Objective The cohort study examined the performance of the Work Ability Index in predicting health-related exit and absence from work, work participation, and death among a sample of workers previously receiving sickness absence benefits. Methods Workers aged 40–54 years who received sickness absence benefits in 2012 completed the Work Ability Index in 2013. Outcomes were extracted from administrative data records covering the period until the end of 2016. Results Data for 2266 participants were included (mean age: 47.9 years; 54.4% women). Maximum follow-up was 43 months. In terms of work ability, 38.4% had good scores, 38.2% moderate scores, and 23.4% poor scores. Fully adjusted analyses showed an increased risk of a disability pension in workers with poor (HR = 12.98; 95% CI 5.81–28.99) and moderate Work Ability Index scores (HR = 3.17; 95% CI 1.36–7.38) compared to workers with good or excellent scores. The risk of a rehabilitation measure was also significantly increased for workers with poor and moderate scores. In addition, poor scores were prospectively associated with a longer duration of sickness absence and unemployment benefits, and fewer employment days and less income from regular employment. Those with poor Work Ability Index scores also had a significantly increased risk of premature death. Conclusions The Work Ability Index is a potential tool to identify individuals with previous long-term sickness absence having an increased risk of health-related exit and absence from work and poor work participation outcomes.
Background Quality assurance programmes measure and compare certain health outcomes to ensure high quality care in the health care sector. The outcome health related quality of life (HRQOL) is typically measured by patient-reported outcome measures (PROMs). However, certain patient groups are less likely to respond to PROMs than others. This non-response bias can potentially distort results in quality assurance programmes. Our study aims to identify relevant predictors for non-response during assessment using the PROM MacNew Heart Disease questionnaire in cardiac rehabilitation. Methods This is a cross-sectional study based on data from the Swiss external quality assurance programme. All patients aged 18 years or older who underwent inpatient cardiac rehabilitation in 16 Swiss rehabilitation clinics between 2016 and 2019 were included. Patients’ sociodemographic and basic medical data were analysed descriptively by comparing two groups: non-responders and responders. We used a random intercept logistic regression model to estimate associations of patient characteristics and clinic differences with non-response. Results Of 24 572 patients, there were 33.3% non-responders and 66.7% responders. The mean age was 70; 31.0% were women. The regression model showed that being female was associated with non-response (odds ratio (OR) 1.22; 95% confidence interval (95% CI) 1.14–1.30), as well as having no supplementary health insurance (OR 1.49; 95% CI 1.39–1.59). Each additional year of age increased the chance of non-response by an OR of 1.02 (95% CI 1.02–1.02). Not being a first language speaker of German, French, or Italian increased the chance of non-response by an OR of 6.94 (95% CI 6.03–7.99). Patients admitted directly from acute care had a higher chance of non-response (OR 1.23; 95% CI 1.10–1.38), as well as patients being discharged back into acute care after rehabilitation (OR 3.89; 95% CI 3.00–5.04). Each point on the cumulative illness rating scale (CIRS) total score increased the chance of non-response by an OR of 1.05 (95% CI 1.04–1.05). Certain diagnoses also influenced the chance of non-response. Even after adjustment for known confounders, response rates differed substantially between the 16 clinics. Conclusion We have found significant non-response bias among certain patient groups, as well as across different treatment facilities. Measures to improve response rates among patients with known barriers to participation, as well as among different treatment facilities need to be considered, particularly when PROMs are being used for comparison of providers in quality assurance programmes or outcome evaluation.
Zusammenfassung Ziel der Studie Der Einfluss des sozialen Status auf die Gesundheit ist gut belegt. Für den Bereich der Rehabilitation geben wenige Studien erste Hinweise auf sozial ungleiche Versorgung. Die Studie untersucht anhand einer Risikokohorte der Deutschen Rentenversicherung Bund die Rolle sozialer Ungleichheiten beim Zugang und in der Inanspruchnahme von Leistungen zur medizinischen Rehabilitation. Methodik Die Datengrundlage bilden Fragebogendaten der ersten beiden Wellen des Dritten Sozialmedizinischen Panels für Erwerbspersonen (SPE III) sowie administrative Daten der Teilnehmenden (2013–2016). Diese Risikokohorte umfasst 40- bis 54-jährige Erwerbspersonen mit Krankengeldbezug im Jahr 2012. Mittels logistischer Regressionsmodelle wurden Antragstellung, Bewilligung und Ablehnung, Bewilligung nach Widerspruch und Inanspruchnahme von Rehabilitationsleistungen analysiert. Der soziale Status wurde sowohl als sozioökonomischer Status (Index) als auch in der Einzeldimension Bildung als Prädiktor herangezogen. Die Analysen erfolgten getrennt nach Geschlecht. Alter, Erwerbsstatus sowie der subjektive Gesundheitszustand wurden als Kontrollvariablen berücksichtigt. Ergebnisse Insgesamt wurden 2376 Versicherte, davon 1284 Frauen, in die Analysen eingeschlossen. 639 (26,9%) stellten mindestens einen Antrag auf Leistungen zur medizinischen Rehabilitation. Die Chance auf Antragstellung war bei Männern mit niedrigem sozioökonomischen Status (OR=1,8; 95%-KI=1,3–2,5) bzw. niedriger (OR=1,9; 95%-KI=1,3–2,8) und mittlerer Bildung (OR=1,5; 95%-KI=1,1–2,2) im Vergleich zur hohen Status- bzw. Bildungsgruppe erhöht. Bei den Frauen zeigte sich bei der Antragstellung ein signifikanter Unterschied zugunsten niedriger Bildung (OR=1,6; 95%-KI=1,1–2,5). Nach Adjustierung des Gesundheitszustandes und der aktuellen Erwerbstätigkeit verschwanden die Unterschiede. Hinsichtlich Bewilligung und Inanspruchnahme zeigten sich keine signifikanten Unterschiede nach sozialem Status, jedoch erfolgte bei Frauen mit mittlerer Bildung signifikant häufiger eine Bewilligung auf Grundlage eines Widerspruchverfahrens (OR=3,0; 95%-KI=1,1–8,2) als bei Frauen mit hoher Bildung. Schlussfolgerung Die Analysen gaben keine Hinweise auf einen sozial ungleichen Zugang oder eine sozial ungleiche Inanspruchnahme von Leistungen zur medizinischen Rehabilitation. Allerdings beantragten Versicherte mit niedrigem sozialen Status insbesondere aufgrund einer schlechteren subjektiven Gesundheit häufiger Leistungen zur medizinischen Rehabilitation. Weitere Untersuchungen sind nötig, um zu überprüfen, ob dies dem objektiven Bedarf dieser Statusgruppe gerecht wird.
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