Productivity and Social Engagement

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Productivity and Social Engagement
Debra Lerner, MS, PhD The Health
Institute Institute for Clinical Research and
Health Policy Studies Tufts-New England Medical
Center Director of The Health Institute's Program
on Health, Work and Disability Associate
Professor of Medicine, Tufts University School of
Medicine and Sackler School of Biomedical
Sciences email WLQ_at_tufts-nemc.org
Presented at Disability and Aging Seeking
Solutions to Improve Health, Productivity, and
Community Living. A Mini-Conference of the 2005
White House Conference on Aging. Sponsored by the
U.S. Department of Health and Human Services.
Washington, DC. July 21-22, 2005
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• Millions of Americans have work disabilities
  related to chronic health conditions (CCs) or are
  vulnerable to developing them
• Sustaining the employability and productivity of
  these Americans is essential economically and
  socially
• Services to help adults with CCs cope with work
  disabilities are narrowly focused and fragmented
• New research can guide progress in programs in
  policies

Source Lerner D, Allaire SH and Reisine ST.
Work Disability From Chronic Health Conditions.
JOEM 473, March 2005.
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• 100m Americans have one or more CCs, rising to
  160m by 2020
• Number with CCs and work disabilities is
  difficult to estimate
• 10.4m Americans 18-64 yrs. with at least 1 CC
  have a work limitation
• Americans 45-69 have three times the work
  limitation rate of those 18-44
• 25 of employed Americans surveyed missed one or
  more workdays in the past month due to CCs or
  worked at a reduced level of effort.
• One-third of a US employed sample with CCs also
  had difficulty working
• In 1999, 5m Americans received SSDI and 6.7
  received SSI benefits
• Annual productivity costs due to CCs is estimated
  to be 234b

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Source Lerner D, Adler DA, Chang H, et al.
Unemployment, job retention and productivity loss
among employees with depression. Psychiatr Serv
200455(12)1371-1378.
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Source Hemp P. Presenteeism At Work But Out
of it. Harvard Business Review 20041049-58.
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Identifying Quality of Care Issues
Depression Groups
Source Depression and Productive Work Activity
Study, D. Lerner, Principal Investigator, 2004.
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Do Programs Sustain the Employability and
Productivity of Working People with CCs?

• Medical care delivery system is disease-focused
  and not sufficiently oriented to functional
  outcomes and the full range of determinants
• Employers are service brokers and silo-focused
  chiefly administering benefits for medical care,
  FMLA, disability insurance, and/or Workers
  Compensation
• Government programs serve narrowly-defined
  constituencies through SSDI and SSI, VR, and job
  training. ADA has reached few.

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A Proposed Research Agenda
Medical Care Sector

• Determine whether multi-disciplinary provider
  teams are effective in reducing work disability
  among patients with chronic health problems.
• Assess the cost-effectiveness of specific work
  disability-prevention interventions provided by
  the different types of providers.
• Identify effective methods for motivating
  patients to use self-care strategies.
• Identify critical success factors for translating
  new care models into practice.

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A Proposed Research Agenda
Employer Sector

• Develop methods for applying current innovations
  (e.g., disability case management and disease
  management programs) to help employees remain
  productive.
• Improve methods for optimizing employer and
  employee participation in programs.
• Determine the impact of work organization
  variables (e.g., job autonomy) on work disability
  and test interventions to modify these variables.
  

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A Proposed Research Agenda
Government Sector

• Design and evaluate less intensive "VR-type"
  services aimed at individuals with chronic health
  problems and work experience.
• Test VR and Employment Support programs that have
  been redesigned with a job retention focus.
• Test whether job retention services can be
  provided effectively in non-traditional settings.
  
• Identify individual and organizational barriers
  to workplace accommodation.

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Interdisciplinary Research

• Develop and apply accurate, consistent methods
  for measuring work disabilities and the
  population at risk of developing them.
• Assess the prevalence of work disabilities within
  the population and specific subgroups (including
  groups defined by type of employment).
• Identify the full range of risk factors for work
  disabilities.
• Monitor public and private sector initiatives for
  addressing employee work disability and chronic
  health problems.
• Promote health literacy around health and work
  disability issues.
• Develop and test the impact of boundary-spanning
  personnel and arrangements, which attempt to
  bridge multiple service delivery sectors.
• Identify economic incentives and disincentives to
  funding work disability prevention services and
  test innovative payment schemes by key
  stakeholders.