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Quality of Life & Disability Assessment

Quality of Life & Disability Assessment. Kenneth D. Rosenman, MD Professor of Medicine Michigan State University. Health-Related Quality of Life Questionnaires. www.qolid.org - 437 Generic - 75 Medical Outcome Study Short Form Health Survey (SF-20) (Carver et al, 1999)

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Quality of Life & Disability Assessment

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  1. Quality of Life&Disability Assessment Kenneth D. Rosenman, MD Professor of Medicine Michigan State University

  2. Health-RelatedQuality of Life Questionnaires www.qolid.org - 437 Generic - 75 Medical Outcome Study Short Form Health Survey (SF-20) (Carver et al, 1999) Asthma - 20 Mini-Asthma Quality of Life (Juniper et al, 1999)

  3. Uses in LiteratureQOL Health Questionnairesfor Asthma • Impact of pharmacological treatment • Impact of allergy specialist care • Pollen vs. non pollen season • Clinical evaluation

  4. Malo et al, 1993 • 134 OA (Quebec 1986-1988 on W.C.) • 91 Asthma – 2 tertiary care hospitals • OA 2.9 vs. 2.3* Asthma • Limitations • All compensated (only 8% unemployed) • Possibility of exaggeration in responses because of compensation

  5. Percentage of Patients with Work-Related Asthma Not Working

  6. Work Status of Work-Related Asthma in Michigan, SENSOR, 1988-2003

  7. Percentage of PatientsReporting Income Loss

  8. Hospitalizations for Asthma Among Individuals with Work-Related Asthma

  9. Risk Factors for Poor Prognosis • Increased duration of exposure • Increased duration of symptoms before diagnosis • Increased severity of disease at diagnosis • More baseline airway obstruction • React to lower dose methacholine • Continued exposure after diagnosis • Absence of IgE antibody to TDI-Human Serum Albumin Conjugate (Park and Nahm, 1997) • Eosinophils in BAL (Paggiaro et al, 1993)

  10. Risk Factors for Unemployment • Older/Younger • Compensation claim • Less education • Small company (Ameille et al, 1997) • Women (Gassert et al, 1998) • Industrial worker (Gassert et al, 1998) • Chest doc vs. occupational doc (Ross & McDonald, 1998) • Low molecular weight compound, particularly in smokers (Ross & McDonald, 1998)

  11. Quebec System of Compensation for Occupational Asthma: Criteria Used to Determine Permanent Disability (Malo; Chest 1990)

  12. Impairment Classification for Asthma Severity (AMA, 5th ed, 2001)

  13. Impairment Rating for Asthma

  14. Social Security Disability(SSA Pub No. 64-039, 1998) Attacks occurring at least 6x/year despite adherence to prescribed treatment (hospitalization > 24 hrs = 2 attacks) Spirometric results between attacks document baseline airflow obstruction (severity not specified) Documentation of adherence to prescribed meds

  15. Class of Respiratory Impairment FEV1 PC20 EOS% NO (Chan-Yeing et al, 1999)

  16. Worker Compensation Claims for Work-Related Asthma, United States State of Washington, 1995-2002 1,377 work-related asthma claims 59% accepted (vs. 90% overall) (33% orchards to 100% electroplating or boilermaking) (Curwick and Bonauto, 2003) State of Michigan, SENSOR, 1988-2002 818 of 1,740 (47%) applied 51% Pending 34% Awarded 15% Denied (Rosenman et al, 2003) State of California, SENSOR, 1993-1996 58 of 141 (41%) applied (Reinisch et al, 2001)

  17. Total Costs for Work-Related Asthma, USA, Billions of 1996 Dollars, Assuming a 15% PAR

  18. Summary • Only a single study using QOL instrument • Percentage out of work/economic loss is high • True for all types of work-related asthma • Variations in socio/economic losses across geopolitical boundaries • Implementation and evaluation of interventions to reduce adverse health and socio/economic complications

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