Identifying factors associated with physical therapy use versus non-use among injured workers with back pain in Washington State.

BACKGROUND: There is little information about predictors of physical therapy (PT) use among injured workers with back pain. The primary objective of this study is to investigate the associations between PT use and baseline factors not routinely captured in workers' compensation (WC) data. METHODS: We conducted a secondary analysis using the Washington State Workers' Compensation Disability Risk Identification Study Cohort, which combines self-reported surveys with claims data from the Washington State Department of Labor and Industries State Fund. Workers with an accepted or provisional WC claim for back injury between June 2002 and April 2004 were eligible. Baseline factors for PT use were selected from six domains (socio-demographic, pain and function, psychosocial, clinical, health behaviors, and employment-related). The outcome was a binary measure for PT use within 1 year of injury. Bivariate and multivariable logistic regression models were conducted to evaluate the associations between PT use and baseline factors. RESULTS: Among the 1370 eligible study participants, we identified 673 (49%) who received at least one PT service. Baseline factors from five of the six domains (all but health behaviors) were associated with PT use, including gender, income, pain and function measures, injury severity rating, catastrophizing, recovery expectations, fear avoidance, mental health score, body mass index, first provider seen for injury, previous injury, and several work-related factors. CONCLUSION: We identify baseline factors that are associated with PT use, which may be useful in addressing disparities in access to care for injured workers with back pain in a WC system.

Using the Functional Comorbidity Index with administrative workers' compensation data: Utility, validity, and caveats.

BACKGROUND: Chronic health conditions impact worker outcomes but are challenging to measure using administrative workers' compensation (WC) data. The Functional Comorbidity Index (FCI) was developed to predict functional outcomes in community-based adult populations, but has not been validated for WC settings. We assessed a WC-based FCI (additive index of 18 conditions) for identifying chronic conditions and predicting work outcomes. METHODS: WC data were linked to a prospective survey in Ohio (N = 512) and Washington (N = 2,839). Workers were interviewed 6 weeks and 6 months after work-related injury. Observed prevalence and concordance were calculated; survey data provided the reference standard for WC data. Predictive validity and utility for control of confounding were assessed using 6-month work-related outcomes. RESULTS: The WC-based FCI had high specificity but low sensitivity and was weakly associated with work-related outcomes. The survey-based FCI suggested more comorbidity in the Ohio sample (Ohio mean = 1.38; Washington mean = 1.14), whereas the WC-based FCI suggested more comorbidity in the Washington sample (Ohio mean = 0.10; Washington mean = 0.33). In the confounding assessment, adding the survey-based FCI to the base model moved the state effect estimates slightly toward null (<1% change). However, substituting the WC-based FCI moved the estimate away from null (8.95% change). CONCLUSIONS: The WC-based FCI may be useful for identifying specific subsets of workers with chronic conditions, but less useful for chronic condition prevalence. Using the WC-based FCI cross-state appeared to introduce substantial confounding. We strongly advise caution-including state-specific analyses with a reliable reference standard-before using a WC-based FCI in studies involving multiple states.

Overview of Occupational Injuries Among Registered Nurses in Washington State, 2007 to 2019.

BACKGROUND: Registered nurses (RNs) represent the largest segment of the health care workforce and have unique job demands and occupational health considerations. The purpose of this study was to describe the incidence, cost, and causes of occupational injuries among RNs in Washington State and to quantify the cumulative cost and burden of each type of injury, relative to all injuries among RNs. METHODS: Annual injury claims data covered under Washington State workers' compensation (WC) fund were analyzed over a 13-year period (2007-2019). Annual mean incidence and cost of injuries were calculated and stratified by nature, source, and event/exposure. Negative binomial regression models were used to examine trends in injury incidence over time, for injury incidence overall, and by the most common injury classifications. RESULTS: Between 2007 and 2019, 10,839 WC claims were filed and accepted for Washington State RNs (annual M = 834), totaling more than US$65 million. No significant trend in overall injury incidence was observed (incidence rate ratio [IRR]: 0.99, 95% confidence interval [CI] = [0.94, 1.05]). The most common injury exposures were bodily reaction and exertion, contact with objects and equipment, falls, and assaults and violent acts. DISCUSSION: To our knowledge, this is the first broad study of the incidence and costs of occupational injuries among RNs across all workplace settings. We identified high-cost, high-frequency incidence rates of musculoskeletal, sharp, and violence-related occupational injury claims, highlighting intervention targets. Implications for Occupational Health Practice: Policy makers, health systems, and occupational health nurse leaders can use this information to identify priority areas where evidence-based occupational health and prevention programs are most needed.

