Measuring Results

1
Measuring Results In Occupational Health
Benjamin C. Amick III, Ph.D. Associate Professor
of Behavioral Sciences and Epidemiology School of
Public Health University of Texas Health Science
Center at Houston Associate Director Texas
Institute for Society and Health
1st International Symposium Occupational Risks
in the Public Sector November 7-8, 2002 Oviedo,
Spain
2
Todays Business Language for New Management
Practices and Workplaces Where is Health?

• Global Integration
• Technology-based Strategy
• Rationalization of Core/Periphery Business
• Reorganizing Workflow, Job Design and HR (Core
  and Contingent Workforce)
• Managing Supply Chains
• High Performance Practices
• Labor Relations

3
Five Key Concepts For Social Action To Change
Labor Markets To Improve Health
1. Complementarity Institutional strategic
2. Participation Local boundary spanning (e.g.
regional-global)
3. Power Ability to cut across social/organization
al fissures
4. New Metrics
?
5. Non-Linearity
Amick and Wallerstein, 2002
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Why Measure Work Outcomes?

• To assess productivity loss in clinical trials
• To evaluate health service effectiveness
• To target injury and re-injury prevention
• To maximize worker work capacity
• To improve provider-worker and provider-engineer
  interaction
• To improve labor-management communication over
  health
• To describe health inequities
• To communicate with policy leaders and change
  agents

5
Work Outcomes Commonly Used In Health Research

• Incidence and Prevalence
• Employment Status - Return to Work
• Disability Claims/OSHA Logs
• Time Loss, Productivity Loss or Gains
• Percent Effectiveness at Work
• Social Role Functioning Measures
• Work Focused Questionnaire Limitations in
  Ability to Meet Work Demands Due to Health

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Company Environment
Disability Prevention Management Interventions
Outcomes
Habeck et al, 1998
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Impact of A 10 Change In Organizational Action
on Lost Work Day Cases/100 Employees
Reduction In Lost Work Days
Source Habeck et al., 1998
8
Treatment Variations Create A 13 Productivity
Gap
NSNon Sedating Antihistamine SSedating
Antihistamine
Source Cockburn et al, JOEM 1999
9
Why Self-Reported Outcomes Are of Value

• Administrative data easy to collect, but limited
  by information available and potential biases
• Clinical data expensive to collect
• Worker self-report easy to obtain and capture
  worker relevant outcomes
• Best solution multiple sources of data collection

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Capturing Self-Reported Health-Related
Performance Advances Measurement
Usual Therapy
3
Sumatriptan
2.2
1.6
2
Mean Hours Lost Time
1
0
plt0.05, sumatriptan vs. usual therapy
Adelman et al., 1996
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Work Limitation Captures More of the Disability
Ice Berg
Lost Time
Limitations In Ability To Meet Work Demands
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SF-36 Role Functioning Scale Sets The Stage For
New Outcome Measures
75
?
Shoulder (N16)
Elbow (N15)
Wrist/Hand (N34)
Source Data from Cheng et al, 2001
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SF-36 Role Functioning Items Mix Work and Other
Roles

• Cut down the amount of time you spent on work or
  other activities
• Accomplished less than you would like
• Were limited in kind of work or other activities
• Had difficulty performing the work or other
  activities

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Work Role Functioning A Conceptual Overview
Work Productivity
Work Demands
Health-Related Work Role Functioning
Individual Performance
Health Status
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Work Role Functioning WRF-27

• 27 Items covering 5 work dimensions time
  management (work scheduling), physical demands,
  social demands, psychological demands, output
  demands
• Response categories anchored by of time to
  facilitate development of cost algorithms
• Respond about the past 4 weeks
• Applicable to a range of jobs in the economy
• Employs a Does Not Apply to My Job category
• Applicable to a range of illness and disease
  states

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Measuring Work Role Functioning

• In the past 4 weeks, how much of the time did
  your physical health or emotional problems make
  it difficult for you to do the following

Most of The Time
Half of The Time (50)
A Slight Bit of The Time
None of The Time (0)
Does Not Apply to My Job
All of The Time (100)
Start on job as soon as you arrived at work
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Work Role Functioning A Conceptual Overview
Work Productivity
Work Demands
Health-Related Work Role Functioning
Individual Performance
Health Status
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Health-Related Work Role Functioning Predicts
On-The Job Performance
360
350
340
330
320
Predicted Average Call Handling Time (Seconds)
310
300
290
280
270
260
0
50
100
Work Role Functioning
Source Lerner and Amick 1999, This study Uses
WLQ from Lerner et al, 2001
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Work Role Functioning Economic Valuation

• Physical Demands, Output Demands and Work
  Scheduling Demands
• A 10 point increase in work role functioning
  associated with a 5-6 increase in total
  productivity
• For those with depression, a 10 point increase in
  work role functioning associated with a 15-20
  increase in total productivity

Source Lerner et al, 2002 This study Uses WLQ
from Lerner et al, 2001
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Measuring Work Functioning as A New Metric for
Health Care Provider Accountability
Changes Following Physical Therapy Treatment
Company Norm 85
Source Amick et al, 2000
21
Measuring Work Role Functioning as a New Metric
for Business Accountability
Changes Following Carpal Tunnel Surgery
Public Revenue Co. Norm
Mail Order Co. Norm
Work Role Functioning
WRF gt 90
91 lt WRF gt 74
WRF lt 75
Source Unpublished Data
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Measuring Work Role Functioning as a New Metric
for Business Accountability
Changes Following Purchase of a New Office Chair
Work Role Functioning
WRF gt 90
91 lt WRF gt 74
WRF lt 75
Source Unpublished Data
23
Work Role Functioning Improved 18 in Nurse
Telecare For Depression
Changes Following Physician Directed Nurse
Telecare
Work Role Functioning
Source Unpublished Data
24
Back of the Envelope Cost Calculation For Nurse
Telecare Project

Source Unpublished Data
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Importance of Expanding Our Definition of A
Productive Life

• Look beyond the business case to the human and
  social case
• Consider other roles
• Household functioning
• Leisure time functioning
• College student role functioning
• Civic functioning
• Idea of Whole Life Functioning

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ROI for Ergonomics Improvements in Office
Environments
Twelve months post intervention

• A one point reduction in pain is associated with
  a
• 22 increase in revenue collections

• Office chair with office ergonomics training
  intervention
• is associated with a 2.32 point pain reduction

• This leads to a productivity increase of 2415
• 2.32 (pain reduction) x
• 1041 (monthly increase revenues collected)

Source DeRango, Amick et al., 2002
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Thank You
Presentation Available At www.benamick.com