Advancing the Evidence Base for Health and ProductivityImprovement: The Work Limitations QuestionnaireThe Tufts Program in...
Today’s Topics•   Health and Productivity (H&P) Improvement as a Strategy•   Tools for H&P Improvement•   An H&P Improveme...
H & P Improvement  Generally refers to strategies undertaken to prevent,  reduce or otherwise manage the adverse effects o...
Health and Productivity Improvement          Contributes to ValueHealth and Productivity Improvement Contributes to Value
Why Focus on Productivity?                    The Value Perspective                 (Adapted from Peter Neumann, ScD, Medi...
Components of Health-Related Productivity Loss•   Presenteeism        WLQ•   Absenteeism         Time Loss Module
The Science of Self-Report Has    Advanced Considerably
The US Food and Drug Administration GuidelinesPatient-Reported Outcome Measure Development Process          Cultural & Lan...
The Work Limitations Questionnaire (WLQ)•   Presenteeism measured in 25 or 8-item versions•   Questions cover 4 domains of...
The Work Limitations Questionnaire (WLQ)                          Sample from 25 Q Version: Time Management ScaleIn the pa...
The Work Limitations Questionnaire (WLQ)                        Sample from 25 Q Version: Output ScaleIn the past 2 weeks,...
How the WLQ is Used•   Employee health assessment•   Employer health improvement initiatives•   Clinical trials within the...
Levels of WLQ DataSummary Score              Job Level                   Task Level% Productivity Lost        % Time with ...
How is Presenteeism Impacting the Company?                      Cathy Baase MD, Dow Chemical                              ...
The Impact of Different Medical Conditions on                                                    Presenteeism at Bank One ...
Burden of Pain on Performance at Work:                              Difficulty in Meeting Job Demands                     ...
Making the Case for Change With the WLQ:             Impact of Chronic Conditions                                         ...
Making the Case for Change With the WLQ: Impact                        of Risk Factors                          Health Ris...
Depression Viewed Through the H & P Improvement Lens •   Common chronic illness adversely effects how people     think, fe...
The Work Burden of Depression•   Between 10-20% of the population stricken at least once    during lifetime•   One of the ...
What is Behind the Staggering Work and                  Productivity Impact?•   Variability in treatment efficacy and effe...
The Health & Work Study 2000-2004                                          Depression’s Burden Persists                   ...
The Health & Work Study 2000-2004                                                             The Work Productivity Gap   ...
The Health & Work Initiative (WHI)               A New Workplace Intervention•   Opportunity to detect depression in a com...
The Work and Health Initiative (WHI)                        Aeronautics Manufacturer and State Government Pilot Tests•   W...
Pre-Intervention Presenteeism and Absenteeism                           WHI Treatment and Usual Care Groups:              ...
Percent of Post-Intervention Change from Baseline:                                      State Government RCT              ...
Summary of Results•   The WHI was superior to Usual Care on every metric•   The WHI resulted in an average reduction in at...
Upcoming SlideShare
Loading in …5
×

Debra Lerner's Presentation at the WWCMA April Meeting

2,766 views

Published on

Presenteeism: Measuring Employee Productivity

Debra Lerner, MS, PhD
Director, Program in Health, Work & Productivity
Senior Scientist, Institute for Clinical Research & Health Policy Studies

Debra Lerner, MS, PhD is a Senior Scientist within the Tufts Medical Center Institute for Clinical Research and Health Policy Studies (ICRHPS), where she directs the Program on Health, Work and Productivity. She is also a Professor within the Departments of Medicine and Psychiatry within the Tufts University School of Medicine and the Sackler School of Biomedical Sciences.

Dr. Lerner is a leader in research concerning the work and productivity impact of health problems. Under her leadership, Dr. Lerner and her colleagues developed the Work Limitations Questionnaire (WLQ). The WLQ is used throughout the world and has become a standard of measurement. WLQ users include employers, insurers, pharmaceutical companies, health and wellness providers and academic researchers. Hundred of thousands of employees complete the WLQ annually as part of routine health assessment and corporate health strategy.

