Hospital records as a data source for occupational disease surveillance: A feasibility study

Abstract

To assess the feasibility of using hospital records for occupational disease surveillance and to evaluate the quality of the industry/occupation (I/O) information available in these records, the computer file of all discharge diagnoses from a large health maintenance organization during 1985 was reviewed. The frequencies of discharge diagnoses previously listed as Sentinel Health Events (Occupational), or SHE (O), were calculated and three possible SHE(O) diagnoses--lung cancer, bladder cancer, and toxic hepatitis--were selected for further review. Outpatient charts of patients discharged for each diagnosis were abstracted with regard to I/O information and the discharged patients were interviewed by telephone to obtain a lifetime occupational history. The accuracy of the I/O information obtained from the hospital chart was compared to that obtained by patient interview by number of digits matched on standard classification codes. The frequencies of matches for occupation and industry were greater for "usual" than for "last" categories with both cancer diagnoses, but were similar for "usual" and "last" categories with toxic hepatitis. To assess the proportion of each possible SHE(O) diagnosis that was related to workplace exposures, the I/O information obtained by interview was rated in a blinded fashion by an experienced occupational medicine physician. The highest probability ratings for work-relatedness were noted for lung cancer, primarily due to asbestos exposure. The results of this study suggest that hospital records can be used to identify possible SHE(O); if adequate I/O information is available, then work-relatedness can be assessed. However, the accuracy of I/O obtained from hospital charts is relatively low. The efficient and accurate collection of I/O information from hospital records will require the use of a simple, easily coded instrument to be routinely administered on admission.

Inpatient hospital care for work‐related injuries and illnesses

“…Cases were included in our study group if ''workers' compensation'' was identi-fied on the discharge record as the expected primary payer for the hospital stay. Previous studies [Balmes et al, 1992;Sorock et al, 1993b] have demonstrated that the designation of WC payment on a hospital discharge record is closely correlated with a patient's self-report of occupational causation, and is an excellent indicator of the work relatedness of an injury. Sorock et al [1993b] found that WC payer codes on the discharge record were strongly correlated with patient self-report of occupational causation (Kappa ¼ 0.78; 95% confidence limits of 0.67-0.89).…”

“…A few previous occupational health research investigations have been performed using hospital discharge data. Several researchers have tested the use of state-based hospital discharge records for occupational disease surveillance covering a variety of specific disorders including ocular injuries [Baker et al, 1999], work-related asthma [Henneberger et al, 1999], silicosis [Geidenberger et al, 1998], chemical-related respiratory disease [Reilly and Rosenman, 1995], pneumoconiosis [Liss et al, 1997], occupational cancer [Balmes et al, 1992], and finger amputations [Sorock et al, 1993a]. However, hospital discharge records have not previously been used to compile a comprehensive picture of inpatient care for a cross-section of work-related conditions.…”

Availability and quality of industry and occupation information in the Massachusetts cancer registry

“…In one study of cases in a hospital in Philadelphia, the authors found information about current/most recent occupation for 52% of patients and usual occupation for 49% of patients; current business was available for 40% of patients and usual business for 32% [McDiarmid et al, 1991]. Among cases identi®ed in an HMO in California, at least some information was available for industry or occupation for 80% of the cases [Balmes et al, 1992].…”

“…The authors concluded that information from registry-collected data is suitable for exploratory studies although the concordance was only evaluated on cases where information was available in the CR. Balmes et al [1992] matched information from hospital charts against that obtained by interview, and found that although some information on occupation was available for 80% of charts reviewed, the accuracy of usual industry/ occupation from chart review was relatively low. The authors suggested routine administration of an I/O instrument upon admission.…”

Molecular surveillance of hepatitis and tuberculosis infections in a cohort exposed to methyl isocyanate

“…In the past, hospital-based records were seldom utilized as a data source for monitoring possible occupational health effects [17]. In the current study, we have performed a retrospective analysis of molecular diagnostics records for the surveillance of hepatitis and Mycobacterium tuberculosis (MTB) infections amongst the first and the second generation of survivors of the Bhopal gas tragedy.…”