Reforming the workers' compensation process for occupational lung disease among miners in South Africa: an efficiency study of claims assessment.
Compensation
Computer aided detection
Process efficiency
Silicosis
Triage
Tuberculosis
Journal
International archives of occupational and environmental health
ISSN: 1432-1246
Titre abrégé: Int Arch Occup Environ Health
Pays: Germany
ID NLM: 7512134
Informations de publication
Date de publication:
05 2022
05 2022
Historique:
received:
02
06
2021
accepted:
24
07
2021
pubmed:
10
1
2022
medline:
28
4
2022
entrez:
9
1
2022
Statut:
ppublish
Résumé
The large burden of silicosis and tuberculosis (TB) in the South African mining industry, coupled with an under-resourcing of the compensation agencies responsible for certifying occupational lung disease, have resulted in serious backlogs. This work aimed to measure the efficiency gains from triaging occupational lung disease claims using claim type, years of mining exposure and computer aided detection (CAD) to save on scarce medical adjudicators. During 2020, the compensation authority started to triage claims for TB and those of miners with < 10 years of service to two-person panels instead of the four-person panel plus radiologist used previously. Efficiency gain was calculated in medical person-units saved and reduction in delays. Different service thresholds predictive of silicosis were simulated, as well as the impact of pre-classification of chest X-rays with CAD using different combinations of sensitivity and specificity. The new triage system saved 20.3% in person-time units and reduced delays by 10-20 days. Without CAD the greatest efficiency gain (28%) was projected from dispensing with a mining service threshold and routing all non-TB claims to the small panels at the outset. Simulation of four different CAD sensitivity/specificity combinations yielded efficiency gains of 18.2-36.1%, with 31.1% judged the most realistic. Use of sensitivity of close to 100% would not be feasible because of the very low resulting specificity. Pre-adjudication triage of claims at the compensation agency is capable of saving a substantial proportion of adjudicator time and reducing certification delays. Additional efficiency gains are achievable by referring all claims to small panels to begin with and improvement of CAD performance for this ex-miner population.
Identifiants
pubmed: 34999999
doi: 10.1007/s00420-021-01805-9
pii: 10.1007/s00420-021-01805-9
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
825-833Informations de copyright
© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.
Références
Adams S, Ehrlich R, Ismail N, Quail Z, Jeebhay MF (2013) Occupational health challenges facing the Department of Health. In: Padarath A, English R (eds) South African Health Review 2012/2013. Health Systems Trust, Durban, pp 67–82
Broughton T (2019) Landmark silicosis settlement made order of court. Groundup, 26 July. https://www.groundup.news/article/landmark-silicosis-settlement-made-order-court/ Accessed 15 May 2021
Brouwer DH, Rees D (2020) Can the South African milestones for reducing exposure to respirable crystalline silica and silicosis be achieved and reliably monitored? Front Public Health 8:107. https://doi.org/10.3389/fpubh.2020.00107
doi: 10.3389/fpubh.2020.00107
Ehrlich RI (2012) A century of miners’ compensation in South Africa. Am J Ind Med 55(6):560–569. https://doi.org/10.1002/ajim.22030
doi: 10.1002/ajim.22030
Ehrlich RI, Montgomery A, Akugizibwe P, Gonsalves G (2017) Health implications of changing trends in the origins and characteristics of mineworkers in South Africa, 1973–2012. BMC Public Health 18 (93) https://doi.org/10.1186/s12889-017-4640-x
