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Occupational exposure monitoring data collection, storage, and use among state-based and private workers' compensation insurers.

ABSTRACT: Despite substantial financial and personnel resources being devoted to occupational exposure monitoring (OEM) by employers, workers' compensation insurers, and other organizations, the United States (U.S.) lacks comprehensive occupational exposure databases to use for research and surveillance activities. OEM data are necessary for determining the levels of workers' exposures; compliance with regulations; developing control measures; establishing worker exposure profiles; and improving preventive and responsive exposure surveillance and policy efforts. Workers' compensation insurers as a group may have particular potential for understanding exposures in various industries, especially among small employers. This is the first study to determine how selected state-based and private workers' compensation insurers collect, store, and use OEM data related specifically to air and noise sampling. Of 50 insurers contacted to participate in this study, 28 completed an online survey. All of the responding private and the majority of state-based insurers offered industrial hygiene (IH) services to policyholders and employed 1 to 3 certified industrial hygienists on average. Many, but not all, insurers used standardized forms for data collection, but the data were not commonly stored in centralized databases. Data were most often used to provide recommendations for improvement to policyholders. Although not representative of all insurers, the survey was completed by insurers that cover a substantial number of employers and workers. The 20 participating state-based insurers on average provided 48% of the workers' compensation insurance benefits in their respective states or provinces. These results provide insight into potential next steps for improving the access to and usability of existing data as well as ways researchers can help organizations improve data collection strategies. This effort represents an opportunity for collaboration among insurers, researchers, and others that can help insurers and employers while advancing the exposure assessment field in the U.S.

SUBMITTER: Shockey TM

PROVIDER: S-EPMC8672207 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:Workers' compensation (WC) insurers collect large amounts of industrial hygiene (IH) data in the United States. The data collected is not easily accessible for research or surveillance purposes. Individual WC insurers are using computerized systems to standardize and store the IH data, leaving a gap in standardization among the different WC insurers. This study sought to standardize IH data collection among WC insurers and to determine the feasibility of pooling collected IH data. IH air and noise survey forms were collected from WC insurers. Data fields on the forms were evaluated for importance and a study list of core fields was developed. The core study list was presented to an IH review panel for review before finalization. The final core study list was compared to recommendations published by the American Conference of Governmental Industrial Hygienists (ACGIH) and the American Industrial Hygiene Association (AIHA). Fifty-nine forms from 10 organizations were collected. Industrial hygienists from research organizations, state-based WC insurers, and private WC insurers participated in the data field evaluation and on the review panel. For both air and noise survey forms, more than half the data fields (55% and 54%, respectively) were ranked as "essential." Three of the four fields in the worker and control observations category ranked "essential" were found less than half of the time on both types of survey forms. The study list of core data elements consisted of more than half of the data fields from both the air and noise survey forms. Three additional fields were added based on the comparison to the ACGIH-AIHA recommendations. Data fields essential to standardizing IH data collection were identified and verified. The "essential" data fields will be made available and have the potential to be incorporated into WC insurers electronic IH data management systems. Future research should focus on other IH survey forms, such as those used in ergonomic assessments and specific chemical exposures, and methods to transfer data fields to electronic platforms.

Project description:BackgroundThe extent to which different US private insurers require their enrollees to meet the same coverage criteria before gaining access to treatment is unclear. Our objective was to scrutinize the patient access criteria imposed by US private insurers for a set of rare neuromuscular disease (NMD) disease-modifying therapies (DMTs).MethodsWe examined coverage policies issued by 17 large US private insurers for the following NMD treatments: nusinersen and onasemnogene abeparvovec for spinal muscular atrophy, edaravone for amyotrophic lateral sclerosis, and eteplirsen for Duchenne muscular dystrophy. We reviewed the plans' coverage policies and identified the patient access criteria, including clinical prerequisites, step therapy protocols, and prescriber requirements. We compared the plans' patient access criteria with the therapies' US Food and Drug Administration (FDA)-labeled indications.ResultsThe included insurers issued 65 coverage policies for the included therapies. Plans imposed coverage restrictions beyond the FDA-approved indications in 60 coverage policies; plans did not cover eteplirsen in five policies. No therapy was covered the same way by all insurers. Plans applied clinical criteria beyond the FDA label indication in 56 policies and step therapy protocols in three policies. Plans required that a neurologist prescribe the therapy in 37 policies, 22 of which required the neurologist to have expertise in the particular disease. Plans often required patients to suffer from symptoms of particular severity; e.g. for eteplirsen, plans differed in their 6-min walk test requirements; for edaravone, some plans required that patients had normal respiratory function, while others required only that patients did not require ventilation; for nusinersen and onasemnogene abeparvovec, plans differed in the number of SMN2 gene copies they required patients to have (SMN2 copy number is correlated with disease severity).ConclusionsThe evaluated large US private insurers tended to impose coverage restrictions beyond the FDA label indication for the included set of rare NMD DMTs. Plans rarely applied the same patient access criteria in their coverage policies for the same products. Inconsistent coverage criteria mean that patients with different insurers have variable access to the same therapies across insurers.

Dataset Information

Occupational exposure monitoring data collection, storage, and use among state-based and private workers' compensation insurers.

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