Debra Lerner's Presentation at the WWCMA April Meeting
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Transcript of Debra Lerner's Presentation at the WWCMA April Meeting
Advancing the Evidence Base for Health and Productivity Improvement: The Work Limitations Questionnaire
The Tufts Program in Health, Work and ProductivityInstitute for Clinical Research and Health Policy Studies Tufts Medical Center
Debra Lerner, MS, PhD
Today’s Topics
• Health and Productivity (H&P) Improvement as a Strategy• Tools for H&P Improvement• An H&P Improvement Intervention for Depression
H & P Improvement
Generally refers to strategies undertaken to prevent, reduce or otherwise manage the adverse effects of a
population’s health problems on its work performance and productivity.
Health and Productivity Improvement Contributes to Value
Health and Productivity Improvement Contributes to Value
Why Focus on Productivity?The Value Perspective
Impact on cost
Impact on outcome
Cost-saving Cost-Neutral Cost-Increasing
Higher Effectiveness
Adopt (big winner)
Adopt (winner)
Depends on Willingness
To Pay
Similar Effectiveness
Adopt (winner)
Other factors may decide Do not adopt (loser)
Lower Effectiveness
Depends on Willingness
To PayDo not adopt (loser) Do not adopt (big
loser)
(Adapted from Peter Neumann, ScD, Medical Center, 2007)
Components of Health-Related Productivity Loss
• Presenteeism WLQ
• Absenteeism Time Loss Module
The Science of Self-Report Has Advanced Considerably
Develop Instrument• Item generation• Choice of response option • Recall period• Item reduction• Scoring • Relationship among concepts, items, domains• Instructions and format• Respondent and administrative burden
Identify Concept & Establish Conceptual Framework
• Intended population• Intended application • Concepts & domains measured• How concepts relate to other
endpoints
Assess Measurement Properties
• Reliability• Validity• Ability to detect change• Minimum important difference
Modify Instrument• Concepts measured• Population studied• Instrumentation• Application• Administration
Cultural & Language Adaptations
The US Food and Drug Administration GuidelinesPatient-Reported Outcome Measure Development Process
• Cultural adaptation• Linguistic validation• Psychometric validation
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
The Work Limitations Questionnaire (WLQ)
In 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 the Time (100%)
Most of the Time
Some of the Time (About 50%)
A Slight Bit of
the Time
None of the Time
(0%)
Does Not
Apply to My Job
a. work the required number of hours . . . . . . . . . . . . . . . . 1 2 3 4 5 0
b. get going easily at the beginning of the workday . . . . . . . . . . . . . .
1 2 3 4 5 0
c. start on your job as soon as you arrived at work . . . . . 1 2 3 4 5 0
d. do your work without stopping to take breaks or rests . . . . . . . . . . . . . . . . .
1 2 3 4 5 0
e. stick to a routine or schedule . . . . . . . . . . . . . . 1 2 3 4 5 0
Note: For permission to use the WLQ, contact [email protected]
Sample from 25 Q Version: Time Management Scale
In 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 the
Time (100%)
Most of the Time
Some of the Time (About
50%)
A Slight Bit of
the Time
None of the Time
(0%)
Does Not
Apply to 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 making mistakes. . . . 1 2 3 4 5 0
e. feel you’ve done what you are capable of doing. . . .
