Measuring Work Outcomes

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Measuring Work Outcomes
Benjamin C. Amick III, Ph.D. Associate
Professor School of Public Health University of
Texas Health Science Center at Houston Associate
Director for Training, Education and Leadership
Development Texas Institute for Society and
Health
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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 the effectiveness of health services
• To target injury and re-injury prevention
• To maximize work capacity of workers
• 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

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Work Outcomes Commonly Used In Health Research

• Employment Status - Return to Work
• Disability Claims/OSHA Logs
• Time Loss
• Percent Effectiveness at Work
• Social Role Functioning Measures
• Work Focused Questionnaire Limitations in
  Ability to Meet Work Demands

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Organizational Business Characteristics
Company Environment
Managerial Style Corporate Culture
Disability Prevention Management Interventions
Before Injury Behaviors
After Injury Responses
Injury Incidence
Outcomes
Disability Incidence
Disability Duration
Overall Outcomes Costs
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
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Treatment Variations Create A 13 Productivity Gap
NSNon Sedating Antihistamine SSedating
Antihistamine
Source Cockburn et al, JOEM 1999
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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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Measuring Lost Productivity In Clinical Trials
Advanced By Capturing Health-Related Performance
2.2
1.6
Mean Hours
plt0.05, sumatriptan vs. usual therapy
Adelman et al., 1996
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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 Key Design Criteria

• Questions have to be understood consistently
• People have to be able and willing to answer
  questions
• Respondent burden must be minimized
• Answers must have clinical utility
• Answers must have economic valuation

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Work Role Functioning Phase I Content
Development

• Conceptual development of work demand dimensions
  based on work classification systems developed
  for the US economy
• Focus groups (N14) by disease to identify key
  items phrasing
• Cognitive interviews to assess item comprehension
  and response scales (n70)

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Work Role Functioning Phase II Validation
Studies

• Expert MD panel to assess content validity
• Matched case-control to asses validity of
  retrospective recall (n51)
• Work site validation to assess validity of job
  assessments (n70)
• Productivity study to assess construct validity
• Multiple field tests to assess psychometrics

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Work Role Functioning Phase III Interpretation
Studies

• Employer studies to assess linkages with
  productivity
• NIOSH study to assess correspondence with
  economic burden
• Clinical studies to assess relationship to
  clinical outcomes responsiveness
• Work organization studies to assess relationship
  to other work outcomes and responsiveness

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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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WL-26 Scales Are Internally Consistent and
Measure Hypothesized Work Demand
Items Cronbach Alpha Scaling
Success Work Scheduling 6 .88
100 Physical Demands 8 .88 91 Mental
Demands 4 .92 94 Social Demands
3 .80 92 Output Demands 5 .90
95
Source Amick et al, 2000
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WL-26 Discriminates Those With Low and High Upper
Extremity Functioning In a Population with Carpal
Tunnel Syndrome
All Differences Significant at P lt 0.05
Work Limitations Mean Score
Source Amick et al, 2000
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WL-26 Discriminates Those With Low and High Upper
Extremity Symptoms In a Population with Carpal
Tunnel Syndrome
All Differences Significant at P lt 0.05
Work Limitations Mean Score
Source Amick et al, 2000
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Health-Related Work Functioning Predicts On-The
Job Performance
Predicted Average Call Handling Time (Seconds)
Source Lerner and Amick 1999, This study Uses
WLQ from Lerner et al, 2001
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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 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
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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
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Work Role Functioning Improved 18 in Nurse
Telecare For Depression
Changes Following Physician Directed Nurse
Telecare
Work Role Functioning
Source Unpublished Data
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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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Work, Household, and Leisure Time Functioning
All Improve
Health-Related Functioning
Source Unpublished Data
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Thank You

• For slides go to www.benamick.com
• For information on the injury prevention research
  pre-doctoral training program go to
  http//www.sph.uth.tmc.edu8052/swcoeh/injurypreve
  ntion/Home/
• For information on the Texas Institute for
  Society and Health go to www.societyandhealth.org