Key features of high-quality occupational disease and injury surveillance systems
The review of international systems for the surveillance of occupational disease and injury5 revealed several key features of high-quality occupational surveillance systems. (Note, these are not ranked in importance.)
Data inputs
Both worker health and injury are monitored with an equal focus on occupational disease and injury. The division between “health” and “injury” is arbitrary and depends on the context existing in each jurisdiction. Surveillance systems that focus on only one or the other are necessarily weakened by the types of boundary disputes over causation and responsibility that occur.
The work environment is comprehensively monitored, in addition to worker health status (due to illness or injury). The effectiveness of surveillance systems is derived from observing correlations between factors in the work environment and workers’ health status.
Multiple data capture techniques are used, in a targeted and effective manner, including:
- mandatory disease or injury reporting by healthcare providers or facilities
- mandatory disease or injury reporting by employers or workplaces
- reports by laboratories
- sentinel surveillance
- periodic or ongoing prevalence surveys
- vital records
- secondary analysis of data sets collected for other purposes
- expert opinion
- mixed systems.
Data should be included from national, regional, and enterprise levels.
Surveillance system – including functions, characteristics and quality assurance
Case definitions are standardised and accurately applied. These should be based on the best available standard international classifications, augmented by expert agreement.
The system of defining cases needs to be able to effectively manage ill-defined health and injury problems, such as the spectrum of clinical “syndromes” over which there may not be either clinical or administrative agreement. This requires development of a classification system that has forward flexibility, allowing inclusion of more detailed sub-categories as soon as expert agreement can be obtained.
A standardised minimum data set should be used, which conforms to international trends for data collection, allowing “harmonised” data to be compared and contrasted meaningfully.
The system should provide suitable incentives to maximise data capture. The types of incentives used can range from providing contributors with information on why the surveillance system exists, right through to mandatory reporting requirements.
The system should comply with legislation and international treaty obligations.
The system should have a core concept-driven design, based on excellent theoretical models, but also take advantage of opportunities to collect secondary data wherever possible. This means it should make use of multiple data sources, including opportunistic and custom-designed ones.
The system should be capable of effectively managing data collected for other purposes to minimise bias.
The system uses a comprehensive range of selected indicators and, wherever possible, collects information in free-text fields.
Systems need to be well-designed and implemented, with the core attributes of sensitivity, specificity, representativeness, timeliness, simplicity, flexibility, and acceptability.
Systems should include appropriate validity and reliability checks.
Those responsible for managing the system should act responsibly to minimise both false positives and false negatives. The strength of evidence underlying estimates from the surveillance system should be reported.
It should be cost-effective.
Ongoing system improvement should be based on usefulness, cost, and quality.
Universal usage of a unique identifier so that different data sets can be directly compared and integrated.
The system should be effective at managing ethical matters, such as privacy issues arising from tracking workers across job changes.
The system should be capable of rapid response to emerging problems.