In addition, Dr. Lerner’s program team has developed a new program aimed at preventing productivity loss due to depression. The effectiveness and economic impact of this program is being tested in the United States in multiple companies. Sponsorship for this research has been provided by the National Institute on Aging, the National Institute of Mental Health and the Centers for Disease Control and Prevention.

Dr. Lerner’s program is involved in health and productivity improvement projects with employers and other high profile organizations such as Aetna, Mayo Clinic Health Care Solutions, Ortho-McNeil Janssen and many health and wellness firms.

0 Comments
1 Like
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total views
2,766
On SlideShare
0
From Embeds
0
Number of Embeds
8
Actions
Shares
0
Downloads
54
Comments
0
Likes
1
Embeds 0
No embeds

No notes for slide

Debra Lerner's Presentation at the WWCMA April Meeting

  1. 1. Advancing the Evidence Base for Health and ProductivityImprovement: The Work Limitations QuestionnaireThe Tufts Program in Health, Work and ProductivityInstitute for Clinical Research and Health Policy StudiesTufts Medical CenterDebra Lerner, MS, PhD
  2. 2. Today’s Topics• Health and Productivity (H&P) Improvement as a Strategy• Tools for H&P Improvement• An H&P Improvement Intervention for Depression
  3. 3. H & P Improvement Generally refers to strategies undertaken to prevent, reduce or otherwise manage the adverse effects of apopulation’s health problems on its work performance and productivity.
  4. 4. Health and Productivity Improvement Contributes to ValueHealth and Productivity Improvement Contributes to Value
  5. 5. Why Focus on Productivity? The Value Perspective (Adapted from Peter Neumann, ScD, Medical Center, 2007) Impact on cost Cost-saving Cost-Neutral Cost-Increasing Depends on Higher Adopt Adopt Willingness Effectiveness (big winner) (winner) To PayImpact on outcome Similar Adopt Other factors may Do not adopt (loser) Effectiveness (winner) decide Depends on Lower Do not adopt (big Willingness Do not adopt (loser) Effectiveness loser) To Pay
  6. 6. Components of Health-Related Productivity Loss• Presenteeism WLQ• Absenteeism Time Loss Module
  7. 7. The Science of Self-Report Has Advanced Considerably
  8. 8. The US Food and Drug Administration GuidelinesPatient-Reported Outcome Measure Development Process Cultural & Language Identify Concept & Establish Adaptations Conceptual Framework • Cultural adaptation • Intended population • Linguistic validation • Intended application • Psychometric validation • Concepts & domains measured • How concepts relate to other endpoints Modify Instrument • Concepts measured • Population studied Develop Instrument • Instrumentation • Item generation • Application • Choice of response option • Administration • Recall period • Item reduction • Scoring • Relationship among concepts, items, domains Assess • Instructions and format • Respondent and administrative burden Measurement Properties • Reliability • Validity • Ability to detect change • Minimum important difference
  9. 9. The Work Limitations Questionnaire (WLQ)• Presenteeism measured in 25 or 8-item versions• Questions cover 4 domains of work: time, physical, mental-interpersonal, and output demands• Scale scores range from 0 (Limited None of the Time) to 100 (Limited All of the Time)• Validated• Available in multiple versions (mail, phone, web) and 40+ languages• WLQ Absenteeism module available
