Measurement Tools for Integrated Worker Health Protection and Promotion: Lessons Learned From the SafeWell Project.

OBJECTIVES: To describe (a) a conceptual approach, (b) measurement tools and data collection processes, (c) characteristics of an integrated feedback report and action plan, and (d) experiences of three companies with an integrated measurement approach to worker safety and health. METHODS: Three companies implemented measurement tools designed to create an integrated view of health protection and promotion based on organizational- and individual-level assessments. Feedback and recommended actions were presented following assessments at baseline and 1-year follow-up. Measurement processes included group dialogue sessions, walk-through, online surveys, and focus groups. RESULTS: The approach and measurement tools generated actionable recommendations and documented changes in the physical (eg, safety hazards) and psychosocial (eg, health and safety culture) work environment between baseline and 1-year follow-up. CONCLUSIONS: The measurement tools studied were feasible, acceptable, and meaningful to companies in the SafeWell study.

Correlation between physical activity, fitness, and musculoskeletal injuries in police officers.

In order to explore the correlation between physical activity, fitness, and injury among police officers, a cross section of active-duty members of the Minneapolis Police Department were surveyed about their level of fitness, physical activity, and prevalence of injury and chronic pain within the past year. In the study, officers with the highest self-reported fitness levels were less likely to experience sprains (OR 0.27, 95% CI 0.08-0.88), back pain (OR 0.48, 95% CI 0.09-0.88), and chronic pain (OR 0.21, 95% CI 0.06-0.73) than those who considered themselves less fit. Officers who were the most physically active were about a third as likely to report back pain (OR 0.37, 95% CI 0.10-0.73) and less than half as likely to report chronic pain (OR 0.42, 95% CI 0.19-0.91) as those who engaged in less activity. And officers with a BMI greater than 35 were 3 times more likely to report back pain (OR 3.36, 95% CI 1.17-9.66) than those whose BMI fell in the normal range (18-25). Thus, officers who engage in higher levels of physical activity and are more physically fit have a lower prevalence of musculoskeletal injuries and chronic pain.

Challenges of change: a qualitative study of chronic care model implementation.

PURPOSE: The Chronic Care Model (CCM) provides a conceptual framework for transforming health care for patients with chronic conditions; however, little is known about how to best design and implement its specifics. One large health care organization that tried to implement the CCM in primary care provided an opportunity to study these issues. METHODS: We conducted a qualitative, comparative case study of 5 of 18 group clinics 18 to 23 months after the implementation began. Built on knowledge of the clinics from a previous study of advanced access implementation, data included in-depth interviews with organizational leaders and varied clinic personnel, observation of clinic care processes, and review of written materials. RESULTS: Relatively small and highly variable care process changes were made during the study period. The change process underwent several marked shifts in strategy when initial efforts failed to achieve much and bore little resemblance to the change process used in the previously successful large-scale implementation of advanced access scheduling. Many barriers were identified, including too many competing priorities, a lack of specificity and agreement about the care process changes desired, and little engagement of physicians. CONCLUSION: These findings highlight specific organizational challenges with health care transformation in the absence of a blueprint more specific than the CCM. Effective models of organizational change and detailed examples of proven, feasible care changes still need to be demonstrated if we are to transform care as called for by the Institute of Medicine.

A proposed curvilinearity index for quantifying airflow obstruction.

BACKGROUND: Though forced expiratory volume in the first second (FEV(1)) is the primary indicator of airway obstruction, curvilinearity in the expiratory flow-volume curve is used to support the quantitative assessment of obstruction via FEV(1). Currently there is no available index to quantify a pathological contour of curvilinearity. STUDY PURPOSE: We propose a "curvature" index (k(max)) and compare FEV(1) values to the index with a sequential sample of spirometry data. METHODS: The hyperbolic function b(0)Q + b(1)Q V + b(2)V = 1 (in which Q = flow rate, V = volume, and b(0), b(1), and b(2) are estimated from the patient's flow-volume data) is fit to a fixed segment of the descending phase of the expiratory flow-volume curve. A previously developed biomechanical interpretation of this relationship associates the coefficient b(1) with the rate of airway-resistance-increase as exhaled volume increases. A global curvature index k(max)=b(1)/2(b(0)b(2)+b(1)) is defined to quantify the curvilinearity phenomenon. We used statistics software to determine the k(max) of spirometry data from 67 sequential patients, and to determine the relationship of k(max) to FEV(1). RESULTS: Individual k(max) estimates appeared to correspond well with the degree of curvilinearity observed and were related in an exponential manner to FEV(1). CONCLUSIONS: We defined a curvature index to quantify the curvilinearity phenomenon observed in the expiratory limb of flow-volume loops from patients with obstructive lung disease. This index uses data from a major segment of the flow-volume curve, and our preliminary data indicate an exponential relationship with FEV(1). This new index allows the putative association between curvilinearity and obstructive lung disease to be examined quantitatively in clinical practice and future studies.

The Minnesota Health Partnership and Coordinated Health Care and Disability Prevention: the implementation of an integrated benefits and medical care model.

In the spring of 1996, the Minnesota Health Partnership (MHP) received a demonstration grant from the Robert Wood Johnson Foundation Workers Compensation Health Initiative to pilot a model of health care that was designed to combine the best practices of general health and workers' compensation medical care. This paper outlines the genesis of the MHP, and the relationship of its Coordinated Health Care and Disability Prevention model to traditional managed care and 24-h care models. In order to effectively implement disability prevention principles within a primary care clinical setting, it is essential to increase health care provider awareness that the disability relating to a specific impairment can be positively impacted by specific clinical strategies. The basis and specifics of these strategies are also discussed. Plans for the evaluation of this model will also be described.