BACKGROUND:  Although patients who work and have related health issues are usually first seen in primary care, providers in these settings do not routinely ask questions about work. Guidelines to help manage such patients are rarely used in primary care. Electronic health record (EHR) systems with worker health clinical decision support (CDS) tools have potential for assisting these practices. OBJECTIVE:  This study aimed to identify the need for, and barriers and facilitators related to, implementation of CDS tools for the clinical management of working patients in a variety of primary care settings. METHODS:  We used a qualitative design that included analysis of interview transcripts and observational field notes from 10 clinics in five organizations. RESULTS:  We interviewed 83 providers, staff members, managers, informatics and information technology experts, and leaders and spent 35 hours observing. We identified eight themes in four categories related to CDS for worker health (operational issues, usefulness of proposed CDS, effort and time-related issues, and topic-specific issues). These categories were classified as facilitators or barriers to the use of the CDS tools. Facilitators related to operational issues include current technical feasibility and new work patterns associated with the coordinated care model. Facilitators concerning usefulness include users' need for awareness and evidence-based tools, appropriateness of the proposed CDS for their patients, and the benefits of population health data. Barriers that are effort-related include additional time this proposed CDS might take, and other pressing organizational priorities. Barriers that are topic-specific include sensitive issues related to health and work and the complexities of information about work. CONCLUSION:  We discovered several themes not previously described that can guide future CDS development: technical feasibility of the proposed CDS within commercial EHRs, the sensitive nature of some CDS content, and the need to assist the entire health care team in managing worker health.

OBJECTIVE: The aim of this study was to determine the perceived value and feasibility of increased access to information about workers' health for primary care providers (PCPs) by evaluating the need for clinical decision support (CDS) related to worker health in primary care settings. METHODS: Qualitative methods, including semi-structured interviews and observations, were used to evaluate the value and feasibility of three examples of CDS relating work and health in five primary care settings. RESULTS: PCPs and team members wanted help addressing patients' health in relation to their jobs; the proposed CDS examples were perceived as valuable because they provided useful information, promoted standardization of care, and were considered technically feasible. Barriers included time constraints and a perceived inability to act on the findings. CONCLUSION: PCPs recognize the importance and impact of work on their patients' health but often lack accessible knowledge at the right time. Occupational health providers can play an important role through contributions to the development of CDS that assists PCPs in recognizing and addressing patients' health, as well as through the provision of referral guidelines.

OBJECTIVE: This article outlines an approach to developing clinical decision support (CDS) for conditions related to work and health. When incorporated in electronic health records, such CDS will assist primary care providers (PCPs) care for working patients. METHODS: Three groups of Subject Matter Experts (SMEs) identified relevant clinical practice guidelines, best practices, and reviewed published literature concerning work-related asthma, return-to-work, and management of diabetes at work. RESULTS: SMEs developed one recommendation per topic that could be supported by electronic CDS. Reviews with PCPs, staff, and health information system implementers in five primary care settings confirmed that the approach was important and operationally sound. CONCLUSION: This compendium is intended to stimulate a dialogue between occupational health specialists and PCPs that will enhance the use of work information about patients in the primary care setting.

