Total Worker Health Exclusive: A Perspective from an Occupational Health Physician

Dr. MosesEditors’ Note: Each year, millions of American workers develop health conditions that may temporarily or permanently remove them from the workforce. Although most individuals are able to work again after a brief recovery period, in approximately 10% of cases, workers incur injuries or illnesses severe enough to lead to prolonged or permanent withdrawal from the workforce. For workers and their families, life disruptions caused by serious illness or injury are compounded by the economic impact of being out of work. Although workers’ compensation and other programs assist injured and ill workers, these programs do not fully cover economic loss and the health care costs related to the injury or illness. Nor can these programs begin to fully recover the personal costs and burdens of significant life disruptions. By considering functional outcomes with Total Worker Health approaches in workplaces, occupational safety and health practitioners may begin to better address the challenges faced by workers experiencing these injuries and illnesses. In our invited guest commentary below, Dr. Moses makes the passionate case to occupational health practitioners on why they should focus not only on delivering quality care, but also squarely on improving measures of functional outcomes in ill and injured workers.


Function Matters to Workforce Health

By X.J. Ethan Moses, MD, MPH
Associate Medical Director, Colorado Division of Workers’ Compensation
President, Rocky Mountain Academy of Occupational and Environmental Medicine

“It is time for a paradigm shift in occupational and environmental medical practice. Let’s build upon our attention on quality to also focus on functional outcomes.”

The occupational and environmental medicine community is appropriately obsessed with quality of care. But what is “quality care?” Accreditation standards have dramatically improved healthcare delivery. Evidence-based medical treatment guidelines have helped guide appropriate clinical practice. The recent link between patient satisfaction scores and reimbursement has led to improved levels of customer service.

But with all this emphasis on quality, why haven’t disability costs declined? The national cost of caring for those who are functionally disabled is the highest in history at over $160 billion per year,1,2 and continues to rise at an unsustainable rate. And, sixty percent of those absent from their job for five weeks will never return to work.3

Quality measures addressing structure, process, and patient experience are all vitally important, but as healthcare providers, many of us have neglected quality measures related to functional outcomes. This is not true of all outcomes. After all, healthcare providers will regularly monitor the hemoglobin A1c of their patients with diabetes, so why do they not routinely measure the quality of life of their patients? Why ignore something so ultimately vital as a patient’s ability to function at home and work?

It is time for a new philosophy based on function. Functional status, the ability to perform activities of daily living, needs to be viewed as an important measure of health. We must realize that work is not only a healthy human activity, but also that work can help individuals regain their health. By regularly using functional outcome measures, healthcare providers can manage patients experiencing functional disability preventively.

There are many free functional outcome measures that have been appropriately validated, such as the Oswestry Disability IndexCdc-pdfExternal and the QuickDASHCdc-pdfExternal. These and other functional outcome measures are routinely used in evidence-based research, but they are rarely used in evidence-based treatment. Perhaps occupational medicine providers can change their perspective by regularly measuring the quality of their care by routinely assessing its impact on the recovery of function. Because, doesn’t better function equal a better outcome?

The use of functional outcomes, integrated with current evidence-based clinical practice, can significantly improve the lives of patients and workers. If patients are better, then the societal impact of disability will decrease, the quality of workers’ lives will improve, and organizations and workers can be better positioned to thrive and perform more productively.

Once the physical, occupational, psychosocial, and societal impacts of illness and injury are recognized, it becomes clear that functional outcome measures must be implemented into daily medical practice.

In short, function matters to workforce health.

For more information on functional outcome measures, see the recommendations in the American College of Occupational and Environmental Medicine position paper at:

To learn more about this topic, please view the recent NIOSH TWH webinar in conjunction with the NIOSH Center for Workers’ Compensation Studies on Integrating Functional Outcomes with Clinical Measures here:

1 O’Leary P, Boden LI, Seabury SA, Ozonoff A, Scherer E. Workplace injuries and the take-up of Social Security Disability Benefits. Soc Secur Bull. 2012;72:1–14.
2 Social Security Administration Office of Retirement and Disability Policy Office of Research, Evaluation, and Statistics. Annual Statistical Report on the Social Security Disability Insurance Program, 2014. Washington, DC: SSA Publication No. 13-11826; November 2015.
3 Wynne R, MacAnaney D. Employment and disability: Back to work strategies. Dublin: European Foundation for the Improvement of Work and Living Conditions; 2004. 128 p.