Measuring Functional Capacity and Work Requirements

Summary of a Workshop

Gooloo S. Wunderlich, Editor

Committee to Review the Social Security Administration's Disability Decision Process Research

Dorothy Rice, Chair

Division of Health Care Services

INSTITUTE OF MEDICINE
and

Committee on National Statistics

Commission on Behavioral and Social Sciences and Education

NATIONAL RESEARCH COUNCIL

NATIONAL ACADEMY PRESS
Washington, D.C. 1999



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Measuring Functional Capacity and Work Requirements: Summary of a Workshop Measuring Functional Capacity and Work Requirements Summary of a Workshop Gooloo S. Wunderlich, Editor Committee to Review the Social Security Administration's Disability Decision Process Research Dorothy Rice, Chair Division of Health Care Services INSTITUTE OF MEDICINE and Committee on National Statistics Commission on Behavioral and Social Sciences and Education NATIONAL RESEARCH COUNCIL NATIONAL ACADEMY PRESS Washington, D.C. 1999

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Measuring Functional Capacity and Work Requirements: Summary of a Workshop NATIONAL ACADEMY PRESS 2101 Constitution Avenue, N.W. Washington, D.C. 20418 NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance. The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Bruce Alberts is president of the National Academy of Sciences. The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. William A. Wulf is president of the National Academy of Engineering. The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Kenneth I. Shine is president of the Institute of Medicine. The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy's purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Bruce Alberts and Dr. William A. Wulf are chairman and vice chairman, respectively, of the National Research Council. The project that is the subject of this report is supported by Contract No. 600-96-27893 between the National Academy of Sciences and the Social Security Administration. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the view of the agency that provided support for this project. International Standard Book Number 0-309-06385-X Additional copies of this report are available for sale from the National Academy Press, 2101 Constitution Avenue, N.W., Box 285, Washington, D.C. 20055. Call (800) 624-6242 or (202) 334-3313 (in the Washington metropolitan area), or visit the NAP’s home page at www.nap.edu. The full text of this report is available on line at www.nap.edu/readingroom. For more information about the Institute of Medicine, visit the IOM home page at www2.nas.edu/iom. For more information about the Committee on National Statistics, visit the CNSTAT home page at www2.nas.edu/cnstat. Copyright 1999 by the National Academy of Sciences. All rights reserved. Printed in the United States of America.

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Measuring Functional Capacity and Work Requirements: Summary of a Workshop COMMITTEE TO REVIEW THE SOCIAL SECURITY ADMINISTRATION'S DISABILITY DECISION PROCESS RESEARCH DOROTHY P. RICE* (Chair), Professor Emeritus, Department of Social and Behavioral Sciences, Institute for Health and Aging, University of California at San Francisco MONROE BERKOWITZ, Professor of Economics, Emeritus, and Director, Disability and Health Economics Research, Rutgers University RONALD S. BROOKMEYER, Professor of Biostatistics, The Johns Hopkins University School of Hygiene and Public Health GERBEN DEJONG, Director, National Rehabilitation Hospital Research Center, and Professor of Family Medicine and Adjunct Professor, Georgetown University Institute of Public Policy MARSHAL F. FOLSTEIN, Chairman and Professor of Psychiatry, Tufts University School of Medicine, and Psychiatrist-in-Chief, New England Medical Center, Boston ROBERT M. GROVES, Professor and Program Director, Survey Research Center of the University of Michigan at Ann Arbor, and Director of the Joint Program on Survey Methodology at the University of Maryland at College Park ALAN M. JETTE, Professor and Dean, Sargent College of Health and Rehabilitation Sciences, Boston University WILLIAM D. KALSBEEK, Professor of Biostatistics and Director, Survey Research Unit, University of North Carolina at Chapel Hill JERRY L. MASHAW, Sterling Professor of Law and Management and Professor, Institute for Social and Policy Studies, Yale University CATHARINE C. MASLOW, Director, Initiative on Alzheimer's and Managed Care, Alzheimer's Association, Washington, D.C. DONALD L. PATRICK,* Professor of Health Services, University of Washington School of Public Health and Community Medicine HAROLD A. PINCUS, Deputy Medical Director and Director, Office of Research, American Psychiatric Association, Washington, D.C. JOHN A. SWETS,** Chief Scientist, Information Sciences, BBN Corporation, Cambridge, Massachusetts EDWARD H. YELIN, Professor of Medicine and Health Policy, Department of Medicine and Institute for Health Policy Studies, University of California at San Francisco Study Staff GOOLOO S. WUNDERLICH, Study Director KATHLEEN NOLAN, Research Associate KRISTEN ROBINSON, Program Officer (until May 1998) REBECCA LUCCHESE, Administrative Assistant MARGO CULLEN, Administrative Assistant (until July 1998) *   Member, Institute of Medicine. **   Member, National Academy of Sciences.

