Publications by authors named "Robert K McLellan"

19 Publications

  • Page 1 of 1

A Worksite Self-management Program for Workers with Chronic Health Conditions Improves Worker Engagement and Retention, but not Workplace Function.

J Occup Rehabil 2021 May 13. Epub 2021 May 13.

University of South-Eastern Norway, Raveien 215, 3184, Borre, Norway.

Purpose An increasing number of workers in the US have chronic health conditions that limit their ability to work, and few worksite interventions have been tested to improve worker coping and problem solving at work. The purpose of this study was to evaluate a worksite-based health self-management program designed to improve workplace function among workers with chronic health conditions. Methods We conducted a randomized, controlled trial of a worksite self-management program ("Manage at Work") (clinicaltrials.gov #NCT01978392) for workers with chronic health conditions (N = 119; 82% female, ages 20-69). Most workers were recruited from the health care or light manufacturing industry sectors. Workers attended a 5-session, facilitated psychoeducational program using concepts of health self-management, self-efficacy, ergonomics, and communication. Changes on outcomes of work engagement, work limitation, job satisfaction, work fatigue, work self-efficacy, days absent, and turnover intention at 6-month follow-up were compared to wait-list controls. Results The most prevalent chronic health conditions were musculoskeletal pain, headaches, vision problems, gastrointestinal disorders, respiratory disorders, and mental health disorders. The self-management program showed greater improvement in work engagement and turnover intent at 6-month follow-up, but there was no evidence of a parallel reduction in perceived work limitation. Trends for improved outcomes of work self-efficacy, job satisfaction, and work fatigue in the intervention group did not reach statistical significance in a group x time interaction test. Conclusions Offering a worksite self-management program to workers with chronic health conditions may be a feasible and beneficial strategy to engage and retain skilled workers who are risking disability.Clinical trial registration: Clinicaltrials.gov #NCT01978392.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s10926-021-09983-6DOI Listing
May 2021

Medical qualification for respirator use: An essential component of respiratory protection.

Am J Ind Med 2020 10 29;63(10):949-950. Epub 2020 Jul 29.

Geisel School of Medicine at Dartmouth, The Dartmouth Institute for Health Policy & Clinical Practice, Hanover, New Hampshire.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/ajim.23162DOI Listing
October 2020

Using Electronic Health Records and Clinical Decision Support to Provide Return-to-Work Guidance for Primary Care Practitioners for Patients With Low Back Pain.

J Occup Environ Med 2017 11;59(11):e240-e244

From the Occupational and Environmental Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH (Dr McLellan); The Permanente Medical Group, San Francisco, California (Dr Kownacki); University of Massachusetts Medical School, Sudbury, Massachusetts (Dr Pransky; and ACOEM, Elk Grove Village, Illinois (Ms Dreger).

Objective: The aim of this study was to describe the process by which a group of subject matter experts in the area of return to work developed a resource tool to provide clinical decision support (CDS) for primary care clinicians.

Methods: A common musculoskeletal disorder, low back pain (LBP), was selected, pertinent literature reviewed, and specific recommendations for action in the clinical setting developed.

Results: Primary care practitioners (PCPs) are routinely expected to create work activity prescriptions. The knowledge base for a CDS tool that could be embedded in electronic health records has been developed.

Conclusion: Improved clinical support should help prevent and manage work limitations associated with LBP not caused by work. The proposed decision support should reduce administrative burden and stimulate PCPs to explore the role of occupation and its demands on patients.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/JOM.0000000000001180DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5957077PMC
November 2017

Work, Health, And Worker Well-Being: Roles And Opportunities For Employers.

Health Aff (Millwood) 2017 02;36(2):206-213

Robert K. McLellan is section chief of the Department of Occupational and Environmental Medicine at the Dartmouth-Hitchcock Medical Center, and a professor of medicine at the Geisel School of Medicine at Dartmouth, both in Lebanon, New Hampshire.

Work holds the promise of supporting and promoting health. It also carries the risk of injury, illness, and death. In addition to harms posed by traditional occupational health hazards, such as physically dangerous workplaces, work contributes to health problems with multifactorial origins such as unhealthy lifestyles, psychological distress, and chronic disease. Not only does work affect health, but the obverse is true: Unhealthy workers are more frequently disabled, absent, and less productive, and they use more health care resources, compared to their healthy colleagues. The costs of poor workforce health are collectively borne by workers, employers, and society. For business as well as altruistic reasons, employers may strive to cost-effectively achieve the safest, healthiest, and most productive workforce possible. Narrowly focused health goals are giving way to a broader concept of employee well-being. This article explores the relationship between health and work, outlines opportunities for employers to make this relationship health promoting, and identifies areas needing further exploration.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1377/hlthaff.2016.1150DOI Listing
February 2017

Commentary of the Special Panel at the Hopkinton Conference Working Group on Workplace Disability Prevention.