Using a severity threshold to improve occupational injury surveillance: Assessment of a severe traumatic injury-based occupational health indicator across the International Classification of Diseases lexicon transition.

BACKGROUND: Traumatic injury is a leading cause of death and disability among US workers. Severe injuries are less subject to systematic ascertainment bias related to factors such as reporting barriers, inpatient admission criteria, and workers' compensation coverage. A state-based occupational health indicator (OHI #22) was initiated in 2012 to track work-related severe traumatic injury hospitalizations. After 2015, OHI #22 was reformulated to account for the transition from the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) to ICD-10-CM. This study describes rates and trends in OHI #22, alongside corresponding metrics for all work-related hospitalizations. METHODS: Seventeen states used hospital discharge data to calculate estimates for calendar years 2012-2019. State-panel fixed-effects regression was used to model linear trends in annual work-related hospitalization rates, OHI #22 rates, and the proportion of work-related hospitalizations resulting from severe injuries. Models included calendar year and pre- to post-ICD-10-CM transition. RESULTS: Work-related hospitalization rates showed a decreasing monotonic trend, with no significant change associated with the ICD-10-CM transition. In contrast, OHI #22 rates showed a monotonic increasing trend from 2012 to 2014, then a significant 50% drop, returning to a near-monotonic increasing trend from 2016 to 2019. On average, OHI #22 accounted for 12.9% of work-related hospitalizations before the ICD-10-CM transition, versus 9.1% post-transition. CONCLUSIONS: Although hospital discharge data suggest decreasing work-related hospitalizations over time, work-related severe traumatic injury hospitalizations are apparently increasing. OHI #22 contributes meaningfully to state occupational health surveillance efforts by reducing the impact of factors that differentially obscure minor injuries; however, OHI #22 trend estimates must account for the ICD-10-CM transition-associated structural break in 2015.

Full practice authority and burnout among primary care nurse practitioners.

BACKGROUND: Full practice authority (FPA) improves clinical autonomy for nurse practitioners (NPs). Autonomy may reduce burnout. PURPOSE: Estimate the effect of changing from reduced or restricted practice authority to FPA on NP burnout. METHODS: In this quasi-experimental study, we compared NP burnout before (2016) and after (2018) a Veterans Health Administration (VHA) regulation authorized NP FPA. Burnout proportions were estimated for VHA facilities by aggregating responses to the VHA's All Employee Survey from 1,352 primary care NPs. DISCUSSION: Seventy-seven percent of facilities changed to FPA postregulation. Burnout was six points lower among NPs in facilities that changed to FPA compared to facilities that had FPA prior to the regulation; however, this association was not statistically significant. CONCLUSION: NPs are increasingly working under independent practice. While changing to FPA did not reduce NP burnout, this association may vary by health care setting or when burnout is measured for individuals or teams.

Development and maturation of the occupational health services research field in the United States over the past 25 years: Challenges and opportunities for the future.

Work is an important social determinant of health; unfortunately, work-related injuries remain prevalent, can have devastating impact on worker health, and can impose heavy economic burdens on workers and society. Occupational health services research (OHSR) underpins occupational health services policy and practice, focusing on health determinants, health services, healthcare delivery, and health systems affecting workers. The field of OHSR has undergone tremendous expansion in both definition and scope over the past 25 years. In this commentary, focusing on the US, we document the historical development and evolution of OHSR as a research field, describe current doctoral-level OHSR training, and discuss challenges and opportunities for the OHSR field. We also propose an updated definition for the OHSR field: Research and evaluation related to the determinants of worker health and well-being; to occupational injury and illness prevention and surveillance; to healthcare, health programs, and health policy affecting workers; and to the organization, access, quality, outcomes, and costs of occupational health services and related health systems. Researchers trained in OHSR are essential contributors to improvements in healthcare, health systems, and policy and programs to improve worker health and productivity, as well as equity and justice in job and employment conditions. We look forward to the continued growth of OHSR as a field and to the expansion of OHSR academic training opportunities.

