Emile Tompa

A Systematic Review of Disability Management Interventions with Economic Evaluations

Introduction We present the results of a systematic literature review of disability management interventions to answer the question: “what is the credible evidence that incremental investment in disability management interventions is worth undertaking?” Methods We identified studies through searches in journal databases and requests to content experts. After assessing the quality of studies that met content requirements, we employed a best-evidence synthesis approach. Studies were stratified across several dimensions for evidence synthesis, with industry as the core stratification criterion. Results We identified 17 disability management interventions with economic analyses, of which eight were of high or medium quality. We found strong evidence supporting the economic merits of multi-sector disability management interventions, but could not make a positive statement about the remaining five industry clusters with studies. For stratification by intervention components, we found moderate evidence for interventions that included an education component, moderate evidence for those with physiotherapy, limited evidence for those with a behavioural component, and moderate evidence for those with a work/vocational rehabilitation component. For stratification by intervention features, we found moderate evidence for interventions that included a work accommodation offer, contact between health care provider and workplace, early contact with worker by workplace, ergonomic work site visits, and interventions with a return-to-work coordinator. Conclusions We found credible evidence supporting the financial benefits of disability management interventions for one industry cluster and several intervention components and features.

A Systematic Review of Occupational Health and Safety Interventions With Economic Analyses

Objective: We reviewed the occupational health and safety intervention literature to synthesize evidence on financial merits of such interventions. Methods: A literature search included journal databases, existing systematic reviews, and studies identified by content experts. Studies meeting inclusion criteria were assessed for quality. Evidence was synthesized within industry-intervention type clusters. Results: We found strong evidence that ergonomic and other musculoskeletal injury prevention interventions in manufacturing and warehousing are worth undertaking in terms of their financial merits. We also found strong evidence that multisector disability management interventions are worth undertaking. Conclusions: While the economic evaluation of interventions in this literature warrants further expansion, we found a sufficient number of studies to identify strong, moderate, and limited evidence in certain industry-intervention clusters. The review also provided insights into how the methodological quality of economic evaluations in this literature could be improved.

Practice and potential of economic evaluation of workplace-based interventions for occupational health and safety

Background: We review economic analyses in studies of workplace-based occupational health and safety interventions in order to report on evidence of their financial merits and assess the quality of application of economic evaluation methodologies. The focus of the review is interventions applicable to an office setting. Materials and Methods: We draw on several systematic reviews to identify studies that consider both the costs and consequences of an intervention, or simply the consequences in monetary terms. Results: In total, we identified 23 studies which we included in our final synthesis. More than half of these studies considered only the consequences in monetary terms, rather than both the costs and consequences associated with the intervention. Conclusions: In reviewing the studies, we identified a number of methodological shortcomings which we discuss in detail. A key message from our review is that there is a need for economic expertise in the multidisciplinary research teams evaluating workplace-based occupational health and safety interventions.

An evaluation of hospital discharge records as a tool for serious work related injury surveillance

Objectives: To identify and describe work related serious injuries among sawmill workers in British Columbia, Canada using hospital discharge records, and compare the agreement and capturing patterns of the work related indicators available in the hospital discharge records. Methods: Hospital discharge records were extracted from 1989 to 1998 for a cohort of sawmill workers. Work related injuries were identified from these records using International Classification of Disease (ICD-9) external cause of injury codes, which have a fifth digit, and sometimes a fourth digit, indicating place of occurrence, and the responsibility of payment schedule, which identifies workers’ compensation as being responsible for payment. Results: The most frequent causes of work related hospitalisations were falls, machinery related, overexertion, struck against, cutting or piercing, and struck by falling objects. Almost all cases of machinery related, struck by falling object, and caught in or between injuries were found to be work related. Overall, there was good agreement between the two indicators (ICD-9 code and payment schedule) for identifying work relatedness of injury hospitalisations (kappa = 0.75, p < 0.01). There was better concordance between them for injuries, such as struck against, drowning/suffocation/foreign body, fire/flame/natural/environmental, and explosions/firearms/hot substance/electric current/radiation, and poor concordance for injuries, such as machinery related, struck by falling object, overexertion, cutting or piercing, and caught in or between. Conclusions: Hospital discharge records are collected for administrative reasons, and thus are readily available. Depending on the coding reliability and validity, hospital discharge records represent an alternative and independent source of information for serious work related injuries. The study findings support the use of hospital discharge records as a potential surveillance system for such injuries.

