Washington State Department of Labor and Industries

Olympia, WA, United States

Washington State Department of Labor and Industries

Olympia, WA, United States
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Franklin G.,University of Washington | Jones C.M.,Centers for Disease Control and Prevention | Mai J.,Washington State Department of Labor and Industries | Banta-Green C.J.,University of Washington | And 2 more authors.
American Journal of Public Health | Year: 2015

An epidemic of morbidity and mortality has swept across the United States related tothe use of prescription opioids for chronic noncancer pain. More than 100 000 people have died from unintentional overdose, making this one of the worst manmade epidemics in history.Much of health care delivery in the United States is regulated at the state level; therefore, both the cause and much of the cure for the opioid epidemic will come from state action.We detail the strong collaborations across executive health care agencies, and between those public agencies and practicing leaders in the pain field that have led to a substantial reversal of the epidemic in Washington State.

Martin B.I.,Dartmouth College | Franklin G.M.,Washington State Department of Labor and Industries | Deyo R.A.,Oregon Health And Science University | Wickizer T.M.,Ohio State University | And 2 more authors.
Spine Journal | Year: 2014

Background context In response to increasing use of lumbar fusion for improving back pain, despite unclear efficacy, particularly among injured workers, some insurers have developed limited coverage policies. Washington State's workers' compensation (WC) program requires imaging confirmation of instability and limits initial fusions to a single level. In contrast, California requires coverage if a second opinion supports surgery, allows initial multilevel fusion, and provides additional reimbursement for surgical implants. There are no studies that compare population-level effects of these policy differences on utilization, costs, and safety of lumbar fusion. Purpose The purpose of this study was to compare population-level data on the use of complex fusion techniques, adverse outcomes within 3 months, and costs for two states with contrasting coverage policies. Study design and setting The study design was an analysis of WC patients in California and Washington using the Agency for Healthcare Research and Quality's State Inpatient Databases, 2008-2009. Patient sample All patients undergoing an inpatient lumbar fusion for degenerative disease (n=4,628) were included the patient sample. Outcome measure(s) Outcome measures included repeat lumbar spine surgery, all-cause readmission, life-threatening complications, wound problems, device complications, and costs. Methods Log-binomial regressions compared 3-month complications and costs between states, adjusting for patient characteristics. Results Overall rate of lumbar fusion operations through WC programs was 47% higher in California than in Washington. California WC patients were more likely than those in Washington to undergo fusion for controversial indications, such as nonspecific back pain (28% versus 21%) and disc herniation (37% versus 21%), as opposed to spinal stenosis (6% versus 15%), and spondylolisthesis (25% versus 41%). A higher percentage of patients in California received circumferential procedures (26% versus 5%), fusion of three or more levels (10% versus 5%), and bone morphogenetic protein (50% versus 31%). California had higher adjusted risk for reoperation (relative risk [RR] 2.28; 95% confidence interval [CI], 2.27-2.29), wound problems (RR 2.64; 95% CI, 2.62-2.65), device complications (RR 2.49; 95% CI, 2.38-2.61), and life-threatening complications (RR 1.31; 95% CI, 1.31-1.31). Hospital costs for the index procedure were greater in California ($49,430) than in Washington ($40,114). Conclusions Broader lumbar fusion coverage policy was associated with greater use of lumbar fusion, use of more invasive operations, more reoperations, higher rates of complications, and greater inpatient costs. © 2014 Elsevier Inc. All rights reserved.

Graves J.M.,Washington State University | Miller M.E.,Washington State Department of Labor and Industries
American Journal of Industrial Medicine | Year: 2015

Background: The relationship between sleep and occupational injury risk has not been adequately explored for working adolescents. Methods: Data were analyzed from the 2010 Washington State Healthy Youth Survey of 8th, 10th, and 12th grade public school students. Teens reported average school and weekend night sleep hours and history of work-related injury that received medical treatment. Multivariable logistic regression evaluated the association between sleep duration and occupational injury. Results: Of 4,144 working teens, 6.4% reported ever having an occupational injury. Teens who sleep ≤5hr/school night had greater odds of a history of occupational injury than those sleeping 8hr (OR:2.91, 95% CI:1.85-4.57). No significant association was observed for weekend night sleep duration. Conclusions: Reduced school night sleep was associated with increased odds of work-related injury in adolescents. Long hours and late night schedules may contribute to decreased sleep time and potentially have other health and developmental impacts for youth. Am. J. Ind. Med. 58:464-471, 2015. © 2015 Wiley Periodicals, Inc.

