What is the most cost-effective way to identify silica problem worksites?

Background State bused surveillance systems to identify cases of silicosis have been developed over the past 18 years to target worksite interventions to reduce the incidence of silicosis, Using data from the Michigan silicos is surveillance system, we conducted an analysis to determine the most cost -effective way to identify problem worksites. Methods The initial reporting source of all 470 confirmed cases of silicosi s reported to the Michigan surveillance system from 1989 to 1995 was identi fied. The cost of identifying confirmed cases, worksites, problem worksites , silica problem worksites, and the number of current silica-exposed worker s was determined for four reporting sources: hospitals; physicians; workers ' compensations; and death certificates. Results Hospital reports were th first to identify 67% of the confirmed cas es, 74% of the worksites, and 58% of the problem worksites. Physician repor ts initially identified 17% of confirmed cases, 15% of worksites, and 26% o f problem worksites. Workers' compensation records initially identified 11% of confirmed cases, 4% of worksites, and 8% of problem worksites. Death ce rtificates initially identified 5% of confirmed cases, 7% of worksites, and 8% of problem worksites. Hospital reports were the most cost-effective way to identify cases (US$ 143), worksites (US$ 313), and problem worksites (U S$ 454). Conclusions Hospital discharge records identified the greatest number of co nfirmed cases and problem worksites and was the most cost-effective approac h to identify both individuals with silicosis and worksites with problems. Am. J. Ind. Med. 39:629-635, 2001. (C) 2001 Wiley-Liss, Inc.