Implementation of a disability management policy in a large healthcare employer: a quasi-experimental, mixed-method evaluation

Objective: This study describes the process and outcomes of the implementation of a strengthened disability management policy in a large Canadian healthcare employer. Key elements of the strengthened policy included an emphasis on early contact, the training of supervisors and the integration of union representatives in return-to-work (RTW) planning. Design: The study applied mixed methods, combining a process evaluation within the employer and a quasi-experimental outcome evaluation between employers for a 3-year period prior to and following policy implementation in January 2012. Participants: Staff in the implementation organisation (n=4000) and staff in a peer group of 29 large hospitals (n=1 19 000). Outcomes: Work disability episode incidence and duration. Results: Both qualitative and quantitative measures of the implementation process were predominantly positive. Over the 6-year observation period, there were 624 work disability episodes in the organisation and 8604 in the comparison group of 29 large hospitals. The annual per cent change in episode incidence in the organisation was −5.6 (95% CI −9.9 to −1.1) comparable to the annual per cent change in the comparison group: −6.2 (-7.2 to –5.3). Disability episode durations also declined in the organisation, from a mean of 19.4 days (16.5, 22.3) in the preintervention period to 10.9 days (8.7, 13.2) in the postintervention period. Reductions in disability durations were also observed in the comparison group: from a mean of 13.5 days (12.9, 14.1) in the 2009–2011 period to 10.5 days (9.9, 11.1) in the 2012–2014 period. Conclusion: The incidence of work disability episodes and the durations of work disability declined strongly in this hospital sector over the 6-year observation period. The implementation of the organisation’s RTW policy was associated with larger reductions in disability durations than observed in the comparison group

Implementation of a disability management policy in a large healthcare employer: a quasi-experimental, mixed-method evaluation

Objective: This study describes the process and outcomes of the implementation of a strengthened disability management policy in a large Canadian healthcare employer. Key elements of the strengthened policy included an emphasis on early contact, the training of supervisors and the integration of union representatives in return-to-work (RTW) planning. Design: The study applied mixed methods, combining a process evaluation within the employer and a quasi-experimental outcome evaluation between employers for a 3-year period prior to and following policy implementation in January 2012. Participants: Staff in the implementation organisation (n=4000) and staff in a peer group of 29 large hospitals (n=1 19 000). Outcomes: Work disability episode incidence and duration. Results: Both qualitative and quantitative measures of the implementation process were predominantly positive. Over the 6-year observation period, there were 624 work disability episodes in the organisation and 8604 in the comparison group of 29 large hospitals. The annual per cent change in episode incidence in the organisation was −5.6 (95% CI −9.9 to −1.1) comparable to the annual per cent change in the comparison group: −6.2 (-7.2 to –5.3). Disability episode durations also declined in the organisation, from a mean of 19.4 days (16.5, 22.3) in the preintervention period to 10.9 days (8.7, 13.2) in the postintervention period. Reductions in disability durations were also observed in the comparison group: from a mean of 13.5 days (12.9, 14.1) in the 2009–2011 period to 10.5 days (9.9, 11.1) in the 2012–2014 period. Conclusion: The incidence of work disability episodes and the durations of work disability declined strongly in this hospital sector over the 6-year observation period. The implementation of the organisation’s RTW policy was associated with larger reductions in disability durations than observed in the comparison group

Antenatal Steroid Therapy for Fetal Lung Maturation and the Subsequent Risk of Childhood Asthma: A Longitudinal Analysis

This study was designed to test the hypothesis that fetal exposure to corticosteroids in the antenatal period is an independent risk factor for the development of asthma in early childhood with little or no effect in later childhood. A population-based cohort study of all pregnant women who resided in Nova Scotia, Canada, and gave birth to a singleton fetus between 1989 and 1998 was undertaken. After a priori specified exclusions, 80,448 infants were available for analysis. Using linked health care utilization records, incident asthma cases developed after 36 months of age were identified. Extended Cox proportional hazards models were used to estimate hazard ratios while controlling for confounders. Exposure to corticosteroids during pregnancy was associated with a risk of asthma in childhood between 3–5 years of age: adjusted hazard ratio of 1.19 (95% confidence interval: 1.03, 1.39), with no association noted after 5 years of age: adjusted hazard ratio for 5–7 years was 1.06 (95% confidence interval: 0.86, 1.30) and for 8 or greater years was 0.74 (95% confidence interval: 0.54, 1.03). Antenatal steroid therapy appears to be an independent risk factor for the development of asthma between 3 and 5 years of age

Est-il possible de décider d’un ordre de priorité dans nos investissements dans les technologies médicales et autres programmes de santé?

Dans le domaine des soins médicaux, l'adoption rapide de nouvelles méthodes thérapeutiques semble s'imposer. Dans cet article, l'auteur analyse le cas précis des nouvelles technologies de la santé afin de voir de quelle façon les sociétés contemporaines arrêtent leur choix en matière d'investissements porteurs de santé. Il examine les méthodes officielles d'évaluation des technologies en vigueur aujourd'hui et présente deux études de cas qui illustrent la difficulté de faire des choix rationnels dans ce domaine. En conclusion, l'auteur prône une évaluation des interventions sociales et économiques en fonction de leur influence sur la santé et soutient que le moyen le plus efficace de réduire la demande des seules technologies médicales à l'égard des ressources que la société consacre à la santé serait peut-être d'accroître la concurrence face à ces ressources.In medical care, there is a strong imperative to rapidly adopt new therapeutic technology. This paper considers focuses on the specific case of innovative health care technologies to consider the issue of how contemporary societies make choices concerning health producing investments. The paper reviews the contemporary practices of formal health technology assessment and presents two case studies which illustrate some of the challenges in making rational choices in this area. The paper concludes with an argument to evaluate social and economic interventions for their contribution to health, proposing that the most effective strategy for reducing the singular claim of medical technology on society's resources allocated to producing health may lie in increasing the competition for those resources.En el sector médico, la adopción de nuevos métodos terapéuticos parece imponerse. En el presente artículo, el autor analiza el caso preciso de las nuevas tecnologías de la salud afin de ver de que manera las sociedades contemporáneas decidirán sus inversiones en materia de salud. Él examina los métodos oficiales de evaluación de las tecnologías en vigor actualmente y presenta dos estudios de caso que ilustran la dificultad de elegir racionalmente en ese sector. Como conclusión, el autor propone una evaluación de las intervenciones sociales y económicas en función de su influencia sobre la salud y sostiene que el medio más eficaz de reducir la demanda de tecnologías médicas con respecto a los recursos que la sociedad consagra a la salud, sería tal vez de incrementar la competencia frente a estos recursos