Graves J.M.,University of Washington | Fulton-Kehoe D.,University of Washington | Jarvik J.G.,Cost and Outcomes Research Center | Jarvik J.G.,University of Washington | And 2 more authors.
Spine | Year: 2012

STUDY DESIGN.: A population-based, prospective cohort study. OBJECTIVE.: To evaluate the association of early imaging and health and disability status 1 year following acute low back injury, among a population-based sample of Washington State workers' compensation claimants. SUMMARY OF BACKGROUND DATA.: Use of early diagnostic magnetic resonance imaging (MRI) for low back pain (LBP) contributes to increasing health care costs but may not lead to better outcomes than delayed imaging. In the worker's compensation system, LBP is common and costly. This research examines the association between early MRI among workers with LBP and health outcomes (pain intensity, Roland disability score, and 36-Item Short Form Health Survey scores) and disability status 1 year after injury. METHODS.: This nonrandomized prospective cohort study of Washington State workers' compensation claimants with nonspecific LBP used administrative claims and interview data. Multivariable regression methods were used to estimate change in health outcome scores, the relative risk of disability at 1 year, and the rate of recovery 1 year after injury. RESULTS.: Of 1226 participants, 18.6% received early MRI. Most (77.9%) had mild/major sprains and 22.1% had radiculopathy. Participants with early MRI differed significantly at baseline in pain, function, and psychosocial variables. After adjusting for covariates, early imaging was not associated with substantial differences in 1-year health outcomes for sprains or radiculopathy. For workers with mild/major sprain, early imaging was associated with a 2-fold increase in the likelihood of work disability benefits at 1 year (adjusted relative risk: 2.03, 95% confidence interval: 1.33-3.11). Early imaging was not associated with an increased risk of long-term disability for workers with radiculopathy (adjusted relative risk: 1.31, 95% confidence interval: 0.84-2.05). For both groups, early MRI was associated with longer disability duration (P < 0.001). CONCLUSION.: Among workers with LBP, early MRI is not associated with better health outcomes and is associated with increased likelihood of disability and its duration. These associations warrant further testing in a randomized controlled trial. Our findings suggest that adherence to evidence-based guidelines is an important factor in ensuring that workers receive the highest quality care for occupational injuries. Copyright © 2012 Lippincott Williams & Wilkins.

Franklin G.M.,University of Washington | Franklin G.M.,Washington State Department of Labor and Industries | Mai J.,Washington State Department of Labor and Industries | Turner J.,University of Washington | And 3 more authors.
American Journal of Industrial Medicine | Year: 2012

Background: Opioid use and dosing for patients with chronic non-cancer pain have dramatically increased over the past decade, resulting in a national epidemic of mortality associated with unintentional overdose, and increased risk of disability among injured workers. We assessed changes in opioid dosing patterns and opioid-related mortality in the Washington State (WA) workers' compensation system following implementation of a specific WA opioid dosing guideline in April, 2007. Methods: Using detailed computerized billing data from WA workers' compensation, we report overall prevalence of opioid prescriptions, average morphine-equivalent dose (MED)/day, and proportion of workers on disability compensation receiving opioids and high-dose (≥120mg/day MED) opioids over the past decade. We also report the trend of unintentional opioid deaths during the same time period. Results: Compared to before 2007, there has been a substantial decline in both the MED/day of long-acting DEA Schedule II opioids (by 27%) and the proportion of workers on doses ≥120md/day MED (by 35%). There was a 50% decrease from 2009 to 2010 in the number of deaths. Conclusions: The introduction in WA of an opioid dosing guideline appears to be associated temporally with a decline in the mean dose for long-acting opioids, percent of claimants receiving opioid doses ≥120mg MED per day, and number of opioid-related deaths among injured workers. © 2011 Wiley Periodicals, Inc.

Miller M.E.,Washington State Department of Labor and Industries
Journal of Agromedicine | Year: 2012

The purpose of this paper is to review the background of key legislative and regulatory milestones of the initial laws and federal child labor provisions limiting hazardous work by children in agriculture up to the more recent developments contributing to the proposed updates to the agricultural hazardous occupations orders. A summary of the key changes are described and the significant differences between agricultural and nonagricultural regulations are highlighted. Recommendations for future policy are provided. © 2012 Copyright Taylor and Francis Group, LLC.

