The Union Health Center: A working model of clinical care linked to preventive occupational health services

Abstract

As health care provision in the United States shifts to primary care settings, it is vital that new models of occupational health services be developed that link clinical care to prevention. The model program described in this paper was developed at the Union Health Center (UHC), a comprehensive health care center supported by the International Ladies Garment Workers Union (now the Union of Needletrades, Industrial and Textile Employees) serving a population of approximately 50,000 primarily minority, female garment workers in New York City. The objective of this paper is to describe a model occupational medicine program in a union‐based comprehensive health center linking accessible clinical care with primary and secondary disease prevention efforts. To assess the presence of symptoms suggestive of occupational disease, a health status questionnaire was administered to female workers attending the UHC for routine health maintenance. Based on the results of this survey, an occupational medicine clinic was developed that integrated direct clinical care with worker and employer education and workplace hazard abatement. To assess the success of this new approach, selected cases of sentinel health events were tracked and a chart review was conducted after 3 years of clinic operation. Prior to initiation of the occupational medicine clinic, 64% (648) of the workers surveyed reported symptoms indicative of occupational illnesses. However, only 42 (4%) reported having been told by a physician that they had an occupational illness and only 4 (.4%) reported having filed a workers' compensation claim for an occupational disease. In the occupational medicine clinic established at the UHC, a health and safety specialist acts as a case manager, coordinating worker and employer education as well as workplace hazard abatement focused on disease prevention, ensuring that every case of occupational disease is treated as a potential sentinel health event. As examples of the success of this approach, index cases of rotator cuff tendonitis, lead poisoning, and formaldehyde overexposure in three patients and their preventative workplace follow‐up, affecting approximately 150 workers at three worksites, are described. Work‐related conditions diagnosed during the first 3 years of clinic operation included cumulative trauma disorders (141 cases), carpal tunnel syndrome (47 cases), low back disorders (33 cases), lead poisoning (20 cases), and respiratory disease (9 cases). This pilot project represents a new model for effective integration of clinical care and occupational disease prevention efforts within a primary care center. It could serve as a prototype for development of such services in other managed and primary care settings. Am. J. Ind. Med. 31:263–273, 1997. © 1997 Wiley‐Liss, Inc.

Barriers to Use of Workers' Compensation for Patient Care at Massachusetts Community Health Centers

“…Finally, WC claims are some of the few forms of feedback to individual employers enabling them to identify and correct workplace hazards (Herbert et al. ; Burgel et al. ; Boden and Ozonoff ; Dembe ; Du and Leigh ; Leigh and Marcin ; Utterback et al.…”

“…WC claims also provide unique public health data key to identifying and preventing occupational hazards and WRII. Finally, WC claims are some of the few forms of feedback to individual employers enabling them to identify and correct workplace hazards (Herbert et al 1997;Burgel et al 2004;Boden and Ozonoff 2008;Dembe 2010;Du and Leigh 2011;Leigh and Marcin 2012;Utterback et al 2012).…”

“…Studies suggest that 25-55 percent of costs of care for WRII are shifted away from WC for all eligible cases (Leigh and Robbins 2004;Fan et al 2006;Rosenman et al 2006;Won and Dembe 2006;Lakdawalla, Reville, and Seabury 2007;Boden and Ozonoff 2008;Centers for Disease Control and Prevention 2010;Luckhaupt and Calvert 2010;Premji and Krause 2010;Leigh and Marcin 2012), rising to 75-95 percent for selected conditions or populations (Herbert et al 1997;Milton et al 1998;Morse et al 1998;Azaroff, Levenstein, and Wegman 2004;Burgel et al 2004;Dong et al 2007;Bernhardt et al 2009;Luckhaupt and Calvert 2010;Rosenman et al 2010).…”

Work‐related cumulative trauma disorders of the upper extremity: Navigating the epidemiologic literature

“…A primary source of epidemiologic data on CTDUE has been workers' compensation databases. Unfortunately, numerous limitations of workers' compensation data for research purposes have been cited, such as variation in policy by region and over time [Bednar et al, 1998]; variation in compliance with reporting requirements [Korrick et al, 1994]; incomplete coverage of all workers [Yassi et al, 1996]; difficulty in generating direct ''at risk'' denominators [Franklin et al, 1991;Ashbury, 1995;Yassi et al, 1996;Sprout, 1997]; differential treatment of sudden onset vs. gradual onset injuries [Webb et al, 1989;Blessman, 1991]; significant under-reporting by workers and health professionals [Fine et al, 1986;Cummings et al, 1989;Webb et al, 1989;Franklin et al, 1991;Korrick et al, 1994;Beaton, 1995;Maizlish et al, 1995;Yassi et al, 1996;Herbert et al, 1997;Meservy et al, 1997;Silverstein et al, 1997;Biddle, 1998;Homan et al, 1999]; obtaining benefits under other sickness and disability insurance [Maizlish et al, 1995]; poor measurement of exposure due to broad industrial and occupational categories [Franklin et al, 1991;Silverstein et al, 1997]; lack of validated, quantitative case definitions [Cummings et al, 1989;Franklin et al, 1991;Silverstein et al, 1997]; the limited number of coded variables, particularly with respect to clinical data [Korrick et al, Job-related factors . Differences in jobs normally held by men and women Mergler et al,1987;Ashbury, 1995;Brogmus et al,1996;…”

Integrating occupational health services and occupational prevention services*

“…A health and safety specialist coordinates education and prevention efforts, and every case of occupational disease is treated as a potential sentinel health event. Successful workplace follow-up of index cases of rotator cuff tendonitis, lead poisoning, and formaldehyde overexposure has been documented; the authors estimate that follow-up of just three cases affected 150 workers [Herbert et al, 1997].…”