Patient Enrollment Growth and Burnout in Primary Care at the Veterans Health Administration.

BACKGROUND: Patient enrollment levels at Veterans Health Administration (VHA) facilities change based on Veteran demand for care, potentially affecting demands on staff. Effects on burnout in the primary care workforce associated with increases or decreases in enrollment are unknown. OBJECTIVE: Estimate associations between patient enrollment and burnout. DESIGN: In this serial cross-sectional study, VHA patient enrollment and workforce data from 2014 to 2018 were linked to burnout estimates for 138 VHA facilities. The VHA's annual All Employee Survey provided burnout estimates. PARTICIPANTS: A total of 82,421 responses to the 2014-2018 All Employee Surveys by primary care providers (PCPs), including physicians, nurse practitioners, and physician assistants; nurses; clinical associates; and administrative clerks were included. Respondents identified as patient-aligned care team members. MAIN MEASURES: Independent variables were (1) the ratio of enrollment to PCPs at VHA facilities and (2) the year-over-year change in enrollment per PCP. Burnout was measured as the annual proportion of staff at VHA facilities who reported emotional exhaustion and/or depersonalization. Each primary care role was analyzed independently. KEY RESULTS: Overall enrollment decreased from 1553 enrollees per PCP in 2014 to 1442 enrollees per PCP in 2018 across VHA facilities. Forty-three facilities experienced increased enrollment (mean of 1524 enrollees/PCP in 2014 to 1668 in 2018) and 95 facilities experienced decreased enrollment (mean of 1566 enrollees/PCP in 2014 to 1339 in 2018). Burnout decreased for all primary care roles. PCP burnout was highest, decreasing from a facility-level mean of 51.7% in 2014 to 43.8% in 2018. Enrollment was not significantly associated with burnout for any role except nurses, for whom a 1% year-over-year increase in enrollment was associated with a 0.2 percentage point increase in burnout (95% CI: 0.1 to 0.3). CONCLUSIONS: Studies assessing changes in organizational-level predictors are rare in burnout research. Patient enrollment predicted burnout only among nurses in primary care.

Changes in electronic notification volume and primary care provider burnout.

OBJECTIVES: Electronic health record (EHR) inbox notifications can be burdensome for primary care providers (PCPs), potentially contributing to burnout. We estimated the association between changes in the quantities of EHR inbox notifications and PCP burnout. STUDY DESIGN: In this observational study, we tested the association between the percent change in daily inbox notification volumes and PCP burnout after an initiative to reduce low-value notifications at the Veterans Health Administration (VHA). METHODS: The VHA initiative resulted in increases and decreases in notification volumes for PCPs. For each facility, the proportion of PCPs reporting burnout was estimated using VHA All Employee Survey responses before and after the initiative in 2016 and 2018, respectively. Survey responses were aggregated for 6459 PCPs (physicians, nurse practitioners, and physician assistants) at 138 VHA facilities. Fixed effects regression models estimated the association of small and large increases and small and large decreases in notifications on burnout. RESULTS: Daily inbox notifications per PCP decreased by a mean (SD) of 5.9% (30.1%) across study facilities, from a mean (SD) of 128 (52) notifications to 114 (44) notifications after the initiative. Fifty-one percent of facilities experienced reductions in notifications, 30% experienced no change, and 20% experienced increased notifications. PCP burnout was not significantly associated with any level of increase or decrease in notifications. CONCLUSIONS: Changes in notification volumes alone did not predict PCP burnout. Future research to reduce burnout might still address EHR notification volumes, but as part of a broader set of strategies that consider the other stressors that PCPs experience.

Development and Evaluation of an Online Toolkit for Managers of 9-1-1 Emergency Communications Centers to Reduce Occupational Stress.