J Occup Rehabil 2017 03;27(1):1-3

University of Sydney, 5 Moseley St, Carlingford, Sydney, NSW, 2118, Australia.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s10926-016-9676-8DOI Listing
March 2017

Total Worker Health: A Promising Approach to a Safer and Healthier Workforce.

Ann Intern Med 2016 08 31;165(4):294-5. Epub 2016 May 31.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.7326/M16-0965DOI Listing
August 2016

Integrating health and safety in the workplace: how closely aligning health and safety strategies can yield measurable benefits.

J Occup Environ Med 2015 May;57(5):585-97

From Chief Health Officer (Dr Baase), The Dow Chemical Company, Midland, MI; Northwestern University and University of Illinois at Chicago, School of Public Health (Dr Bunn), Hilton Head, SC; Chief Medical Officer (Dr Burton), American Express, Chicago; Executive Director (Mr Eisenberg), American College of Occupational and Environmental Medicine, Elk Grove Village, IL; VP Denver Risk Control Manager, Risk Control and Claim Advocacy Practice (Ms Ennis), Willis Group, Wheat Ridge, CO; Co-founder & President (Dr Fabius), HealthNEXT, Newtown Square, PA; Director, Environmental Health & Safety (Mr Hawkins), Time Warner Cable, Inc., Charlotte, NC; Global Director - Workplace Health and Safety (Mr Hohn), Underwriters Laboratories, Inc.; Medical Director, Occupational and Employee Health (Dr Hudson), UCLA Health System and Campus, Los Angeles; Chief Medical Officer (Dr Hymel), Walt Disney Parks and Resorts, Anaheim, CA; Director Corporate Relations (Ms Konicki), ACOEM, Chicago; Paul Larson Communications (Mr Larson), Evanston, IL; Vice-Chairman (Dr Loeppke), US Preventive Medicine, Inc., Brentwood, TN; Associate Professor (Dr McLellan), Medicine, Community and Family Medicine, and The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH; Principal Scientist/Director Center for Occupational & Environmental Health (Dr Roberts), Exponent, Chicago, IL; Process Improvement Leader (Mr Usrey), Predictive Solutions, Oakdale, PA; Risk Control Director - Nashville & New Orleans (Mr Wallace), CNA Insurance, Old Hickory, TN; Director of Medical Strategies (Dr Yarborough), Lockheed Martin Corporation, Bethesda, MD; and Health Educator (Ms Siuba), Department of Health and Environmental Control, Columbia, SC.

Objective: To better understand how integrating health and safety strategies in the workplace has evolved and establish a replicable, scalable framework for advancing the concept with a system of health and safety metrics, modeled after the Dow Jones Sustainability Index.

Methods: Seven leading national and international programs aimed at creating a culture of health and safety in the workplace were compared and contrasted.

Results: A list of forty variables was selected, making it clear there is a wide variety of approaches to integration of health and safety in the workplace.

Conclusion: Depending on how well developed the culture of health and safety is within a company, there are unique routes to operationalize and institutionalize the integration of health and safety strategies to achieve measurable benefits to enhance the overall health and well-being of workers, their families, and the community.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/JOM.0000000000000467DOI Listing
May 2015

Manage at work: a randomized, controlled trial of a self-management group intervention to overcome workplace challenges associated with chronic physical health conditions.

BMC Public Health 2014 May 28;14:515. Epub 2014 May 28.

Liberty Mutual Research Institute for Safety, 71 Frankland Rd,, Hopkinton, MA 01748, USA.

Background: The percentage of older and chronically ill workers is increasing rapidly in the US and in many other countries, but few interventions are available to help employees overcome the workplace challenges of chronic pain and other physical health conditions. While most workers are eligible for job accommodation and disability compensation benefits, other workplace strategies might improve individual-level coping and problem solving to prevent work disability. In this study, we hypothesize that an employer-sponsored group intervention program employing self-management principles may improve worker engagement and reduce functional limitation associated with chronic disorders.