CDC's National Institute for Occupational Safety and Health (NIOSH), state health departments, and other state entities maintain a state-based surveillance program of confirmed silicosis cases. Data on confirmed cases are collected and compiled by state entities and submitted to CDC. This report summarizes information for cases of silicosis that were reported to CDC for 2003–2010. The data for this report were final as of December 31, 2010. Data are presented in tabular form on the prevalence of silicosis, the number of cases and the distribution of cases by year, industry, occupation, and the duration of occupational exposure to dust containing respirable crystalline silica (Tables 1–4). The number of cases by year is presented graphically (Figure). This report is a part of the first-ever Summary of Notifiable Noninfectious Conditions and Disease Outbreaks, which encompasses various surveillance years but is being published in 2015 (1). The Summary of Notifiable Noninfectious Conditions and Disease Outbreaks appears in the same volume of MMWR as the annual Summary of Notifiable Infectious Diseases (2). | Background | Silicosis, a form of pneumoconiosis, is a progressive occupational lung disease caused by the inhalation, deposition, and retention of respirable dust containing crystalline silica. There is no effective specific treatment, and patients with silicosis can be offered only supportive care. Silicosis is preventable by using non-silica substitution materials, effective dust control measures, and personal protective equipment.* Occupational exposure to respirable dust containing crystalline silica occurs in mining, quarrying, sandblasting, rock drilling, construction, pottery making, stone masonry, and tunneling operations (3). The Occupational Safety and Health Administration (OSHA) estimates that approximately 2.2 million workers are currently exposed† to respirable crystalline silica in industries where exposure might occur: 1.85 million workers in the construction industry and 320,000 workers in general industry and maritime workplaces (4,5). Typically a disease of long latency, silicosis usually is diagnosed through a chest radiograph after ≥10 years of exposure to respirable crystalline silica dust. Nodular silicosis can also develop within 5–10 years of exposure to higher concentrations of crystalline silica. A clinical continuum exists between the accelerated and the chronic forms of silicosis. Acute silicosis has a different pathophysiology than accelerated or chronic silicosis. It might develop within weeks of initial exposure and is associated with exposures to extremely high concentrations† of crystalline silica. Respiratory impairment is severe, and the disease is usually fatal within a year of diagnosis. In addition, occupational exposure to respirable crystalline silica puts workers at increased risk for other serious health conditions including chronic obstructive lung disease, kidney and connective tissue disease, tuberculosis and other mycobacterial-related diseases, and lung cancer (6). In 1997, the International Agency for Research on Cancer classified crystalline silica as carcinogenic to humans (7), and this classification was reconfirmed in 2012 (8). | During 1968–2010, the number of deaths in the United States for which silicosis was listed on the death certificate declined from 1,065 (age-adjusted death rate: 8.21 per million persons aged ≥15 years) in 1968 to 101 (rate: 0.39) in 2010 (9). Analysis of 1968–2005 data indicated that silicosis-attributable years of potential life lost before age 65 years decreased substantially during 1968–2005, but the decline slowed during the last 10 years of that period (10). However, no decline occurred in the number of hospitalizations for which silicosis was listed as one of the discharge diagnoses during 1993–2011.§ Cases of silicosis continue to occur despite the existence of legally enforceable exposure limits.† Silicosis in any of its clinical forms is consistently undercounted by the Survey of Occupational Injuries and Illnesses (SOII), an employer-based surveillance system maintained by the Bureau of Labor Statistics (11). Estimates indicate that 3,600–7,300 new cases of silicosis might be occurring each year (11). In 2008, the National Academy of Sciences recommended that surveillance efforts to prevent silicosis and other interstitial lung diseases be continued and expanded (12). | Cases of silicosis are sentinel events that indicate the need for intervention (13). Silicosis was first designated as a notifiable condition at the national level in 1999¶ and reconfirmed in 2009.** In 2010, silicosis was a reportable condition in 25 states.†† | NIOSH has supported efforts by states to conduct surveillance for silicosis under several cooperative agreements, including the Sentinel Event Notification system for Occupational Risks (SENSOR) and the State-Based Occupational Safety and Health Surveillance agreements. In 1987, states initiated active silicosis surveillance under SENSOR and began providing data voluntarily to NIOSH (14,15). Since 1992, data summaries have been published in a series of reports.§§ The number of states¶¶ that conduct silicosis surveillance varies by year based on funding support by NIOSH. Currently, Michigan and New Jersey continue to maintain their sentinel case-based silicosis surveillance systems and intervention programs. These two states are the only states that continue to provide data voluntarily to NIOSH. | This report summarizes data for silicosis cases that met the surveillance case definition for a confirmed silicosis case for the period 2003–2010 as reported by Michigan and New Jersey. Data from state programs are updated annually and are available through the CDC's Work-Related Lung Disease Surveillance System (eWoRLD).***

OBJECTIVE: To characterize work-related asthma by gender. METHODS: We analyzed state-based sentinel surveillance data on confirmed work-related asthma cases collected from California, Massachusetts, Michigan, and New Jersey during 1993-2008. We used Chi-square and Fisher's Exact Test statistics to compare select characteristics between females and males. RESULTS: Of the 8239 confirmed work-related asthma cases, 60% were female. When compared to males with work-related asthma, females with work-related asthma were more likely to be identified through workers' compensation (14.8% versus 10.6%) and less likely to be identified through hospital data (14.2% versus 16.9%). Moreover, when compared to males, females were more likely to have work-aggravated asthma (24.4% versus 13.5%) and less likely to have new-onset asthma (48.0% versus 56.5%). Females were also more likely than males with work-related asthma to work in healthcare and social assistance (28.7% versus 5.2%), educational services (11.8% versus 4.2%), and retail trade (5.0% versus 3.9%) industries and in office and administrative support (20.0% versus 4.0%), healthcare practitioners and technical (13.4% versus 1.6%), and education training and library (6.2% versus 1.3%) occupations. Agent groups most frequently associated with work-related asthma were miscellaneous chemicals (20.3%), cleaning materials (15.3%), and indoor air pollutants (14.9%) in females and miscellaneous chemicals (15.7%), mineral and inorganic dusts (13.2%), and pyrolysis products (12.7%) in males. CONCLUSIONS: Among adults with work-related asthma, males and females differ in terms of workplace exposures, occupations, and industries. Physicians should consider these gender differences when diagnosing and treating asthma in working adults.