Transcript Keaney_evaluation health data

EPA’s Health Care Provider Initiative
Kevin Keaney, Chief
Pesticide Worker Safety Programs
U. S. EPA
2005
EPA’s Health Care Provider Initiative
EPA’s Health Care Provider Initiative
EPA’s Health Care Provider Initiative
EPA’s Health Care Provider Initiative
EPA’s Health Care Provider Initiative
Resources for Pesticide Competency & Practice Skills
Government
-- Federal Government Agencies
-- State Government Contacts and Resources
Resources and Publications
-- Key Resources on the Web
-- Handbooks, Databases, and Publications
-- Software and Training
-- Case Studies
-- Journals
Background Papers
-- A Pesticide Primer
--Pesticide Laws and Regulations Glossary
Environmental History Taking Tool
EPA’s Health Care Provider Initiative
2005 - 2010
EPA’s Health Care Provider Initiative
Pacific Northwest Agricultural Safety & Health Center
(PNASH)
Established in 1996
One of nine Agricultural Safety & Health Centers created by NIOSH
Part of the Dept. of Environmental & Occupational Health Sciences at the
University of Washington School of Public Health & Community Medicine.
Ranked as fourth best school of public health in the nation.
Goal:
Reduce occupational disease and injury among those who work in
agriculture and their families.
Emphasizes partnerships and collaboration with a wide range of
stakeholders, from employers to community organizations.
EPA’s Health Care Provider Initiative
2005 - 2010
EPA’s Health Care Provider Initiative
Migrant Clinicians Network
A national, not-for-profit organization
Founded in 1984 by clinicians working in migrant health.
Nearly 2,000 members
The oldest and second largest clinical network serving the
underserved
Goal:
Improve health care of migrants and other mobile poor
populations by providing support, technical assistance,
and professional development services to clinicians.
Tracking Occupational
Pesticide Incidents
for Pesticide Worker Safety
.
Occupational Pesticide Incidents
Incidents:
“health” = a well-documented exposure from
pesticide use in an occupational context
resulting in adverse health effects. The
source of the data must be credible, accurate
and unbiased.
“enforcement” = a well documented regulatory
agency’s pesticide enforcement action.
Problem and Intent
Problem: Currently there is no national
program that collects accurate, unbiased
pesticide incident data.
Statement of Intent: Collect, analyze and
communicate accurate, unbiased
incident data in order to improve risk
assessment, risk management and field
programs that affect occupational
pesticide workers.
Goals
Utilize incident data to:
1. Improve field programs
2. Improve risk assessment
3. Improve risk management
4. Enhance communications with
stakeholders
5. Evaluate program progress
Pesticide Worker Safety
Workers Exposed
to Pesticides
Data Selection
Identify
Evaluate
Select
Establish & Communicate
Safety Measures
Risk Management
Data Analysis
Outcome Measures
Trend Analyses
Communicate
to the public
Feedback to Data Selection
Data Selection: Incident
Databases
There are a number of databases which
capture worker incident data. Specific
criteria will be used to evaluate and make
proposed decisions for our use of these
data bases.
Data Selection
• Are the data valuable, acceptable, useful,
and meaningful?
• Is the associated burden low – easy to
collect, costs are acceptable, small
number of measures, and user friendly
• Data that can be used now
• Data that could be used, if modified
Data Selection List
Health
Enforcement
Support Data
SENSOR
National Pesticide
Field Data plan
National
Agricultural
Workers Survey
CA Program
Poison Control
Compliance Action
Tracking Systems
FIFRA 6(a)2
Bureau of Labor
Statistics
NPIC
Usage Data
Worker’s Comp
Cert. Applic. #s
WA ChE
Data Collection Evaluation Criteria
Content
Occupational extractability
Chemical type - active ingredient
Level of detail in case description, raw data
Link to enforcement - specific violations, investigations, independent
verification
Classification of probability - causality, confidence in pesticides being cause
Severity index - how serious were symptoms
Representative
Data reliability - collection method; are incidents self-reported or do the data
originate from health care practitioner; is there follow-up on the cases
Baseline availability - data longevity, depth and breadth of database
Presentation
Accessibility - can we get the data, is it in a database, are the formats
consistent, cooperation of owner
Cost
$, FTE
Health Data Selection: Evaluation
Data Source
Chemic
al
collect
ed
Occupati
onal
expos
ure
Representativ
e sample for
nation
Userfriendli
ness
Classificatio
n of
probability
Severit
y index
Link with
enforceme
nt
Data
reliabilit
y
Data
accessibi
lity
Level of
detail
Baseline
available
Cost
Proposed
Decision
Y
Y
Y
Y
Y
Y
N
H
Y
M
Y
M
accept
Y
Y
N
Y
Y
N
Y
H
Y
H
Y
L
accept
Y
Not well
?
?
N
Y
N
L
Y
M
Y
M
accept
Y
Not
well
N
N
N
Y
N
L
N
L
Y
L
improve
Y
N
Y
Y
N
L
N
L
Y
H
reject
N
N
N
Y
N
H
N
H
N
H
reject
SENSOR
PISP
PCC/
TESS
FIFRA 6(a)2
NPIC
Y
Workers
Comp
N
Not
well
Y
Enforcement Data
•Information on regulatory investigations linked to
specific incidents useful for:
• Determining application specifics and why incident occurred,
• If a violation, which part of the regulatory scheme was not
followed
• Tracking incident cause in order to formulate program
improvements
•OECA “5700” Forms summarize state inspection totals -
includes totals by WP rule sections
•Most states only report federally funded inspections -
enforcement data is subset of state total
National Pesticide Field Data – Enforcement
• Database is a collection of closed pesticide
enforcement cases from several states
Severely limited in content for purposes of
incident analysis, exact violation not collected
No quality control of the data - no plan for links
to incident data
Proposed action: enforcement and state liaisons
should pursue development to improve
usefulness for measures. In its current state, the
data are not useful.
Compliance Action Tracking Systems Enforcement
• Systems were developed to help state lead agencies
communicate their enforcement activities. Two
regions and several states outside those regions use
these tracking systems for their enforcement data.
+ Collects enforcement data
- Unclear whether adequate detail is available
- Link to incident data seems absent
Proposed Action: continue review and work with
enforcement and state liaisons on gathering
enforcement data
Supporting Data
Information about pesticide use patterns,
migrant worker demographics, worker
attributes
Used to characterize exposed populations and
develop incident rate estimates
Important in understanding the context of
pesticide and agricultural worker issues.
Supporting Data
• National Agricultural Worker Survey
• Bureau of Labor Statistics
• Pesticide usage data – amount used on
crops by state - includes USDA / NASS,
Doane, CA pesticide use reporting
• Certified applicator numbers
Health Care Provider Initiative
&
National Incidents Report
ANY QUESTIONS ?