This article describes the development and evaluation of an online workplace stress reduction toolkit for use by managers of 9-1-1 emergency communication centers (ECCs). A three-step process for development and testing of digital learning resources was used: (1) establishing need and focus through ECC manager stakeholder engagement, (2) pretesting of the toolkit with the target ECC manager audience, and (3) toolkit utilization and evaluation. The toolkit was developed in close partnership with stakeholders throughout the entire process. Toolkit usage was documented via registration data. The evaluation utilized an online survey that included closed and open-ended questions, which were analyzed using descriptive statistics and qualitative thematic analysis. Over a 20-month period, 274 people registered for the toolkit and, of those, 184 (67%) accessed the content. Respondents to the evaluation survey (N = 156) scored the toolkit highly on satisfaction, self-efficacy, and perceived utility measures. Survey respondents reported intent to apply toolkit content through the following: providing organizational resources to help workers take better care of themselves (41%); creating a lower stress worksite environment (35%) and sharing resources with staff to (1) reduce stress (19%), (2) support conflict resolution (21%), and (3) prevent and/or stop bullying (17%). In delivering actionable content to ECC managers, the toolkit shows promise in addressing and mitigating occupational stress in ECCs. Further research needs to determine the relationship of this strategy for reducing ECC stress.

Intensity of physical therapy services: Association with work and health outcomes in injured workers with back pain in Washington State.

BACKGROUND: Associations between the intensity of physical therapy (PT) treatments and health outcomes among individuals with back pain have been examined in the general population; however, few studies have explored these associations in injured workers. Our study objective was to examine whether intensity of PT treatments is positively associated with work and health outcomes in injured workers with back pain. METHODS: We conducted a secondary analysis of prospective data collected from the Washington State Workers' Compensation (WC) Disability Risk Identification Study Cohort (D-RISC). D-RISC combined survey results with WC data from the Washington State Department of Labor and Industries. Workers with a State Fund WC claim for back injuries between June 2002 and April 2004 and who received PT services within the first year of injury were eligible. Intensity of PT treatment was measured as the type and amount of PT services within 28 days from the first PT visit. Outcome measures included work disability and self-reported measures for working for pay, pain intensity, and functional status at 1-year follow-up. We conducted linear and logistic regression models to test associations. RESULTS: We identified 662 eligible workers. In adjusted models, although the intensity of PT treatment was not significantly associated with work disability at 1-year follow-up, it was associated with lower odds of working for pay, decreased pain intensity, and improved functional status. CONCLUSIONS: Our findings suggest that there may be small benefits from receiving active PT, manual therapy, and frequent PT treatments within 28 days of initiating PT care.

Overdose and substance-related mortality after release from prison in Washington State: 2014-2019.

BACKGROUND: Persons released from prison are at an increased risk of mortality compared to the non-incarcerated population, particularly from drug- and opioid-related overdose. Contributors to overdose mortality vary with changing patterns of substance use and updating overdose and mortality statistics may help focus resources for persons released from prison. METHODS: In this retrospective cohort study, records for 33,811 people released from Washington State Department of Corrections prisons between 2014 and 2018 were linked to Washington State death records from 2014 to 2019. We calculated post-release mortality rates by cause of death, including overdose and substance-related mortality. Hazard ratios for risk factors for all-cause, non-overdose, and overdose mortality were estimated using Cox proportional hazards regression. RESULTS: 862 deaths were identified among persons released from prison. The all-cause mortality rate was 747 per 100,000 person-years (95 % CI: 699-800), and drug overdose was the leading cause of death (216 per 100,000 person-years; 95 % CI: 190-244). Psychostimulant-related mortality (152 per 100,000 person-years; 95 % CI: 131-177) and opioid-related mortality (138 per 100,000 person-years; 95 % CI: 118-161) were the most prevalent among substance-related causes of death, with the greatest mortality risk occurring within two weeks after release. Older age at most recent release, previous incarceration, and drug-related convictions were significant risk factors for all-cause and overdose mortality within six years after release. CONCLUSIONS: Psychostimulants were the greatest contributors to substance-related mortality for persons released from Washington State prisons. Greater efforts to prevent psychostimulant- and opioid-related overdose are needed.