Bao S.,Washington State Department of Labor and Industries
Handbook of Clinical Neurology | Year: 2015

This chapter discusses mechanical stressors that are believed to be associated with work-related musculoskeletal disorders. It starts with an introduction to work-related musculoskeletal disorders (particularly those with high incidences in workplaces, such as disorders of low back, neck/shoulder, hand/wrist, elbow, and knee) in high-risk industries, and those mechanical stressors (such as high forces, awkward postures, high repetitions, excessive contact stress, and harmful human vibrations) in workplaces that are responsible for these disorders. Quantification methods of these mechanical stressors are then discussed. Although various quantification methods such as self-report, observational technique, and direct measurement are discussed, details are focused on many of those well-published observational techniques used by practitioners to assess risk levels of these mechanical stressors in jobs. These methods can quantify job mechanical stressors and provide risk level indications that can be used by practitioners to facilitate their decision making. These methods can also be used to evaluate the improvements of ergonomics interventions by comparing the risk levels quantitatively before and after the interventions. © 2015 Elsevier B.V.

Bao S.,Washington State Department of Labor and Industries | Silverstein B.,Washington State Department of Labor and Industries | Stewart K.,University of Washington
Ergonomics | Year: 2013

This study evaluated an ergonomics intervention among Nicaraguan coffee harvesting workers, using electromyography and questionnaire survey techniques. Nicaraguan researchers were involved in the study so that they could gain hands-on experience with ergonomics research and applications, and eventually be the specialists conducting ergonomics interventions in Nicaraguan workplaces. Coffee harvesting activities were studied individually and physical hazards were identified accordingly. The results showed decreased muscle loading on the erector spinae muscle and improved comfort reporting in the back region compared to the commonly used baskets. This fulfils the design objective of a newly developed bag that was used in the intervention to reduce physical workload on the coffee harvesting workers. Workers' opinion survey results showed some issues related to the size of the new bag and the lumbar-shoulder belt mechanism. This information can be used in the modification of the bag in the next design. Key players in the process have been identified.Practitioner summary: Stimulating ergonomics activities in developing countries is suggested by many experts. This study provided an example from coffee workers in Nicaragua. Commonly used job evaluation procedures and physical load quantification methods were used. Ergonomics researchers and practitioners in developing countries may do similar projects on their own in the future. © 2013 Copyright Taylor and Francis Group, LLC.

Wuellner S.E.,Washington State Department of Labor and Industries | Bonauto D.K.,Washington State Department of Labor and Industries
American Journal of Industrial Medicine | Year: 2014

Background: Estimates of select occupational injuries and illnesses often differ across data sources. We explored agreement in injury classifications and the impact of differences on case estimates among records reported to multiple data sources. Methods: We linked cases reported in the Bureau of Labor Statistics (BLS) annual Survey of Occupational Injuries and Illnesses (SOII) to Washington State workers' compensation (WC) claims and evaluated agreement in injury characteristics coded in each data source according to the same occupational injury and illness classification system. Results: Agreement between data sources was greatest for body part and lowest for event or exposure. Agreement on nature of injury varied by condition. WC-assigned injury codes estimated 94% more amputations than SOII-assigned codes while SOII-assigned codes estimated 34% more work-related MSD cases. Conclusions: Accounting for classification differences may improve case ascertainment within individual data sources and help align injury and illness estimates derived from different data sources. © 2013 The Authors. American Journal of Industrial Medicine Published by Wiley Periodicals, Inc.

Sears J.M.,University of Washington | Rolle L.R.,Washington State Department of Labor and Industries | Schulman B.A.,University of Washington | Wickizer T.M.,Ohio State University
Journal of Occupational Rehabilitation | Year: 2014

Purpose Despite the importance and cost of workers' compensation (WC)-based vocational rehabilitation (VR) programs, outcome evaluations are rare, in part due to the scarcity of suitable comparison groups. The aims of this study were to assess (1) the adequacy of a commonly recommended internal comparison group, i.e., workers who were eligible for but did not receive services, and (2) return-to-work (RTW) expectations as a potential source of bias. Methods In this prospective cohort study, we used WC claims data and worker-reported RTW expectations to compare workers who received vocational retraining services to eligible workers who did not receive such services. Workers were surveyed after retraining eligibility determination, prior to the initiation of retraining activities. VR progress and RTW wage outcomes were followed for 3 years. The magnitude of confounding contributed by RTW expectations and other covariates was quantified. Results Workers who were somewhat or very certain they would RTW had significantly better outcomes. RTW expectations played a strong confounding role, reducing the retraining plan effect estimate by about 23 %, while education and physical capacity each changed the effect estimate by <5 %. Conclusions RTW expectations predicted long-term RTW outcomes and can play a strong confounding role if unmeasured. We found that the internal comparison group approach, commonly recommended for VR program evaluation, is inappropriate for WC-based VR evaluations. Ultimately, there is no simple solution to the challenge of identifying a comparison group; however, measurement of RTW expectations, an easily-measured multi-dimensional construct, may be a useful addition to the VR evaluation toolbox. © 2014 Springer Science+Business Media New York.

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