1 2 3 4 5 0
Note: For permission to use the WLQ, contact [email protected]
The Work Limitations Questionnaire (WLQ)Sample from 25 Q Version: Output Scale
How the WLQ is Used
• Employee health assessment• Employer health improvement initiatives• Clinical trials within the pharmaceutical industry• Services research
Levels of WLQ Data
Summary Score
% Productivity Lost Compared to Benchmark
Job Level
% Time with Impaired Job Performance
Task Level
% Time with Impaired Task Performance
Time Management
Physical Demands
Mental-Interpersonal Demands
Output Demands
25 Items
How is Presenteeism Impacting the Company?Cathy Baase MD, Dow Chemical
Employee Medical (US)14%
Retiree Medical (US)19%
Other Admin13%
Global Absenteeism6%
Global Presenteeism48%
The Impact of Different Medical Conditions on Presenteeism at Bank One
0.0
0.5
1.0
1.5
2.0
2.5
3.0
time>0 physical>0 mental>0 output>0
Arthritis**
Back Pain**
Depression**
Diabetes*
Heart disease
Heartburn**
Irritable Bowel*
Odd
s of
Wor
k Pe
rfor
man
ce L
imita
tion
WLQSource: Burton et al., JOEM, 2004; 46 (6 Suppl): S38-S45
Burden of Pain on Performance at Work: Difficulty in Meeting Job Demands
The Harris Allen Group
Exte
nt o
f Lim
itatio
n(0
-100
)
Pain Severity
Type of Work Demand
0
10
20
30
40
50
60
Healthy Low Moderate High
Time
Physical
Mental / Interpers
OutputExte
nt o
f Lim
itatio
n(0
-100
)
Pain Severity
Type of Work Demand
Making the Case for Change With the WLQ:Impact of Chronic Conditions
Pain Severity
Type of Work Demand Total Number of Chronic Conditions
0 7037 (53.1) 1.2 14461 3184 (24.0) 1.5 17922 1647 (12.4) 1.9 22403 734 (5.5) 2.5 30204 349 (2.6) 3.0 3597
5+ 312 (2.4) 4.2 5044
N (%)
% Productivity
Loss
Per Person Productivity
Cost ($)
Making the Case for Change With the WLQ: Impact of Risk Factors
Health Risk Factor Summary Profile - Means
Time Manage
mentPhysical
Tasks
Mental-Interpers
onal Tasks
Output Tasks % Productivity Loss
Per Person Productivity Cost ($)
Total Risks
0 160 (1.2) 1.7 4.1 2.5 1.4 0.6 6161 601 (4.5) 3.4 5.4 3.7 2.4 1.0 9632 1573 (11.9) 3.7 6.0 3.8 2.5 1.0 1,0183 2738 (20.6) 4.5 6.9 5.0 3.5 1.3 1,3074 2853 (21.5) 6.3 7.6 5.7 4.8 1.6 1,6195 2469 (18.6) 6.8 8.3 6.6 4.9 1.8 1,7626 1619 (12.2) 8.8 8.6 7.7 6.3 2.1 2,1167 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
N (%)
WLQ Scale Scores
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
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
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
0.0
5.0
10.0
15.0
20.0
25.0
Baseline 6 Month 12 Month 18 Month
PH
Q-9
Dep
ress
ion
Sev
erity
MDDDoubleDysthymiaAll DepressionControl GroupRA Group
The Health & Work Study 2000-2004Depression’s Burden Persists
Depression Groups:
Months from Baseline
Source: Depression and Productive Work Activity Study, D. Lerner, Principal Investigator,
The Health & Work Study 2000-2004The Work Productivity Gap
0
2
4
6
8
10
12
14
16
18
20
Baseline 6 Months 12 Months 18 Months
WLQ
: Per
cent
age
Pro
duct
ivity
Los
t
Improved or Remitted n=47Same n=176Worse n=63Healthy Employee Controls n=193
Source: Depression and Productive Work Activity Study, D. Lerner, Principal Investigator, 2004.
Employees with Depression:
Months after Baseline
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)
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)
Pre-Intervention Presenteeism and Absenteeism WHI Treatment and Usual Care Groups:
State Government RCT
43.7
18.3
38.5 39.1
10.1
26.6
45.6
23.3
37.340.7
10.3
31.2
0
10
20
30
40
50
60
70
80
90
100
Time Management
Physical Tasks Mental-Interpersonal
Tasks
Output Tasks Productivity Lost
(Presenteeism)
Productivity Lost
(Absenteeism)WLQ Scales, Productivity Lost and Absenteeism*
Bas
elin
e Sc
ore
Usual CareWHI Group
* No significant differences between groups on any baseline score
Percent of Post-Intervention Change from Baseline:State Government RCT
2.110.9 4.2
-2.6
3.0
-100.0
-75.6
-4.9
39.7 46.831.6 34.9
47.1 42.8 41.234.0
-120
-100
-80
-60
-40
-20
0
20
40
60
80
100
TimeManagement
Physical Tasks Mental-Interpersonal
Tasks
Output Tasks Productivity Lost Days Missed Absenteeism DepressionSeverity
Outcome Criteria
Per
cent
Cha
nge
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