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Measuring Functional Capacity and Work Requirements: Summary of a Workshop BOARD ON HEALTH CARE SERVICES INSTITUTE OF MEDICINE DON E. DETMER* (Chair), University Professor of Health Policy, University of Virginia BARBARA J. McNEIL* (Vice Chair), Ridley Watts Professor, Department of Health Care Policy, Harvard Medical School STUART H. ALTMAN,* Sol C. Chaikin Professor of National Health Policy, The Florence Heller Graduate School for Social Policy, Brandeis University PAUL D. CLAYTON,* Medical Informaticist, Intermountain Health Care, Salt Lake City, Utah NANCY W. DICKEY, Private Practice, Bryan, Texas B. KEN GRAY, Corporate Medical Director, Metroplex Emergency Physician Associates, P.A., Dallas, Texas PAUL F. GRINER,* Vice President and Director, Center for the Assessment and Management of Change in Academic Medicine, Association of American Medical Colleges, Washington, D.C. RUBY P. HEARN,* Senior Vice President, Robert Wood Johnson Foundation, Princeton, New Jersey PETER BARTON HUTT,* Partner, Covington & Burling, Washington, D.C. BRENT C. JAMES, Executive Director, Institute for Health Care Delivery Research, and Vice President, Medical Research and Continuing Medical Education, Intermountain Health Care, Salt Lake City, Utah JACQUELINE KOSECOFF, President and Co-Chief Executive Officer, Protocare, Santa Monica, California SHEILA T. LEATHERMAN, Executive Vice President, United HealthCare Corporation, Minneapolis, Minnesota JOHN LUDDEN, Senior Vice President for Medical Affairs, Harvard Pilgrim Health Care, Brookline, Massachusetts RUSSELL L. MILLER, Private Consultant (Retired, State University of New York, Health Science Center, Brooklyn), Washington, D.C. MILDRED MITCHELL-BATEMAN,* Clinical Director, Huntington Hospital, Huntington, West Virginia MARY MUNDINGER,* Dean and Centennial Professor in Health Policy, Columbia University UWE E. REINHARDT,* James Madison Professor of Political Economy, Princeton University MARY LEE SEIBERT, Acting Provost, Ithaca College GAIL L. WARDEN,* President and Chief Executive Officer, Henry Ford Health System, Detroit, Michigan JANET M. CORRIGAN, Director, Board on Health Care Services, IOM

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Measuring Functional Capacity and Work Requirements: Summary of a Workshop COMMITTEE ON NATIONAL STATISTICS NATIONAL RESEARCH COUNCIL JOHN E. ROLPH (Chair), Department of Information and Operations Management, University of Southern California JOSEPH G. ALTONJI, Institute for Research on Poverty, Department of Economics, Northwestern University JULIE DAVANZO, RAND, Santa Monica, California WILLIAM F. EDDY, Department of Statistics, Carnegie Mellon University WILLIAM D. KALSBEEK, Survey Research Unit, Department of Biostatistics, University of North Carolina at Chapel Hill RODERICK J.A. LITTLE, School of Public Health, University of Michigan THOMAS A. LOUIS, Division of Biostatistics, University of Minnesota CHARLES F. MANSKI, Department of Economics, Northwestern University WILLIAM D. NORDHAUS, Department of Economics, Yale University JANET L. NORWOOD, The Urban Institute, Washington, D.C. EDWARD B. PERRIN, Department of Health Services, University of Washington PAUL R. ROSENBAUM, Department of Statistics, The Wharton School, University of Pennsylvania FRANCISCO J. SAMANIEGO, Division of Statistics, University of California at Davis RICHARD L. SCHMALENSEE, Sloan School of Management, Massachusetts Institute of Technology MIRON L. STRAF, Director, Committee on National Statistics, National Research Council ANDREW WHITE, Deputy Director, Committee on National Statistics, National Research Council

