Injury Among Home Care Workers in Washington State.

Home Care Aides (HCAs) have nearly four times the rate of injury as the general U.S. work force. In 2015, the Service Employees International Union 775 Benefits Group conducted a health and safety survey with 672 HCAs in Washington State. The goal was to identify the risk factors for injury and to better assess injury rates through self-report. Quantitative analyses assessed injury prevalence and barriers in reporting injury. Overall, 13 percent responded that they had ever had an injury that required medical attention while working as an HCA. These rates are significantly higher for HCAs employed by home care agencies compared with HCAs who work independently. Over a third reported moderate to high levels of hesitancy in reporting an on-the-job injury; these rates were even higher for independent providers. Study findings suggest that HCAs are well informed about appropriate next steps following workplace injury, but strong barriers may prevent them from attempting the reporting process.

Using Record Linkage to Improve Race Data Quality for American Indians and Alaska Natives in Two Pacific Northwest State Hospital Discharge Databases.

OBJECTIVE: To evaluate and adjust for American Indian and Alaska Native (AI/AN) racial misclassification in two hospital discharge datasets in the Pacific Northwest. DATA SOURCES/STUDY SETTING: Oregon (2010-2011) and Washington (2011) hospital discharge datasets were linked with the Northwest Tribal Registry (NTR), a registry of AI/AN individuals who accessed services at Indian health facilities in the Northwest. STUDY DESIGN: Record linkage was used to match state hospital records to the NTR. A state record was considered misclassified if it matched the NTR and was coded as non-AI/AN or missing race data. Effect of misclassification was evaluated by comparing prelinkage and postlinkage, age-adjusted hospital discharge rates. DATA COLLECTION/EXTRACTION METHODS: Researchers used Link Plus 2.0 software (Atlanta, GA, USA) for linkages and SAS 9.4 (Cary, NC, USA) for statistical analyses. PRINCIPAL FINDINGS: In Oregon, 55.4 percent of matching records were misclassified (66.5 percent miscoded white, and 22.1 percent were missing race information). In Washington, 44.9 percent of matching records were misclassified (61.8 percent miscoded white, and 32.7 percent were missing race information). Linkage increased ascertainment of AI/AN hospitalizations by 31.8 percent in Oregon and 33.9 percent in Washington. Linkage increased the rate ratio (RR) for AI/AN hospitalizations in comparison to non-Hispanic whites (NHW) from 0.81 to 1.07 in Oregon, and from 1.21 to 1.62 in Washington. CONCLUSION: Correction of race in hospital discharge datasets through linkage with a reference file of known AI/AN individuals is an important first step before analytic research on AI/AN health care in the Pacific Northwest can be accomplished with administrative datasets.

Uncovering a missing demographic in trauma registries: epidemiology of trauma among American Indians and Alaska Natives in Washington State.

BACKGROUND: The objectives of this study were to evaluate racial misclassification in a statewide trauma registry and to describe the epidemiology of trauma among the Washington American Indian and Alaska Native (AI/AN) population. METHODS: We performed probabilistic record linkage between the Washington Trauma Registry (2005-2009) and Northwest Tribal Registry, a dataset of known AI/AN. AI/AN patients were compared with caucasians on demographic, injury and clinical outcome factors. A multivariable model estimated odds of mortality. RESULTS: Record linkage increased ascertainment of AI/AN cases in the trauma registry 71%, from 1777 to 3039 cases. Compared with caucasians, AI/AN trauma patients were younger (mean age=36 vs 47 years, p<0.001) and more commonly male (66.5% vs 61.2%, p<0.001). AI/AN experienced more intentional injuries (suicide or homicide: 20.1% vs 6.7%, p<0.001), a higher proportion of severe traumatic brain injury (20.7% vs 16.8%, p=0.004) and were less likely than caucasians to use safety equipment such as seat belts/airbags (53.9% vs 76.7%, p<0.001). ISSs were similar (ISS >15: 21.4% vs 20.5%, p=0.63), and no difference was observed in mortality after adjustment for covariates (p=0.58). CONCLUSIONS: Linkage to a state trauma registry improved data quality by correcting racial misclassification, allowing for a comprehensive description of injury patterns for the AI/AN population. AI/AN sustained more severe injuries with similar postinjury outcomes to caucasians. Future efforts should focus on primary prevention for this population, including increased use of seat belts and child safety seats and reduction of interpersonal violence and suicide.

