Balmes J, Rempel D, Alexander M, Reiter R, Harrison R, Bernard B, Benner D, Cone J
Center for Occupational and Environmental Health, University of California, San Francisco.
Am J Ind Med. 1992;21(3):341-51. doi: 10.1002/ajim.4700210307.
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.
为评估利用医院记录进行职业病监测的可行性，并评价这些记录中行业/职业（I/O）信息的质量，我们查阅了一家大型健康维护组织1985年期间所有出院诊断的计算机文件。计算了先前列为哨兵健康事件（职业性）或SHE（O）的出院诊断频率，并选择了三种可能的SHE（O）诊断——肺癌、膀胱癌和中毒性肝炎——进行进一步审查。针对每种诊断出院的患者门诊病历，提取了I/O信息，并通过电话采访出院患者以获取终生职业史。将从医院病历中获得的I/O信息的准确性与通过患者访谈获得的准确性，按照标准分类代码上匹配的位数进行比较。对于两种癌症诊断，“通常”类别的职业和行业匹配频率高于“最后”类别，但对于中毒性肝炎，“通常”和“最后”类别相似。为评估每种可能的SHE（O）诊断与工作场所暴露相关的比例，由一位经验丰富的职业医学医师以盲法对通过访谈获得的I/O信息进行评级。肺癌的工作相关性概率评级最高，主要是由于接触石棉。本研究结果表明，医院记录可用于识别可能的SHE（O）；如果有足够的I/O信息，那么可以评估工作相关性。然而，从医院病历中获得的I/O信息准确性相对较低。要从医院记录中高效准确地收集I/O信息，将需要使用一种简单、易于编码的工具，在入院时常规使用。