The utility of a safety climate scale among workers with a work-related permanent impairment who have returned to work.

BACKGROUND: Safety climate (SC) is a robust leading indicator of occupational safety outcomes. There is, however, limited research on SC among workers who have returned to work with a work-related permanent impairment. OBJECTIVE: This study examined three propositions: (1) a two-level model of SC (group-level and organization-level SC) will provide the best fit to the data; (2) antecedent factors such as safety training, job demands, supervisor support, coworker support, and decision latitude will predict SC; and (3) previously reported associations between SC and outcomes such as reinjury, work-family conflict, job performance, and job security will be observed. METHOD: A representative cross-sectional survey gathered information about experiences during the first year of work reintegration. About one year after claim closure, 599 interviews with workers were conducted (53.8% response rate). Confirmatory factor analyses were conducted to test the factor structure of the SC construct. Further, researchers used correlation analyses to examine the criterion-related validity. RESULTS: Consistent with general worker populations, our findings suggest the following: (1) the two-factor structure of SC outperformed the single-factor structure in our population of workers with a permanent impairment; (2) correlations demonstrate that workplace safety training, decision latitude, supervisor support, coworker support, and job demands could predict SC; and (3) SC may positively impact reinjury risk, work-family conflict, and may increase job performance and job security. CONCLUSIONS: Our study validated a two-factor SC scale among workers with a history of disabling workplace injury or permanent impairment who have returned to work. Practical applications of this scale will equip organizations with the necessary data to improve working conditions for this population.

The Community-Based Medication-First program for opioid use disorder: a hybrid implementation study protocol of a rapid access to buprenorphine program in Washington State.

BACKGROUND: Opioid use disorder (OUD) is a serious health condition that is effectively treated with buprenorphine. However, only a minority of people with OUD are able to access buprenorphine. Many access points for buprenorphine have high barriers for initiation and retention. Health care and drug treatment systems have not been able to provide services to all-let alone the majority-who need it, and many with OUD report extreme challenges starting and staying on buprenorphine in those care settings. We describe the design and protocol for a study of a rapid access buprenorphine program model in six Washington State communities at existing sites serving people who are unhoused and/or using syringe services programs. This study aimed to test the effectiveness of a Community-Based Medication-First Program model. METHODS: We are conducting a hybrid effectiveness-implementation study of a rapid access buprenorphine model of care staffed by prescribers, nurse care managers, and care navigators. The Community-Based Medication-First model of care was designed as a 6-month, induction-stabilization-transition model to be delivered between 2019 and 2022. Effectiveness outcomes will be tested by comparing the intervention group with a comparison group derived from state records of people who had OUD. Construction of the comparison group will align characteristics such as geography, demographics, historical rates of arrests, OUD medication, and health care utilization, using restriction and propensity score techniques. Outcomes will include arrests, emergency and inpatient health care utilization, and mortality rates. Descriptive statistics for buprenorphine utilization patterns during the intervention period will be documented with the prescription drug monitoring program. DISCUSSION: Results of this study will help determine the effectiveness of the intervention. Given the serious population-level and individual-level impacts of OUD, it is essential that services be readily available to all people with OUD, including those who cannot readily access care due to their circumstances, capacity, preferences, and related systems barriers.

Differential underestimation of work-related reinjury risk for older workers: Challenges to producing accurate rate estimates.

