Recommendations

General recommendations | Specific recommendations for improving data quality

Currently, responsibility for collecting occupational disease and injury surveillance data is dispersed amongst a variety of organisations. Surveillance objectives are often over-ridden by the diverse priorities of individual organisations.

While there will always be legitimate and unavoidable reasons for some differences in data collection, other differences may be addressed through better oversight and coordination of data collection.

General recommendations

1. Establish an expert group

We recommend the establishment of an expert group, whose principal function is to advise on the development of an effective system of occupational disease and injury surveillance, including the establishment of an independent unit and/or agency. Membership should be time-limited, allowing staged turnover to maximise fresh ideas. This group would advise the occupational disease and injury surveillance agency/unit on key topics and priority areas, including:

case definitions
coding, categories, and key indicators
data capture techniques, including those that should be mandatory
analysis, especially of narrative fields
publications
the development of surveillance of specific occupational health issues.

2. Establish an independent unit for the surveillance of occupational disease and injury

In the short term, there should be an independent unit with particular responsibility for occupational disease surveillance and also injury surveillance:

Such a unit could be “stand-alone” or housed within a particular agency; in the latter case, it is crucial that the unit and its funding are “ring-fenced” to enable it to work autonomously. It is also crucial that such a unit has adequate and secure funding, personnel, and resources.
It is also crucial that such a unit be placed in an agency which supports its activities, and which has existing experience and expertise in the methods required for effective surveillance (including epidemiology and biostatistics).
Research into occupational safety and health is essential, and the unit should ensure that the data collected by the unit is available for research as well as more routine surveillance purposes.

3. Establish an Independent Agency for surveillance of Occupational Disease and injury

The long-term goal should be to establish an independent agency for occupational disease and injury surveillance, which should:

have overall responsibility for the surveillance of occupational disease and injury in New Zealand
report to a nominated Minister who will champion the agency and its needs across government
as well as producing publications on more specific issues, produce an annual report to the appropriate Minister(s) on the burden of occupational disease and injury in New Zealand, which integrates the surveillance data obtained from the various agencies
have the mandate and authority to coordinate the data collection of the various agencies.

4. Establish an integrated concept-driven Occupational Disease and Injury Surveillance SYSTEM (ODISSY) within the independent agency

The surveillance system should be concept-driven rather than data-driven, i.e. the unit should decide what data is required and then ensure that the appropriate data is collected, rather than simply collating data that is collected by various agencies for other purposes.
Different systems are required for surveillance of occupational injury and occupational disease, but these different systems should ideally be housed within a single agency/unit.
An effective surveillance system will utilise data from multiple sources and agencies (i.e. mortality, cancer registrations, hospital admissions, NODS registrations, ACC claims). Thus, a “whole-of-government approach” is required, and there must be a commitment from all other government agencies. We recognise that these various agencies may have other priorities and collect their data for other purposes. The surveillance system should “add value” to the work of the agencies and provide incentives for them to report.
These incentives would include the unit providing appropriate feedback to the contributing agencies on a regular basis, including audit of data quality and completeness, analysis of trends, identification of priorities for interventions, and assessment of effectiveness of interventions.
In order to compare and integrate data from multiple sources and agencies, it is crucial that a unique identifier (such as the NHI number) is used in a standardised manner across all the relevant agencies. Standardisation of other information (e.g. coding of occupation, ethnicity, disease, etc) is also essential.
Characteristics of the system would include high sensitivity, specificity, representativeness, timeliness, simplicity, flexibility, and acceptability.
The system should comply with legislation and international treaty obligations.
The system should enable rapid response to emerging problems.

Specific recommendations for improving data quality

1. Improve recording of occupation in NZHIS data

Start coding occupation in the Mortality Collection, NZCR, and NMDS using the standard classification systems used by Statistics New Zealand, and code the backlog of occupation using the methods recently recommended by the report from the Centre for Public Health Research (CPHR)¹².
Include occupation in the NHI database, and record occupation histories of each patient by entering a new occupation and associating it with the date of each event using the methods recently recommended by the report from CPHR¹².

2. Extend and improve the coding of industry in NZHIS and Department of Labour data

Industry is an important variable as it can add depth to the information captured in the occupation field. For example, people whose occupation is classified as “sales representative” could be exposed to different risk factors depending whether they sell office equipment, meat packing equipment, or fertilisers. Therefore, opportunities to improve data collection include:

including industry as a variable in the Mortality Collection, NZCR, and NMDS, using the standard Statistics New Zealand classification system
aligning the industry classification system in NODS/HASARD with the standard Statistics New Zealand classification system.
developing common definitions, identifying or developing a classification system for coding and dating exposure history, and encouraging the recording of exposure histories in patient case notes where a disease has suspected occupational roots.

3. Improve data accuracy

NZHIS should work with hospitals to improve the use of work-related E codes in ICD-10-AM 3rd Edition.
ACC should improve the coding of work-relatedness, proximal cause, and occupation for all claims.
ACC should ensure claim data is updated on the claims database (e.g. following a change in diagnosis).
DoL should review the classification systems and field structures used for recording occupation, industry, diagnosis, agent, and mechanism, with a view to aligning these with standard classification and coding systems and using hierarchical pick-lists for data entry.
DoL should ensure case data is updated upon completion of each investigation.
All agencies should regularly audit the quality of data and publish the results of these audits.

4. Extend and improve the Notifiable Occupational Disease System (NODS)

The Department of Labour should take deliberate steps to increase reporting by general practitioners and others of suspected occupational disease cases. Examples of potential steps include:

targeting employees, unions, and employers and disseminating information about key disease risks (e.g. by industry/occupation) and symptoms to monitor
targeting GPs with information about key disease risks, associated symptoms, questions that they could ask their patients to assist in identifying suspected cases, and to raise awareness about NODS reporting
providing feedback to GPs and others to promote the value of NODS data (acknowledging the current low base and demonstrating improvement in data capture over time)
continuing to enhance those aspects of NODS which are currently working well, including the work of the DoL disease panels. This must include providing adequate resources for the panels, including the resources for collection of data.

5. Improve recording and investigation of work-relatedness of disease and injury

Establish a coronial database to enable surveillance and systemic learning from coronial findings, with a specific module for work-related deaths.
Expand the role of the Coroners’ Court to include inquiry into suspected cases of occupational disease (as occurs in some other countries including the US, Ireland and Hong Kong).
Modify death certificates to capture the certifying medical practitioner’s opinion as to whether the disease was work-related.
Amend the BDM database to capture this information.
Broaden the definition of work-relatedness associated with the corresponding indicator in the Mortality Collection to include suspected occupational disease.
Record the medical practitioner’s opinion within the Mortality Collection.

6. Collect additional information on work-relatedness, occupational history, and exposure history

Develop a common definition of work-relatedness to apply in the recording of occupational disease and injury by NZHIS, DoL, and ACC.
Develop a staged indicator of work-relatedness, for example, to record whether a case is suspected or confirmed, for use by NZHIS and DoL (not applicable to ACC).
Develop common definitions and fields for recording current occupation (at time of diagnosis) and usual occupation (if different from current occupation) in order to identify both potential sources of exposure (applicable to all systems).
Develop common definitions and fields for coding and dating occupation history and encourage the recording of occupation histories in patient case notes where a disease has suspected occupational roots (applicable to all systems).