A systematic review of workplace ergonomic interventions with economic analyses.

Introduction This article reports on a systematic review of workplace ergonomic interventions with economic evaluations. The review sought to answer the question: “what is the credible evidence that incremental investment in ergonomic interventions is worth undertaking?” Past efforts to synthesize evidence from this literature have focused on effectiveness, whereas this study synthesizes evidence on the cost-effectiveness/financial merits of such interventions. Methods Through a structured journal database search, 35 intervention studies were identified in nine industrial sectors. A qualitative synthesis approach, known as best evidence synthesis, was used rather than a quantitative approach because of the diversity of study designs and statistical analyses found across studies. Evidence on the financial merits of interventions was synthesized by industrial sector. Results In the manufacturing and warehousing sector strong evidence was found in support of the financial merits of ergonomic interventions from a firm perspective. In the administrative support and health care sectors moderate evidence was found, in the transportation sector limited evidence, and in remaining sectors insufficient evidence. Conclusions Most intervention studies focus on effectiveness. Few consider their financial merits. Amongst the few that do, several had exemplary economic analyses, although more than half of the studies had low quality economic analyses. This may be due to the low priority given to economic analysis in this literature. Often only a small part of the overall evaluation of many studies focused on evaluating their cost-effectiveness.

The relationship between job tenure and work disability absence among adults: a prospective study.

Little population-based, prospective research has been conducted to examine the demographic and work-related determinants of occupational injury or illness. This study examined the relative contribution of sociodemographic characteristics and work factors to the likelihood of a work-related disability or illness. In a representative sample of adult Canadians 25-70 years old from a prospective survey, a hazard modelling approach of time to work disability absence from the start of a new job was estimated with the following predictors: age, gender, type of job (manual, non-manual, and mixed), hours worked, highest education achieved, multiple concurrent job, job tenure, school activity, union membership and living in a rural or urban area. Workers holding manual or mixed jobs and having a low education level were factors independently associated with the increased likelihood of a work disability absence. Gender was not independently associated with work disability absences. A strong job tenure gradient in the unadjusted work disability absence rates was virtually eliminated when controlling for demographic/individual and other work factors. In multivariate analyses, work-related factors remained predictors of work disability absence whereas individual characteristics such as gender did not. The exception was workers with less education who appeared to be particularly vulnerable, even after controlling of physical demands on the job. This may be due to inadequate job training or increased hazard exposure even in the same broad job category.

Trial-Based Economic Evaluations in Occupational Health: Principles, Methods, and Recommendations

To allocate available resources as efficiently as possible, decision makers need information on the relative economic merits of occupational health and safety (OHS) interventions. Economic evaluations can provide this information by comparing the costs and consequences of alternatives. Nevertheless, only a few of the studies that consider the effectiveness of OHS interventions take the extra step of considering their resource implications. Moreover, the methodological quality of those that do is generally poor. Therefore, this study aims to help occupational health researchers conduct high-quality trial-based economic evaluations by discussing the theory and methodology that underlie them, and by providing recommendations for good practice regarding their design, analysis, and reporting. This study also helps consumers of this literature with understanding and critically appraising trial-based economic evaluations of OHS interventions.

Economic evaluation of a participatory ergonomics intervention in a textile plant.

In this study we report on the economic evaluation of a participatory ergonomics process undertaken at a clothing manufacturer in Southwestern Ontario, Canada that employs approximately 300 workers. We undertake a cost-benefit analysis from the company perspective. Intervention costs amounted to

The impact of temporary employment and job tenure on work-related sickness absence

65,787 and intervention benefits

Bridging the gap between the economic evaluation literature and daily practice in occupational health: A qualitative study among decision-makers in the healthcare sector

360,614 (2011 Canadian dollars). The net present value was