BACKGROUND: Older workers are increasingly represented in the U.S. workforce, but frequently work part-timeor intermittently, hindering accurate injury rate estimates. To reduce the impact of reporting barriers on rate comparisons, we focused on reinjury (both injury recurrence and new injury) among workers with a workers' compensation claim, assessing: (1) reinjury risk for workers age 65+ versus <65; (2) importance of work-time at-risk measurement for rate estimates and comparisons; and (3) age distribution of potential risk factors. METHODS: Washington State workers' compensation claims for a retrospective cohort of workers with work-related permanent impairments were linked to state wage files. Reinjury rates were calculated for the cohort (N = 11,184) and a survey sample (N = 582), using both calendar time and full-time equivalent (FTE)-adjusted time. Risk differentials were assessed using rate ratios and adjusted survival models. RESULTS: The rate ratio for workers age 65+ (vs. <65) was 0.45 (p < 0.001) using calendar time, but 0.70 (p = 0.07) using FTE-adjusted time. Survey-based rates were 35.7 per 100 worker-years for workers age 65+, versus 14.8 for <65. Workers age 65+ (vs. <65) were more likely to work <100% FTE, but were similar regarding job strain, their ability to handle physical job demands, and their comfort reporting unsafe conditions or injuries. CONCLUSIONS: Accounting for work-time at risk substantially improves age-based reinjury comparisons. Although the marked elevation in self-reported reinjury risk for older workers might be a small-sample artifact (n = 34), workers age 65+ are likely at higher risk than previously appreciated. Ongoing workforce trends demand increased attention to injury surveillance and prevention for older workers.

Workplace Wellness Program Interest and Barriers Among Workers With Work-Related Permanent Impairments.

BACKGROUND: Nearly half of U.S. workers have access to workplace wellness programs (WWPs), 58% of workers with access participate. The aim of this study was to assess interest in WWP participation and identify reasons for lack of interest among workers with work-related permanent impairments-a population at elevated risk of adverse health outcomes. METHODS: Workers who returned to work after a work-related permanent impairment were interviewed 11 to 15 months after workers' compensation claim closure. Qualitative content analysis methods were used to code open-ended responses. FINDINGS: Of 560 respondents, 51.4% expressed interest in WWP participation. Numerous adverse health and economic characteristics were associated with WWP interest, for example, interest was expressed by 63.3% of workers reporting fair/poor health status versus 47.1% reporting good/excellent; 56.9% of workers reporting moderate/severe pain versus 41.4% reporting mild/no pain; 64.7% of workers without health insurance versus 50.1% with health insurance; 69.0% of workers reporting depression versus 47.2% without depression; 70.4% of workers reporting obesity versus 48.0% without obesity; and 63.2% of workers often worried about expenses versus 46.9% reporting sometimes/never worried. Specific participation barriers were described by 34.2% of the 272 workers who were not interested. CONCLUSIONS/APPLICATIONS TO PRACTICE: A majority of workers with work-related permanent impairments-particularly those with adverse health and economic characteristics-were interested in WWPs. Many workers who reported no interest cited participation barriers. Further research is needed to determine whether addressing such barriers would enhance equitable access. Those undertaking WWP planning, implementation, and outreach should ensure that WWPs are inclusive and serve workers with disabilities.

Trends and Disparities in the Use of Telehealth Among Injured Workers During the COVID-19 Pandemic.

OBJECTIVE: To describe telehealth trends within a population-based workers' compensation system during the COVID-19 pandemic, and to assess telehealth utilization by sociodemographic characteristics. METHODS: This cross-sectional study used Washington State workers' compensation claims and medical billing data from January 2019 to October 2020. RESULTS: Telehealth use averaged 1.2% of medical bills pre-pandemic, peaked in April 2020 at 8.8%, and leveled off to around 3.6% from July to October 2020. Telehealth utilization differed significantly by age, sex, number of dependents, injury, industry, and receipt of interpreter services. Workers residing in counties with higher population, lower poverty rates, and greater Internet access had higher telehealth usage. CONCLUSIONS: There were dramatic shifts in telehealth; usage differed by sociodemographic characteristics. Further studies evaluating disparities in tele-health access among injured workers are needed.

Appraisal of Washington State workers' compensation-based return-to-work programs and suggested system improvements: A survey of workers with permanent impairments.

