# Presentation: 011880

## 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@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

## 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 47:3, March 2005.

## 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**

## Source: Lerner D, Adler DA, Chang H, et al. Unemployment, job retention and productivity loss among employees with depression. Psychiatr Serv 2004;55(12):1371-1378.

- Source: Lerner D, Adler DA, Chang H, et al. Unemployment, job retention and productivity loss among employees with depression. Psychiatr Serv 2004;55(12):1371-1378.

## Source: Hemp P. Presenteeism:  At Work – But Out of it. Harvard Business Review 2004;10:49-58.

- Source: Hemp P. Presenteeism:  At Work – But Out of it. Harvard Business Review 2004;10:49-58.

## Identifying Quality of Care Issues

- Source:  Depression and Productive Work Activity Study, D. Lerner, Principal Investigator, 2004.

**Depression Groups:**

## Do Programs Sustain the Employability and Productivity of Working People with CCs? 

**Employers are service brokers and silo-focused chiefly administering benefits for medical care, FMLA, disability insurance, and/or Worker’s Compensation**
**Government programs serve narrowly-defined constituencies through SSDI and SSI, VR, and job training. ADA has reached few.**

- Do Programs Sustain the Employability and Productivity of Working People with CCs?

## A Proposed Research Agenda 

**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.**** **

- A Proposed Research Agenda

_**Medical Care Sector**_

## A Proposed Research Agenda 

**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. **

- A Proposed Research Agenda

_**Employer Sector**__** **_

## A Proposed Research Agenda 

**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. **

- A Proposed Research Agenda

_**Government Sector**__** **_

## Interdisciplinary Research 

**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. **

- Interdisciplinary Research