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The NC Agromedicine Institute is a University of North Carolina Institute.

Member Universities:
East Carolina University
North Carolina State University
NC Agricultural & Technical State University
 
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Clinic Level Injury and Illness Surveillance
Project Name: Clinic Level Injury and Illness Surveillance

Principal Investigators: Susan Gustke, MD, FACP, (deceased), East Carolina University
Theresa Costello, M.S., MBA/IM, PT, NC State University

Project Type: Research

Project Description: The migrant and seasonal worker population in NC agriculture is significant and at risk for agricultural injury or illness. A protocol for conducting active surveillance to identify trends in injury and illness among this population is being developed. A pilot protocol to gather this information is being tested at three clinics who serve the migrant worker population.

Project Accomplishments: The overall objective of the project was to develop and test a clinic-level occupational injury and illness (OI&I) surveillance system that would help better understand occupation-related injuries and illnesses of individuals employed in agriculture, fishing, forestry, nurseries/greenhouses, food processing or food packing. The project also had the objective of promoting improved quality of patient care while more cost effectively and efficiently collecting occupational injury and illness surveillance data. Specifically, the pilot project had the following goals:

  1. Develop and test an intake form that would prospectively collect occupational injury and illness information from patients accessing community health centers for treatment.
  2. Create a database that could be used by health practitioners and researchers to improve quality of care for occupational injuries and illnesses relating to employment in agriculture, fishing, forestry, nurseries/greenhouses, food processing or food packing.

The pilot project began in September 2001 at the Robeson Health Care Center in Fairmont, North Carolina. The clinic’s medical director initially committed to the pilot project for one year. Because of the improvement in patient care as a result of using the OI&I intake form, the pilot project has been adopted as an on-going component of the clinic’s patient intake and treatment process. Since the pilot project was successful integrated into the regular patient intake process, the cost of surveillance data collection was minimal compared with the cost of retrospective chart audit protocols traditionally used for occupational injury and illness surveillance. Although the original pilot project design had anticipated expanding into other clinics, after year one, it was determined that it would be more effective to successfully establish the project long-term in one clinic. Given that the Robeson Health Care Center is part of a larger network of community health centers and the project has been supported by the North Carolina Community Health Center Association, it will serve as a best practice model for future expansion of the OI&I clinic-level surveillance project into other community health centers in North Carolina, as well as other states and countries. A major challenge of the study was gaining access to health care centers and identifying an internal “champion” for the pilot project. This was successfully accomplished with the Robeson Health Care Center. A database has been established and it is anticipated that a centralized data entry and database management process was established December, 2004. Publications are forthcoming.

Preliminary Findings to Date:
Among agricultural workers:

  • Females and children come for health care first, then men.
  • Weather influences when patients come in for treatment.
  • STD’s and UTI’s are common diagnoses.
  • Limited work-related musculoskeletal strains and sprains and injuries are treated at the clinic-level.

Improved patient care:

  • Patient information collected prior to meeting with physician - time saver!
  • Spanish language materials help with language barrier and limited translation resources
  • Improved understanding of injury/illness mechanism helps with more accurate and faster diagnosis and treatment.

Achievements and Outcomes: The USDA pilot project phase of the clinic-level occupational injury and illness surveillance project has created an OI&I intake form and process (in English and Spanish) that not only improves patient care but can also be cost effectively expanded into other community health clinics, outreach settings, emergency rooms, etc. Additionally, presentations have increased awareness and understanding of occupational injuries and illnesses affecting agricultural workers, in particular. It is anticipated that this increased awareness and understanding will help health care practitioners more effectively address occupation-related injuries and illnesses affecting individuals employed in agriculture as well as other occupations within their communities. Findings from the clinic-level surveillance contributed to an ergonomic assessment of ground crops and subsequent projects designed to reduce agriculture related WMSD and injuries funded by NIOSH.

Publications:
Costello, T., Mirka, G. Benefits of a Multi-Perspective Approach to Agricultural Injury and Illness Assessment and Ergonomic Intervention. ASAE Annual International Meeting Proceedings, Las Vegas, NV, July 26 – 31, 2003.

Presentations:
Costello, T. Panel Participant: A Health Profile (NC occupational health and safety). Annual Conference 2001, Farmworkers in Transition: Contributing to North Carolina's Future by Recognizing Trends and Improving Services. North Carolina Farmworker Services Coordinating Committee, Atlantic Beach, NC, April, 2001.

Costello, T., Tierney, M. & Butterworth, M. Identifying Musculoskeletal Injury and Illness in Farmworkers. NC Farmworker Health Outreach Training I, Brown Summit, NC, April, 2001.

Costello, T., Mirka, G. Benefits of a Multi-Perspective Approach to Agricultural Injury and Illness Assessment and Ergonomic Intervention. ASAE Annual International Meeting, Las Vegas, NV, July 26 – 31, 2003.

Costello, T., Mason, C., Miranda, J. & Sabella, J. Using Ergonomics in the Prevention and Treatment of Occupational Injuries among Farmworkers. 16th Annual East Coast Migrant Stream Forum, Tarrytown, NY, October 2-25, 2003.

Costello, T., Floyd, H. & Sabella, J. Clinic-level Occupational Injury and Illness Surveillance Pilot Project. 2004 National Symposium on Agricultural Health and Safety. Keystone Resort, Colorado, June 20-24, 2004.

Costello, T., Mason, C., Miranda, J. & Sabella, J. Using Ergonomics in the Prevention and Treatment of Occupational Injuries among Farmworkers. 16th Annual East Coast Migrant Stream Forum, Tarrytown, NY, October 2-25, 2003.

Costello, T., Floyd, H. & Sabella, J. Clinic-level Occupational Injury and Illness Surveillance Pilot Project. 2004 National Symposium on Agricultural Health and Safety. Keystone Resort, Colorado, June 20-24, 2004.

Costello, T. & Mirka, G. Ergonomic Assessment of North Carolina Ground Level Crop Production. 2004 National Symposium on Agricultural Health and Safety. Keystone Resort, Colorado, June 20-24, 2004.

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