Park Robert M, Bushnell P Timothy, Bailer A John, Collins James W, Stayner Leslie T
Education and Information Division, National Institute for Occupational Safety and Health, Cincinnati, Ohio 45226, USA.
Am J Ind Med. 2009 Sep;52(9):683-97. doi: 10.1002/ajim.20731.
The rate of lost-time sprains and strains in private nursing homes is over three times the national average, and for back injuries, almost four times the national average. The Ohio Bureau of Workers' Compensation (BWC) has sponsored interventions that were preferentially promoted to nursing homes in 2000-2001, including training, consultation, and grants up to $40,000 for equipment purchases.
This study evaluated the impact of BWC interventions on back injury claim rates using BWC data on claims, interventions, and employer payroll for all Ohio nursing homes during 1995-2004 using Poisson regression. A subset of nursing homes was analyzed with more detailed data that allowed estimation of the impact of staffing levels and resident acuity on claim rates. Costs of interventions were compared to the associated savings in claim costs.
A $500 equipment purchase per nursing home worker was associated with a 21% reduction in back injury rate. Assuming an equipment life of 10 years, this translates to an estimated $768 reduction in claim costs per worker, a present value of $495 with a 5% discount rate applied. Results for training courses were equivocal. Only those receiving below-median hours had a significant 19% reduction in claim rates. Injury rates did not generally decline with consultation independent of equipment purchases, although possible confounding, misclassification, and bias due to non-random management participation clouds interpretation. In nursing homes with available data, resident acuity was modestly associated with back injury risk, and the injury rate increased with resident-to-staff ratio (acting through three terms: RR = 1.50 for each additional resident per staff member; for the ratio alone, RR = 1.32, 95% CI = 1.18-1.48). In these NHs, an expenditure of $908 per resident care worker (equivalent to $500 per employee in the other model) was also associated with a 21% reduction in injury rate. However, with a resident-to-staff ratio greater than 2.0, the same expenditure was associated with a $1,643 reduction in back claim costs over 10 years per employee, a present value of $1,062 with 5% discount rate.
Expenditures for ergonomic equipment in nursing homes by the Ohio BWC were associated with fewer worker injuries and reductions in claim costs that were similar in magnitude to expenditures. Un-estimated benefits and costs also need to be considered in assessing full health and financial impacts.
私立养老院中因扭伤和拉伤导致误工的发生率超过全国平均水平三倍以上，背部受伤发生率几乎是全国平均水平的四倍。俄亥俄州工人赔偿局（BWC）在2000 - 2001年资助了一些干预措施，并优先向养老院推广，包括培训、咨询以及高达4万美元的设备购置补助金。
本研究利用1995 - 2004年俄亥俄州所有养老院的工人赔偿局关于索赔、干预措施和雇主工资单的数据，通过泊松回归评估BWC干预措施对背部受伤索赔率的影响。对一部分养老院进行了分析，这些养老院有更详细的数据，可用于估计人员配备水平和居民护理难度对索赔率的影响。将干预措施的成本与索赔成本的相关节省进行了比较。
每家养老院工人花费500美元购置设备，可使背部受伤率降低21%。假设设备使用寿命为10年，这意味着每名工人的索赔成本估计降低768美元，按5%的贴现率计算，现值为495美元。培训课程的效果不明确。只有那些接受培训时长低于中位数的人，索赔率才有显著的19%的降低。独立于设备购置之外，咨询服务一般不会使受伤率下降，尽管由于非随机的管理参与可能存在混杂、错误分类和偏差，影响了结果的解读。在有可用数据的养老院中，居民护理难度与背部受伤风险有一定关联，并且受伤率随居民与工作人员的比例增加而上升（通过三个因素起作用：每名工作人员每增加一名居民，相对风险RR = 1.50；仅就比例而言，RR = 1.32，95%置信区间 = 1.18 - 1.48）。在这些养老院中，每名居民护理工人支出908美元（相当于另一种模式中每名员工500美元），也可使受伤率降低21%。然而，当居民与工作人员的比例大于2.0时，相同支出与每名员工10年的背部索赔成本降低1643美元相关，按5%的贴现率计算，现值为1062美元。
俄亥俄州工人赔偿局为养老院购置人体工程学设备的支出，与工人受伤减少以及索赔成本降低相关，索赔成本降低幅度与支出幅度相近。在评估全面的健康和财务影响时，还需要考虑未估计的收益和成本。