Methods: In a randomized controlled trial (RCT), workers participating in an employer-sponsored self-management group intervention will be compared with a no-treatment (wait list) control condition. Volunteer employees (n = 300) will be recruited from five participating employers and randomly assigned to intervention or control. Participants in the intervention arm will attend facilitated group workshop sessions at work (10 hours total) to explore methods for improving comfort, adjusting work habits, communicating needs effectively, applying systematic problem solving, and dealing with negative thoughts and emotions about work. Work engagement and work limitation are the principal outcomes. Secondary outcomes include fatigue, job satisfaction, self-efficacy, turnover intention, sickness absence, and health care utilization. Measurements will be taken at baseline, 6-, and 12-month follow-up. A process evaluation will be performed alongside the randomized trial.

Discussion: This study will be most relevant for organizations and occupational settings where some degree of job flexibility, leeway, and decision-making autonomy can be afforded to affected workers. The study design will provide initial assessment of a novel workplace approach and to understand factors affecting its feasibility and effectiveness.

Trial Registration: Clinicaltrials.gov: NCT01978392 (Issued November 6, 2013).
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/1471-2458-14-515DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4051380PMC
May 2014

Feasibility study of an interactive multimedia electronic problem solving treatment program for depression: a preliminary uncontrolled trial.

Behav Ther 2014 May 7;45(3):358-75. Epub 2014 Feb 7.

Center for Technology and Behavioral Health; Geisel School of Medicine at Dartmouth.

Computer-based depression interventions lacking live therapist support have difficulty engaging users. This study evaluated the usability, acceptability, credibility, therapeutic alliance and efficacy of a stand-alone multimedia, interactive, computer-based Problem Solving Treatment program (ePST™) for depression. The program simulated live treatment from an expert PST therapist, and delivered 6 ePST™ sessions over 9weeks. Twenty-nine participants with moderate-severe symptoms received the intervention; 23 completed a minimally adequate dose of ePST™ (at least 4 sessions). Program usability, acceptability, credibility, and therapeutic alliance were assessed at treatment midpoint and endpoint. Depressive symptoms and health-related functioning were assessed at baseline, treatment midpoint (4weeks), and study endpoint (10weeks). Depression outcomes and therapeutic alliance ratings were also compared to previously published research on live PST and computer-based depression therapy. Participants rated the program as highly usable, acceptable, and credible, and reported a therapeutic alliance with the program comparable to that observed in live therapy. Depressive symptoms improved significantly over time. These findings also provide preliminary evidence that ePST™ may be effective as a depression treatment. Larger clinical trials with diverse samples are indicated.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4003894PMC
http://dx.doi.org/10.1016/j.beth.2014.02.001DOI Listing
May 2014

Optimizing health care delivery by integrating workplaces, homes, and communities: how occupational and environmental medicine can serve as a vital connecting link between accountable care organizations and the patient-centered medical home.

J Occup Environ Med 2012 Apr;54(4):504-12

ACOEM, Elk Grove Village, IL, USA.

In recent years, the health care reform discussion in the United States has focused increasingly on the dual goals of cost-effective delivery and better patient outcomes. A number of new conceptual models for health care have been advanced to achieve these goals, including two that are well along in terms of practical development and implementation-the patient-centered medical home (PCMH) and accountable care organizations (ACOs). At the core of these two emerging concepts is a new emphasis on encouraging physicians, hospitals, and other health care stakeholders to work more closely together to better coordinate patient care through integrated goals and data sharing and to create team-based approaches that give a greater role to patients in health care decision-making. This approach aims to achieve better health outcomes at lower cost. The PCMH model emphasizes the central role of primary care and facilitation of partnerships between patient, physician, family, and other caregivers, and integrates this care along a spectrum that includes hospitals, specialty care, and nursing homes. Accountable care organizations make physicians and hospitals more accountable in the care system, emphasizing organizational integration and efficiencies coupled with outcome-oriented, performance-based medical strategies to improve the health of populations. The ACO model is meant to improve the value of health care services, controlling costs while improving quality as defined by outcomes, safety, and patient experience. This document urges adoption of the PCMH model and ACOs, but argues that in order for these new paradigms to succeed in the long term, all sectors with a stake in health care will need to become better aligned with them-including the employer community, which remains heavily invested in the health outcomes of millions of Americans. At present, ACOs are largely being developed as a part of the Medicare and Medicaid systems, and the PCMH model is still gathering momentum and evolving among physicians. But, the potential exists for implementation of both of these concepts across a much broader community of patients. By extending the well-conceived integrative concepts of the PCMH model and ACOs into the workforce via occupational and environmental medicine (OEM) physicians, the power of these concepts would be significantly enhanced. Occupational and environmental medicine provides a well-established infrastructure and parallel strategies that could serve as a force multiplier in achieving the fundamental goals of the PCMH model and ACOs. In this paradigm, the workplace-where millions of Americans spend a major portion of their daily lives-becomes an essential element, next to communities and homes, in an integrated system of health anchored by the PCMH and ACO concepts. To be successful, OEM physicians will need to think and work innovatively about how they can provide today's employer health services-ranging from primary care and preventive care to workers' compensation and disability management-within tomorrow's PCMH and ACO models.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/JOM.0b013e31824fe0aaDOI Listing
April 2012