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Measuring Functional Capacity and Work Requirements: Summary of a Workshop Acknowledgments The Committee to Review the Social Security Administration's Disability Decision Process Research (the committee) acknowledges with appreciation the many people who participated in the Workshop on Functional Capacity and Work Requirements and contributed to its success. We acknowledge those who served as formal discussants, and the many others who contributed to the lively and informative discussions at the workshop. Support for the study was provided by the Social Security Administration. We particularly wish to thank David Barnes, Rosanne Hanratty, and Scott Muller who served as government project officers for the study. They provided valuable ideas in the planning for the workshop. We also acknowledge with gratitude the commitment and support of the committee staff in organizing the workshop and preparing the report. Gooloo Wunderlich, Study Director, not only undertook the major responsibility for the workshop, but also prepared the report. Kristen Robinson worked closely with the study director in organizing the workshop, developing the agenda, and preparing background material pertinent to the workshop. Margo Cullen, Administrative Assistant, efficiently managed all the logistical and administrative arrangements and the smooth operation of the workshop. Jane West, consultant, served as rapporteur for the workshop, and we gratefully acknowledge her efforts. Many thanks go to Kathleen Nolan and Rebecca Lucchese for reviewing the drafts, preparing the charts for publication, formatting the tables, and making editorial corrections to the entire report. The chair thanks the committee members for their time and commitment to the workshop. The report was reviewed by individuals chosen for their diverse perspectives and technical expertise in accordance with procedures approved by the National Research Council's Report Review Committee. The purpose of this independent

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Measuring Functional Capacity and Work Requirements: Summary of a Workshop review is to provide candid and critical comments to assist the authors and the National Academy of Sciences in making the published report as sound as possible and to ensure that the report meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The content of the review comments and the draft manuscript remain confidential to protect the integrity of the deliberative process. The committee wishes to thank the following individuals for their participation in the report review process: Laurence Branch, Duke University; Joan Leon, independent consultant; Mary Mundinger, Columbia University; Janet Norwood, Urban Institute; and Edward Perrin, University of Washington. While the individuals listed above provided many constructive comments and suggestions, responsibility for the final content of the report rests solely with the authoring committee and the National Academy of Sciences. Dorothy P. Rice, Chair

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Measuring Functional Capacity and Work Requirements: Summary of a Workshop Contents 1   INTRODUCTION   1     Objectives and Focus of the Workshop   2 2   MEASURING FUNCTIONAL CAPACITY OF PERSONS WITH DISABILITIES IN LIGHT OF EMERGING DEMANDS IN THE WORKPLACE   4     Edward Yelin   4     Janet Norwood   27     General Discussion and Comments   29 3   LINKING COMPONENTS OF FUNCTIONAL CAPACITY DOMAINS WITH WORK REQUIREMENTS   32     Howard Goldman   32     Edwin A. Fleishman   36     Cille Kennedy   39     General Discussion and Comments   43 4   DESIRED CHARACTERISTICS OF INSTRUMENTS TO MEASURE FUNCTIONAL CAPACITY TO WORK   45     Alan Jette   45     Allen Heinemann   51     Constantine Lyketsos   52     General Discussion and Comments   55

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Measuring Functional Capacity and Work Requirements: Summary of a Workshop 5   THE USE OF FUNCTIONAL CAPACITY MEASURES IN PUBLIC AND PRIVATE PROGRAMS IN THE UNITED STATES AND IN OTHER COUNTRIES   59     Patricia Owens   59     Richard Burkhauser   63     Ian Basnett   68     General Discussion and Comments   72 6   ADAPTING MEASUREMENT OF FUNCTIONAL CAPACITY TO WORK TO SSA'S DISABILITY DECISION PROCESS   74     Virginia Reno   74     Lisa Iezzoni   78     David Stapleton   79     General Discussion and Comments   83 7   RECURRING THEMES AND ISSUES   85     Definitional and Measurement Issues   85     Issues in Assessment of Functional Capacity to Work   86     Motivation, Work Environment, and Accommodations   87     Medical Listings and Their Role in the Assessment Process   87     Functional Assessment in Other Countries' Programs   88     Concluding Comments   88     REFERENCES   89     APPENDIXES     A   Study Mandate   95 B   Workshop Agenda   96 C   List of Participants   99     ACRONYMS AND ABBREVIATIONS   105     BIOGRAPHICAL SKETCHES OF COMMITTEE MEMBERS   107

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