Franzblau A, teWaterNaude J, Sen A, d’Arcy H, Smilg JS, Mashao KS et al (2018) Comparison of digital and film chest radiography for detection and medical surveillance of silicosis in a setting with a high burden of tuberculosis. Am J Ind Med 61(3):229–238. https://doi.org/10.1002/ajim.22803
doi: 10.1002/ajim.22803
Harris M, Qi A, Jeagal L, Torabi N, Menzies D, Korobitsyn A et al (2019) A systematic review of the diagnostic accuracy of artificial intelligence-based computer programs to analyze chest x-rays for pulmonary tuberculosis. PLoS One 3;14(9):e0221339. https://doi.org/10.1371/journal.pone.0221339
Khan FA, Pande T, Tessema B, Song R, Benedetti A, Pai M et al (2017) Computer-aided reading of tuberculosis chest radiography: Moving the research agenda forward to inform policy. Eur Respir J 50(1):1700953. https://doi.org/10.1183/13993003.00953-2017
doi: 10.1183/13993003.00953-2017
Kistnasamy B, Mtshali N (2017) Compensation Commissioner for Occupational Diseases. Update to Portfolio Committee on Planning, Monitoring & Evaluation. 27 November. https://pmg.org.za/files/171129CCOD.pptx Accessed 29 May 2021
Kistnasamy B, Yassi A, Yu J, Spiegel SJ, Fourie A, Barker S et al (2018) Tackling injustices of occupational lung disease acquired in South African mines: recent developments and ongoing challenges. Global Health 14(1):60. https://doi.org/10.1186/s12992-018-0376-3
doi: 10.1186/s12992-018-0376-3
Knight D, Ehrlich RI, Fielding, K, Jeffery H, Grant A, Churchyard G (2015) Trends in silicosis prevalence and the healthy worker effect among active gold miners in South Africa BMC Public Health 15 (1258). https://doi.org/10.1186/s12889-015-2566-8
Knight D, Ehrlich R, Cois A, Fielding K, Grant A, Churchyard G (2020) Predictors of silicosis in an industry wide study of working gold miners. BMC Public Health 20:829. https://doi.org/10.1186/s12889-020-08876-2
doi: 10.1186/s12889-020-08876-2
Leger JP (1992) Occupational disease in South African mines - a neglected epidemic?. S Afr Med J 81(4):197–201
Maiphetlho L (2010) Ehrlich R (2010) Claims experience of former gold miners with silicosis – a clinic series. Occ Health Southern Afr 16:10–16
McCulloch J (2012) South Africa’s gold mines and the politics of silicosis. Johannesburg, James Currey
Minerals Council of South Africa (2020) Joint effort to improve the occupational lung disease compensation system. Fact sheet: https://www.mineralscouncil.org.za/search-results?q=compensation . Accessed 15 May 2021
ODMWA (2019) Occupational Diseases in Mines and Works, Act 78 of 1973 (Updated to 1 October 2019). http://www.saflii.org/za/legis/consol_act/odimawa1973385.pdf . Accessed May 15 2021
Park HH, Girdler-Brown BV, Ehrlich RI, White N, Churchyard G (2009) Incidence of tuberculosis and HIV and progression of silicosis and lung function impairment among former Basotho gold miners. Am J Ind Med 52(12):901–908. https://doi.org/10.1002/ajim.2076
doi: 10.1002/ajim.2076
Parliamentary Monitoring Group (2011) Minister and Department of Health on Compensation Commission for Occupational Diseases 2009/10 Annual Report: hearings. Cape Town: Parliamentary Monitoring Group. https://pmg.org.za/committee-meeting/12688/ Accessed 29 May 2021
Q(h)ubeka Trust (undated). https://www.qhubekatrust.co.za/ Accessed 15 May 2021
Spiegel J, Ehrlich R, Yassi A, Riera F, Wilkinson J, Lockhart K et al (2021) Using artificial intelligence for high-volume identification of silicosis and tuberculosis: A bio-ethics approach. Ann Glob Health 87(1):58. https://doi.org/10.5334/aogh.3206
doi: 10.5334/aogh.3206
Tshiamiso Trust (undated). https://www.tshiamisotrust.com/ Accessed 21 July 2021
Young C, Barker S, Ehrlich R, Kistnasamy B, Yassi A (2020) Computer-aided detection for tuberculosis and silicosis in chest radiographs of Southern African gold miners. Int J Tuberc Lung Dis 24(4):444–451. https://doi.org/10.5588/ijtld.19.0624
doi: 10.5588/ijtld.19.0624