TY - JOUR
T1 - The error of using returns-to-work to measure the outcomes of health care
AU - Baldwin, Marjorie
AU - Johnson, William
AU - Butler, Richard J.
PY - 1996
Y1 - 1996
N2 - This article uses data from The Survey of Ontario Workers With Permanent Impairment, the world's largest survey of injured workers, to show that, as currently used, return-to-work is a misleading measure of the effectiveness of health care. The article discussed examples of two serious limitations on the use of return- to-work to measure the outcomes of health care, where health care refers to all the medical and rehabilitative services provided to worker following a workplace injury. The first limitation is that return-to-work, like many other outcomes of health care, is influenced by factors that are not directly related to health care. Using a logit model to estimate the determinants of first absences from work after an injury, we find that socioeconomic characteristics, economic incentives, and job characteristics have a significant influence on return-to-work. The second limitation on return-to-work as an outcome measure is that the first return- to-work after an injury, like a hospital discharge, frequently marks the end of only the first of several episodes of work disability caused by the original injury. Using first post-injury returns-to-work as a proxy for recovery, we would assume that 85% of the Ontario workers recovered from their injury when, in fact, 61% had subsequent spell of work disability. We identified four mutually exclusive patterns of post-injury work and work disability. Multinomial logit estimates of the determinants of the patterns show that health care is only one of several influences on return-to-work. The results also demonstrate that if return- to-work is used to measure outcomes, it must be evaluated over a time horizon that permits multiple spells of work disability.
AB - This article uses data from The Survey of Ontario Workers With Permanent Impairment, the world's largest survey of injured workers, to show that, as currently used, return-to-work is a misleading measure of the effectiveness of health care. The article discussed examples of two serious limitations on the use of return- to-work to measure the outcomes of health care, where health care refers to all the medical and rehabilitative services provided to worker following a workplace injury. The first limitation is that return-to-work, like many other outcomes of health care, is influenced by factors that are not directly related to health care. Using a logit model to estimate the determinants of first absences from work after an injury, we find that socioeconomic characteristics, economic incentives, and job characteristics have a significant influence on return-to-work. The second limitation on return-to-work as an outcome measure is that the first return- to-work after an injury, like a hospital discharge, frequently marks the end of only the first of several episodes of work disability caused by the original injury. Using first post-injury returns-to-work as a proxy for recovery, we would assume that 85% of the Ontario workers recovered from their injury when, in fact, 61% had subsequent spell of work disability. We identified four mutually exclusive patterns of post-injury work and work disability. Multinomial logit estimates of the determinants of the patterns show that health care is only one of several influences on return-to-work. The results also demonstrate that if return- to-work is used to measure outcomes, it must be evaluated over a time horizon that permits multiple spells of work disability.
KW - outcome measure
KW - permanent impairment
KW - return- to-work
KW - workplace injury
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U2 - 10.1002/(SICI)1097-0274(199606)29:6<632::AID-AJIM7>3.0.CO;2-L
DO - 10.1002/(SICI)1097-0274(199606)29:6<632::AID-AJIM7>3.0.CO;2-L
M3 - Article
C2 - 8773723
AN - SCOPUS:0030013428
SN - 0271-3586
VL - 29
SP - 632
EP - 641
JO - American Journal of Industrial Medicine
JF - American Journal of Industrial Medicine
IS - 6
ER -