Baldwin M L, Johnson W G, Butler R J
Department of Economics, East Carolina University, Greenville, NC 27858-4353, USA.
Am J Ind Med. 1996 Jun;29(6):632-41. doi: 10.1002/(SICI)1097-0274(199606)29:6<632::AID-AJIM7>3.0.CO;2-L.
This article uses data from The Survey of Ontario Workers With Permanent Impairments. 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 discusses 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 a 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 spells 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.
本文使用了来自安大略省永久性损伤工人调查的数据，这是世界上最大规模的受伤工人调查，旨在表明，按照目前的使用方式，重返工作岗位是衡量医疗保健效果的一个误导性指标。本文讨论了在使用重返工作岗位来衡量医疗保健结果时存在的两个严重局限性的例子，这里的医疗保健是指工人在工作场所受伤后所接受的所有医疗和康复服务。第一个局限性是，与医疗保健的许多其他结果一样，重返工作岗位受到与医疗保健没有直接关系的因素的影响。通过使用逻辑回归模型来估计受伤后首次缺勤的决定因素，我们发现社会经济特征、经济激励措施和工作特征对重返工作岗位有重大影响。作为结果指标的重返工作岗位的第二个局限性是，受伤后的首次重返工作岗位，就像出院一样，通常只标志着由原始损伤导致的几次工作残疾发作中的第一次的结束。将受伤后的首次重返工作岗位用作康复的替代指标，我们会认为安大略省85%的工人从伤病中康复了，而实际上61%的人随后又出现了工作残疾情况。我们确定了受伤后工作和工作残疾的四种相互排斥的模式。对这些模式的决定因素进行多项逻辑回归估计表明，医疗保健只是影响重返工作岗位的几个因素之一。结果还表明，如果使用重返工作岗位来衡量结果，那么必须在允许多次出现工作残疾情况的时间范围内进行评估。
