Barker S, Ehrlich R, Spiegel J M, Kistnasamy B, Riera F, Fourie A, Mtshali N, Rabada M, Lockhart K, Yassi A
School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada.
School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.
Int Arch Occup Environ Health. 2022 May;95(4):825-833. doi: 10.1007/s00420-021-01805-9. Epub 2022 Jan 9.
The large burden of silicosis and tuberculosis (TB) in the South African mining industry, coupled with an under-resourcing of the compensation agencies responsible for certifying occupational lung disease, have resulted in serious backlogs. This work aimed to measure the efficiency gains from triaging occupational lung disease claims using claim type, years of mining exposure and computer aided detection (CAD) to save on scarce medical adjudicators.
During 2020, the compensation authority started to triage claims for TB and those of miners with < 10 years of service to two-person panels instead of the four-person panel plus radiologist used previously. Efficiency gain was calculated in medical person-units saved and reduction in delays. Different service thresholds predictive of silicosis were simulated, as well as the impact of pre-classification of chest X-rays with CAD using different combinations of sensitivity and specificity.
The new triage system saved 20.3% in person-time units and reduced delays by 10-20 days. Without CAD the greatest efficiency gain (28%) was projected from dispensing with a mining service threshold and routing all non-TB claims to the small panels at the outset. Simulation of four different CAD sensitivity/specificity combinations yielded efficiency gains of 18.2-36.1%, with 31.1% judged the most realistic. Use of sensitivity of close to 100% would not be feasible because of the very low resulting specificity.
Pre-adjudication triage of claims at the compensation agency is capable of saving a substantial proportion of adjudicator time and reducing certification delays. Additional efficiency gains are achievable by referring all claims to small panels to begin with and improvement of CAD performance for this ex-miner population.
南非采矿业中矽肺病和结核病（TB）负担沉重，加上负责认证职业性肺病的赔偿机构资源不足，导致了严重的积压。这项工作旨在通过使用索赔类型、采矿接触年限和计算机辅助检测（CAD）对职业性肺病索赔进行分流，以节省稀缺的医学裁决人员，从而衡量效率提升情况。
2020年期间，赔偿当局开始将结核病索赔以及服务年限不足10年的矿工索赔分流到由两人组成的小组，而不是像以前那样由四人小组加放射科医生处理。通过节省的医学人员单位数量和减少的延误时间来计算效率提升情况。模拟了预测矽肺病的不同服务阈值，以及使用不同灵敏度和特异度组合的CAD对胸部X光进行预分类的影响。
新的分流系统节省了20.3%的人工时单位，并将延误时间减少了10 - 20天。在没有CAD的情况下，预计通过取消采矿服务阈值并一开始就将所有非结核病索赔转至小组成员处理，可实现最大效率提升（28%）。对四种不同的CAD灵敏度/特异度组合进行模拟，效率提升幅度为18.2% - 36.1%，其中31.1%被认为是最现实的。由于特异度极低，使用接近100%的灵敏度是不可行的。
赔偿机构在裁决前对索赔进行分流能够节省大量裁决人员时间并减少认证延误。通过一开始就将所有索赔转至小组成员处理以及改善针对这些前矿工群体的CAD性能，可实现额外的效率提升。