  10. 10. The Work Limitations Questionnaire (WLQ) Sample from 25 Q Version: Time Management ScaleIn the past 2 weeks, how much of the time did your physical health or emotional problems make it difficult for you to do the following? (Mark one box on each line a. through e.) All of Most of Some of A Slight None of Does the Time the Time the Time Bit of the Time Not (100%) (About the Time (0%) Apply to 50%) My Job a. work the required number of 1 2 3 4 5 0 hours . . . . . . . . . . . . . . . . b. get going easily at the beginning of the 1 2 3 4 5 0 workday . . . . . . . . . . . . . . c. start on your job as soon as 1 2 3 4 5 0 you arrived at work . . . . . d. do your work without stopping to take breaks or 1 2 3 4 5 0 rests . . . . . . . . . . . . . . . . . e. stick to a routine or 1 2 3 4 5 0 schedule . . . . . . . . . . . . . . Note: For permission to use the WLQ, contact WLQ@tuftmedicalcenter.org
  11. 11. The Work Limitations Questionnaire (WLQ) Sample from 25 Q Version: Output ScaleIn the past 2 weeks, how much of the time did your physical health or emotional problems make it difficult for you to do the following? (Mark one box on each line a. through e.) All of Most of Some of the A Slight None of Does the the Time Time (About Bit of the Time Not Time 50%) the Time (0%) Apply to (100%) My Job a. handle the workload . 1 2 3 4 5 0 b. work fast enough . . . 1 2 3 4 5 0 c. finish work on time . . 1 2 3 4 5 0 d. do your work without 1 2 3 4 5 0 making mistakes. . . . e. feel you’ve done what 1 2 3 4 5 0 you are capable of doing. . . . Note: For permission to use the WLQ, contact WLQ@tuftsmedicalcenter.org
  12. 12. How the WLQ is Used• Employee health assessment• Employer health improvement initiatives• Clinical trials within the pharmaceutical industry• Services research
  13. 13. Levels of WLQ DataSummary Score Job Level Task Level% Productivity Lost % Time with % Time with Compared to Impaired Job Impaired Task Benchmark Performance Performance Time Physical Mental- Output 25 Items Management Demands Interpersonal Demands Demands
  14. 14. How is Presenteeism Impacting the Company? Cathy Baase MD, Dow Chemical Employee Medical (US) 14%Global Presenteeism Retiree Medical (US) 48% 19% Other Admin 13% Global Absenteeism 6%
  15. 15. The Impact of Different Medical Conditions on Presenteeism at Bank One Arthritis** Back Pain** Odds of Work Performance Limitation 3.0 Depression** Diabetes* Heart disease 2.5 Heartburn** Irritable Bowel* 2.0 1.5 1.0 0.5 0.0 time>0 physical>0 mental>0 output>0 WLQSource: Burton et al., JOEM, 2004; 46 (6 Suppl): S38-S45
  16. 16. Burden of Pain on Performance at Work: Difficulty in Meeting Job Demands 60 50 Type of Work Demand Type of Work DemandExtent of LimitationExtent of Limitation 40 Time (0-100) (0-100) 30 Physical Mental / Interpers 20 Output 10 0 Healthy Low Moderate High The Harris Allen Group Pain Severity Pain Severity
  17. 17. Making the Case for Change With the WLQ: Impact of Chronic Conditions % Per Person Productivity Productivity N (%) Loss TypeCost ($) Demand of WorkTotal Number ofChronic Conditions 0 7037 (53.1) 1.2 1446 1 3184 (24.0) 1.5 1792 2 1647 (12.4) 1.9 2240 3 734 (5.5) 2.5 3020 4 349 (2.6) 3.0 3597 5+ 312 (2.4) 4.2 5044 Pain Severity
  18. 18. Making the Case for Change With the WLQ: Impact of Risk Factors Health Risk Factor Summary Profile - Means WLQ Scale Scores Mental- Time Interpers Manage Physical onal Output Per Person N (%) ment Tasks Tasks Tasks % Productivity Loss Productivity Cost ($)Total Risks 0 160 (1.2) 1.7 4.1 2.5 1.4 0.6 616 1 601 (4.5) 3.4 5.4 3.7 2.4 1.0 963 2 1573 (11.9) 3.7 6.0 3.8 2.5 1.0 1,018 3 2738 (20.6) 4.5 6.9 5.0 3.5 1.3 1,307 4 2853 (21.5) 6.3 7.6 5.7 4.8 1.6 1,619 5 2469 (18.6) 6.8 8.3 6.6 4.9 1.8 1,762 6 1619 (12.2) 8.8 8.6 7.7 6.3 2.1 2,116 7 840 (6.3) 10.2 9.7 8.8 6.9 2.4 2,386 8+ 410 (3.1) 12.3 9.8 10.1 8.4 2.8 2,764
