Evaluating State-Based Occupational Health Surveillance As a System Using a Unique Framework

BACKGROUND:  State-based occupational safety and health (OSH) surveillance programs conduct wide-ranging surveillance activities to track the incidence of occupational injuries and illnesses, identify trends, understand risk factors, recognize emerging problems, and develop recommendations for prevention and interventions to protect workers. States rely on several sources of surveillance data for generating occupational health indicators and other surveillance activities, and therefore, it is essential for states to evaluate the data systems they use. The Nebraska Occupational Health Surveillance (NEOHS) Program aimed to evaluate and compare the key attributes of important surveillance data sources to determine their usefulness, strengths, and limitations for OSH surveillance in Nebraska.

METHODS: NEOHS used CDC-developed and state-based guidelines for evaluating public health surveillance systems to design a brief, descriptive process evaluation. We also adapted an attribute scoring system developed by the Oregon Asthma Program. NEOHS described surveillance activities as a system and evaluated four important data sources: Survey of Occupational Injuries and Illnesses (SOII), Census of Fatal Occupational Injuries (CFOI), Workers’ Compensation (WC) Claims, and Hospital Discharge Database (HDD). Information to describe and evaluate each data source was retrieved from published reports and documents and through correspondence with data users, owners, and managers. Key attributes (acceptability, data quality, flexibility, representativeness, simplicity, timeliness and usefulness) were selected to evaluate and compare the four data sources. System-level attributes for each data source were scored from one (very low) to five (very high), and then an overall average score was calculated for each data source.

RESULTS:  Of the four data sources evaluated, CFOI had the highest overall average score (3.7) attributed to its high acceptability, data quality, representativeness, flexibility to changing data and technology needs, and usefulness. With timeliness as its biggest strength, WC claims showed high potential for OSH surveillance, though currently it is underutilized in Nebraska. HDD had the lowest overall average score (2.6), mainly due to lack of representativeness, simplicity to operate, and limited usability for OSH surveillance.

CONCLUSIONS: Evaluation of OSH surveillance in Nebraska improved our understanding of how surveillance activities function as a system. The evaluation allowed us to examine multiple data sources and compare their system-level attributes to identify strengths and weaknesses, which are vital when using these data to guide interventions efforts. We identified the need to improve data systems such as HDD and WC claims and their utilization to enhance Nebraska’s capacity for OSH surveillance.