BACKGROUND: Following a work-related permanent impairment, injured workers commonly face barriers to safe and successful return to work (RTW). Examining workers' experiences with the workers' compensation (WC) system could highlight opportunities to improve RTW outcomes. Objectives included summarizing workers': (1) appraisal of several WC-based RTW programs, and (2) suggestions for vocational rehabilitation and WC system improvements to promote safe and sustained RTW. METHODS: In telephone interviews, 582 Washington State workers with work-related permanent impairments were asked whether participation in specified WC-based RTW programs helped them RTW and/or stay at work. Suggestions for program and system improvements were solicited using open-ended questions; qualitative content analysis methods were used to inductively code responses. RESULTS: Most respondents reported positive impacts from RTW program participation; for example, 62.5% of vocational rehabilitation participants reported it helped them RTW, and 51.7% reported it helped them stay at work. Among 582 respondents, 28.0% reported that no change was needed to the WC system, while 57.6% provided suggestions or critiques. Reduce delays/simplify process/improve efficiency was the most frequent WC system theme-mentioned by 34.9%. Among 120 vocational rehabilitation participants, 35.8% reported that no change was needed to vocational rehabilitation, while 46.7% (N = 56) provided suggestions or critiques. More worker choice/input into the vocational retraining plan was the most frequent vocational rehabilitation theme-mentioned by 33.9%. CONCLUSIONS: This study's findings suggest that there is substantial room for improvement in workers' experience with the WC system. In addition, injured workers' feedback may reflect opportunities to reduce administrative burden and to improve worker health and RTW outcomes.

Workplace improvements to support safe and sustained return to work: Suggestions from a survey of workers with permanent impairments.

BACKGROUND: Roughly 10% of occupational injuries result in permanent impairment. After initial return to work (RTW), many workers with permanent impairments face RTW interruption due to reinjury, unstable health, disability, and layoff. This study used open-ended survey data to: (1) explore workplace factors identified by workers as important levers for change, some of which may previously have been unrecognized; and (2) summarize workers' suggestions for workplace improvements to promote sustained RTW and prevent reinjury. METHODS: This study included data from workers' compensation claims and telephone surveys of 582 Washington State workers who had RTW after a work-related injury involving permanent impairment. The survey was conducted in 2019, about a year after claim closure. We used qualitative content analysis methods to inductively code open-ended survey responses. RESULTS: The most frequent themes were: safety precautions/safer workplace (18.1%), adequate staffing/appropriate task distribution (16.2%), and safety climate (14.1%). Other frequent themes included ergonomics, rest breaks, job strain, predictability and flexibility in work scheduling practices, employer response to injury, social support, communication, and respect. Many workers reported that they were not listened to, or that their input was not sought or valued. Workers often linked communication deficiencies to preventable deficiencies in safety practices, safety climate, and RTW practices, and also to lack of respect or distrust. In counterpoint, nearly one-third of respondents reported that no change was needed to their workplace. CONCLUSIONS: Policies and interventions targeting worker-suggested workplace improvements may promote safe and sustained RTW, which is essential for worker health and economic stability.

The role of nonstandard and precarious jobs in the well-being of disabled workers during workforce reintegration.

BACKGROUND: Nonstandard employment arrangements are becoming increasingly common and could provide needed flexibility for workers living with disabilities. However, these arrangements may indicate precarious employment, that is, employment characterized by instability, powerlessness, and limited worker rights and benefits. Little is known about the role of nonstandard and precarious jobs in the well-being of disabled persons during workforce reintegration after permanent impairment from work-related injuries or illnesses. METHODS: We used linked survey and administrative data for a sample of 442 Washington State workers who recently returned to work and received a workers' compensation permanent partial disability award after permanent impairment from a work-related injury. Multivariable logistic regression models were used to examine associations between nonstandard employment and outcomes related to worker well-being and sustained employment. We also examined associations between a multidimensional measure of precarious employment and these outcomes. Secondarily, qualitative content analysis methods were used to code worker suggestions on how workplaces could support sustained return to work (RTW). RESULTS: Workers in: (1) nonstandard jobs (compared with full-time, permanent jobs), and (2) precarious jobs (compared with less precarious jobs) had higher adjusted odds of low expectations for sustained RTW. Additionally, workers in precarious jobs had higher odds of reporting fair or poor health and unmet need for disability accommodation. Workers in nonstandard and precarious jobs frequently reported wanting safer and adequately staffed workplaces to ensure safety and maintain sustained employment. CONCLUSIONS: Ensuring safe, secure employment for disabled workers could play an important role in their well-being and sustained RTW.