  19. 19. Depression Viewed Through the H & P Improvement Lens • Common chronic illness adversely effects how people think, feel and behave • Attacks motivation, self-confidence, energy, thought processes and social skills many of which are essential to good work performance • Working-age adults with depression experience high rates of job loss, turnover, premature retirement, disability, absences and at-work performance deficits with productivity losses in the billions of dollars annually
  20. 20. The Work Burden of Depression• Between 10-20% of the population stricken at least once during lifetime• One of the top 5 leading sources of health-related productivity loss• The average depressed worker misses from 0.5-4 workdays per month• The average depressed worker is limited in his or her ability to work 35% of the time
  21. 21. What is Behind the Staggering Work and Productivity Impact?• Variability in treatment efficacy and effectiveness• Persistent barriers to obtaining high quality screening, diagnosis and treatment• Limits of the biomedical approach for reducing disability and productivity loss• Slow progress in engaging key stakeholders (employees, employers and healthcare professionals) in solving the problem
  22. 22. The Health & Work Study 2000-2004 Depression’s Burden Persists 25.0 PHQ-9 Depression Severity Depression 20.0 Groups: MDD Double 15.0 Dysthymia All Depression 10.0 Control Group RA Group 5.0 0.0 Baseline 6 Month 12 Month 18 Month Months from BaselineSource: Depression and Productive Work Activity Study, D. Lerner, Principal Investigator,
  23. 23. The Health & Work Study 2000-2004 The Work Productivity Gap 20 WLQ: Percentage Productivity Lost 18 16 Employees with Depression: 14 12 Improved or Remitted n=47 Same n=176 10 Worse n=63 8 Healthy Employee Controls n=193 6 4 2 0 Baseline 6 Months 12 Months 18 Months Months after BaselineSource: Depression and Productive Work Activity Study, D. Lerner, Principal Investigator, 2004.
  24. 24. The Health & Work Initiative (WHI) A New Workplace Intervention• Opportunity to detect depression in a community setting• Uses an existing resource: Employee Assistance Program (EAP)• May encourage employer investment by demonstrating “return on investment” (ROI)
  25. 25. The Work and Health Initiative (WHI) Aeronautics Manufacturer and State Government Pilot Tests• Web-Based Employee Health Screening with Feedback• Depressed and Work-Impaired Employees Enrolled in 16-Week WHI Program• Care Provided by EAP Counselors On the Phone• Three Care Components• Medical Care Coordination• Self-Help using Cognitive Behavioral Therapy Strategies• Work Coaching(Lerner, Adler, Rogers and Hermann, 2004-7)
  26. 26. Pre-Intervention Presenteeism and Absenteeism WHI Treatment and Usual Care Groups: State Government RCT 100 90 Usual Care 80 WHI Group 70 Baseline Score 60 50 45.6 43.7 38.5 37.3 39.1 40.7 40 31.2 30 26.6 23.3 18.3 20 10.1 10.3 10 0 Time Physical Tasks Mental- Output Tasks Productivity Productivity Management Interpersonal Lost Lost Tasks (Presenteeism) (Absenteeism) WLQ Scales, Productivity Lost and Absenteeism** No significant differences between groups on any baseline score
  27. 27. Percent of Post-Intervention Change from Baseline: State Government RCT 100 80 60 46.8 47.1 42.8 39.7 41.2 31.6 34.9 34.0 40Percent Change 20 10.9 2.1 4.2 3.0 0 -2.6 -4.9 -20 -40 -60 -80 -75.6 -100 -100.0 -120 Time Physical Tasks Mental- Output Tasks Productivity Lost Days Missed Absenteeism Depression Management Interpersonal Severity Tasks Outcome Criteria
  28. 28. Summary of Results• The WHI was superior to Usual Care on every metric• The WHI resulted in an average reduction in at-work productivity cost of $3,500 per employee vs. $300 per employee in Usual Care• The WHI resulted in an average 50% improvement (reduction) in absences per employee vs. an average 100% increase in absences per employee in Usual Care

×