Performance and quality measurement in occupational health services: current status and agenda for further research

There is growing interest in evaluating the impact and effectiveness of occupational healthcare services (OHS). Managed care networks, case and disease management, worker health promotion, and utilization review services have proliferated in OHS, usually without scientifically based, objective measures of their impact on the quality of care, outcomes, or costs. Performance and quality improvement (QI) efforts in OHS are different from those in general health care because the population, range of conditions, setting of care, and primary outcomes of interest differ considerably. However, scientific knowledge resulting from the application of QI in general health care can provide a useful framework for the development of measures in OHS.

We describe the development, selection, and evaluation of OHS performance and quality measures, and propose a research agenda.

Quality and performance measures in OHS should address common work-related conditions with high costs, suboptimal outcomes, or unclear parameters for ideal practices. They should reflect stakeholder priorities. Measures should be precise and quantifiable, clearly specified, reliable, valid, and sensitive to important changes. They should be based upon data that can be collected and analyzed at a reasonable cost and effort. The focus of measurement should be on situations where improvement can be achieved by those directly involved in OHS delivery, through defined approaches. Appropriate severity and case-mix adjustment may be especially problematic in OHS. Confidentiality, regulatory concerns, and appropriate use of results must be considered in the development and use of OHS measures. Research is needed to identify, develop, and validate OHS-specific measures, to establish risk adjustment methods, and to test the utility of this information in improving OHS.