Abstract
Purpose
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.
Methods
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.
Results
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.
Conclusion
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.
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Availability of data and material
The data used in this analysis are proprietary to the Q(h)ubeka Trust, the Medical Bureau for Occupational Disease, and the gold mining companies that contributed employment data to the MBOD database.
Code availability
Not applicable.
Notes
Excludes backlog claims not yet entered onto the electronic information system.
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Acknowledgements
The authors thank the medical doctors who served on the panels and the administrative staff of the Medical Bureau for Occupational Diseases for their assistance. We also thank the trustees of the Q(h)ubeka Trust for permission to use anonymised information from the Trust database.
Funding
Funding was received from the Department for International Development (DFID), United Kingdom, under their Frontier Technology Livestreaming opportunity under project, “AI assisted machine-learning tool to assess miners for TB and silicosis”.
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BK and AY conceived of and oversaw the study. The protocol was developed by AY, FR, JS, and RE. Additionally, NM, MR and AF devised and implemented the triage intervention. SB and JS performed quantitative analysis and prepared the figure. All authors contributed to interpretation of the results. Various sections of the article were drafted by SB, RE, JS, KL, and AY. All authors approved of and take responsibility for the final version.
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Prof. Ehrlich has written expert reports for plaintiff attorneys in silicosis litigation. The remaining authors declare no conflict of interest.
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The study protocols were approved by the Human Research Ethics Committee, Faculty of Health Sciences, University of Cape Town (Nos. 563/2019 and 819/2019), and the Behavioural Research Ethics Board, University of British Columbia (H18/01793).
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Barker, S., Ehrlich, R., Spiegel, J.M. et al. Reforming the workers’ compensation process for occupational lung disease among miners in South Africa: an efficiency study of claims assessment. Int Arch Occup Environ Health 95, 825–833 (2022). https://doi.org/10.1007/s00420-021-01805-9
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DOI: https://doi.org/10.1007/s00420-021-01805-9