The association of depression with diabetes management among urban American Indians/Alaska Natives in the United States, 2011.

OBJECTIVE: To determine the relationship between depression and diabetes management among urban American Indians/Alaska Natives (AI/ANs). DESIGN: Retrospective, cross-sectional analysis of medical records. SETTING: 33 Urban Indian Health Organizations that participated in the Indian Health Service Diabetes Care and Outcomes Audit. PATIENTS: 3,741 AI/AN patient records. MAIN OUTCOME MEASURES: Diabetes management outcomes, including HbA1c, smoking, BMI, systolic blood pressure, creatinine, total cholesterol, and receipt of preventive services. RESULTS: Individuals with depression and diabetes were 1.5 times more likely to smoke than individuals with diabetes but without depression (OR=1.51; 95% Cl: 1.23, 1.86), controlling for age, sex, and facility. After adjustment, the geometric mean BMI in diabetes patients with depression was 3% higher than in patients without depression (ß=.034; 95% CI: .011, .057). CONCLUSIONS: Urban AI/ANs with diabetes and depression are more likely to smoke and have higher BMI than those with diabetes but without depression. These findings inform programmatic efforts to address the care of patients with both depression and diabetes.

Disparities in life expectancy of pacific northwest American Indians and Alaska natives: analysis of linkage-corrected life tables.

OBJECTIVES: American Indians and Alaska Natives (AI/ANs) experience a high burden of mortality and other disparities compared with the general population. Life tables are an important population health indicator; however, federal agencies have not produced life tables for AI/ANs, largely due to racial misclassification on death certificates. Our objective was to correct this misclassification and create life tables for AI/ANs who resided in the Pacific Northwest region of the U.S., making comparisons with the general population. METHODS: To correct racial misclassification, we conducted probabilistic record linkages between death certificates from three Northwest states-Idaho, Oregon, and Washington State-issued during 2008-2010, and AI/AN patient registration records. We calculated mortality rates and generated period life tables for AI/ANs and non-Hispanic white (NHW) Americans. RESULTS: Overall life expectancy at birth for Northwest AI/ANs was 72.8 years, which was 6.9 years lower than that of NHW Americans. Male AI/ANs had a lower life expectancy (70.9 years) than female AI/ANs (74.6 years). The disparity in life expectancy between AI/ANs and their NHW counterparts was higher for females (with AI/ANs living 7.3 years fewer than NHW females) than for males (with AI/ANs living 6.7 years fewer than NHW males). The greatest disparity in mortality rates was seen among young adults. CONCLUSION: Data linkage with a registry of known AI/ANs allowed us to generate accurate life tables that had not previously been available for this population and revealed disparities in both life expectancy at birth and survival across the life span. These results represent an important tool to help AI/AN communities as they monitor their health and promote efforts to eliminate health disparities.

Perspectives on self-management in multiple sclerosis: a focus group study.

The aim of this study was to elucidate the experience of self-management among people with multiple sclerosis (MS) and gather their input to inform a self-management intervention. Twelve people with MS participated in focus groups in which they were asked open-ended questions about MS symptoms, challenges, overcoming challenges, symptom management, and treatment preferences. The results suggest four major themes: 1) "The Everyday Experience of MS," including comments about symptoms and their impact on functioning; 2) "Motivation for Self-Management," including descriptions of motivation originating from physical necessity, success with other management techniques, and external sources; 3) "Coping Strategies and Skills," including descriptions of changing behaviors, expanding social support networks, finding resources, utilizing medical treatment, and monitoring symptoms; and 4) "Vision for a Self-Management Intervention," including suggestions that an intervention be individualized, be motivating, and provide resources. The results of this study can inform the design and implementation of self-management interventions. Experiences described by participants are consistent with other qualitative reports suggesting the active role people with MS play in managing their condition. Intervention approaches must consider the complex constellation of symptoms associated with MS and provide individualized treatments that enhance the person's ability to manage their symptoms, barriers presented by such symptoms, and their health care.

Aging with disability in the workplace.

Aging with disabilities, such as multiple sclerosis, spinal cord injury, muscular dystrophy, and postpolio syndrome, can lead to barriers to participation, including employment barriers. Many individuals develop strategies for overcoming these barriers that may become less successful as they experience more secondary conditions concomitant with the aging process. Rehabilitation professionals can help to overcome barriers to workplace participation and should work with clients to enhance employment outcomes.