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Setting the bar... low: Healthy People 2020
Injury rate goal almost met before start of decade
Healthy People 2020, the nation's blueprint for a healthier populace, includes several occupational health goals but with very low expectations for progress.
The objectives set a goal of 10% improvement in the next decade in the overall injury rate, work-related fatalities, assaults, skin disorders and diseases, and the rate of cases involving overexertion or repetitive motion that led to days away from work.
However, Healthy People 2020 used 2008 as the baseline and the goal for a reduced injury rate was almost met by 2009, a year before the program began. In 2008, the U.S. Bureau of Labor Statistics reported an injury rate for general industry of 4.0 per 100 fulltime workers. In 2009, the rate dropped to 3.7. The goal for 2020 is a rate of 3.6. The rate of overexertion cases involving days away from work already dropped by 5% from 2008 to 2009 from 26.4 to 25 per 10,000 fulltime workers.
By contrast, Healthy People 2020 sets a goal for reducing healthcare-associated infections by 75%.
The 10% goal was a default target based upon the difficulty of changing population-based measures, says Carter Blakey, acting deputy director of the Office of Disease Prevention and Health Promotion and the lead for community strategies at the U.S. Department of Health and Human Services.
With more aggressive goals in Healthy People 2010, only about 20% of the targets were met, she says. "To be effective, [the advisory committee] felt the Healthy People 2020 targets should be achievable and realistic," she says.
In some cases, there are already goals set by quality improvement organizations or governmental agencies. For example, an HHS action plan calls for a 50% reduction in the incidence of healthcare-associated invasive MRSA infections and in central line-associated bloodstream infections in the ICU.
The National Institute for Occupational Safety and Health (NIOSH) provided input on the occupational health and safety objectives but didn't have the metrics to establish a higher goal, based on the Healthy People 2020 criteria, says Lore Jackson Lee, MPH, workgroup coordinator for the occupational safety and health focus area in Healthy People 2020. Lee is in the NIOSH Office of Planning and Performance in Atlanta.
"We aren't limiting ourselves to trying just to have a 10% improvement," Lee says.
It's possible to change the goals over the course of the decade, Blakey says. "We're developing a process that will allow us to take a look at the objectives and allow for some updates and revisions," she says.
Progress still elusive in HC
Hospitals may face greater challenges as they seek to reduce their injury rates. The overall injury rate in hospitals is significantly higher than for general industry 6.7 per 100 fulltime employees in 2009 and it declined only by 4% from the 2008 rate of 7.0.
Cases involving days away from work due to overexertion typically related to lifting actually rose from 2008 to 2009, from 60 to 61.8 cases per 10,000 fulltime employees.
NIOSH provides a guide for making improvements through its National Occupational Research Agenda (NORA). The agenda calls for a 25% reduction in the rates of sprains and strain injuries involving days away from work in hospitals and nursing homes due to patient handling by 2016.
NIOSH is funding additional projects on MSD injuries and assaults in health care and is developing employee education materials, says Teri Palermo, RN, public health adviser and coordinator of the health care and social assistance sector of NORA. "We feel confident there will be some movement in those areas by 2020," she says.
In the bigger picture, employers also can impact other Healthy People 2020 objectives with wellness and health promotion programs. In fact, the trend in occupational health is to take an integrated approach, says Palermo.
"There's a movement to look at the total health of the worker to look at off-work exposures as well as at-work exposures and how they impact productivity and the healthcare cost to the employer," she says.
At hospitals, a culture of safety has an even broader impact, she notes. "If a health care worker is stressed, working hurt, or sleep-deprived, or if the worker is afraid of on being assaulted, all those things affect the ability to provide quality care," she says.