) and a community comparison group (n = 299) in rural North Carolina were used to evaluate musculoskeletal symptom reports and to explore factors associated with those reports. Recruitment of participants and collection of data were performed by women in the community circumventing the need to involve employers. RESULTS: Significant differences in musculoskeletal symptom prevalence were observed between women employed in poultry processing and those of similar economic status employed elsewhere in the same area of rural northeastern North Carolina. After adjusting for other factors independently associated with symptoms among these women including age, depression, and perceived isometric load at work, the prevalence of upper extremity and neck symptoms was 2.4 (95% CI 1.7, 3.2) times higher among women working in poultry processing. CONCLUSIONS: The findings add to the documentation of occupational health concerns among vulnerable workers employed in poultry processing in our state; in this economically depressed area of rural northeastern North Carolina poultry processing is the largest single employer of women. On a larger scale, the potential magnitude of upper extremity morbidity among women employed in poultry processing should be viewed with the knowledge that poultry processing is a growing industry in the U.S. with work done largely by blacks and immigrants.