Impact of workplace sociocultural attributes on participation in health assessments.

J Occup Environ Med 2009 Jul;51(7):797-803

Dartmouth Medical School, Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH 03756, USA.

Objective: To investigate the impact of sociocultural workplace attributes on participation in employer sponsored health assessments.

Methods: Medical center employees were encouraged to participate in free, voluntary, and confidential biometric screening and on-line health risk appraisal. A job satisfaction database, aggregated by job type and work area, was used to identify workplace sociocultural attributes correlated with participation.

Results: : Thirty-seven percent of the population engaged in the health assessments; however, participation varied widely by work area (10% to 83%) and by job type (17% to 56%). Participation was significantly correlated with selected aspects of job satisfaction.

Conclusions: Overall participation rates in employee population health assessments can disguise large variation in employee engagement. This variation is associated with work sociocultural characteristics. Attention to these attributes may be essential to improving involvement in employer sponsored health promotion.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/JOM.0b013e3181a4b9e8DOI Listing
July 2009

The usefulness and cost of a shorter duration of fasting in workplace screening for glucose intolerance and metabolic syndrome.

Diabetes Res Clin Pract 2009 Apr 1;84(1):e6-8. Epub 2009 Feb 1.

Dartmouth Medical School, Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH 03756, USA.

For worksite biometric screening, we shortened traditional fasting instructions to 4h. The positive predictive value (PPV) of elevated capillary glucose test results (> or =100mg/dL) for predicting elevated values obtained on repeat testing after an 8h fast was 57%, which rivals the PPV of an 8h fasting glucose.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.diabres.2009.01.005DOI Listing
April 2009

ACOEM denies industry partisanship.

Int J Occup Environ Health 2008 Jan-Mar;14(1):79; author reply 80-1

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1179/oeh.2008.14.1.79DOI Listing
May 2008

Training to optimize the response of supervisors to work injuries--needs assessment, design, and evaluation.

AAOHN J 2006 May;54(5):226-35

Liberty Mutual Research Institute for Safety, Center for Disability Research, Hopkinton, MA, USA.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/216507990605400506DOI Listing
May 2006

A controlled case study of supervisor training to optimize response to injury in the food processing industry.

Work 2006 ;26(2):107-14

Liberty Mutual Research Institute for Safety, 71 Frankland Road, Hopkinton, MA 01748, USA.

The role of supervisors to aid injured workers, access health care, and provide reasonable accommodation may prevent prolonged disability among workers reporting musculoskeletal pain. Although supervisor training has been a common element of broad-based ergonomic interventions to prevent injuries, the impact of supervisor training alone to improve injury response has not been studied. In a controlled design, 11 supervisors in an intervention group and 12 supervisors in a delayed intervention control group from the same plant were provided a 4-hour training workshop. The workshop emphasized communication skills and ergonomic accommodation for workers reporting injuries or health concerns. Workers' compensation claims data in the 7 months before and after the workshop showed a 47% reduction in new claims and an 18% reduction in active lost-time claims versus 27% and 7%, respectively, in the control group. Improving the response of frontline supervisors to employees' work-related health and safety concerns may produce sustainable reductions in injury claims and disability costs.
View Article and Find Full Text PDF

Download full-text PDF

Source
March 2006

Employee perspectives on the role of supervisors to prevent workplace disability after injuries.

J Occup Rehabil 2003 Sep;13(3):129-42

Liberty Mutual Research Institute for Safety, 71 Frankland Road, Hopkinton, Massachusetts 01748, USA.

After workplace injuries, supervisors can play an important role in aiding workers, accessing health care services, and providing reasonable accommodation. However, few studies have identified those aspects of supervisor involvement most valued by employees for postinjury recovery and return to work. As part of needs assessment for a supervisory training program, 30 employees from four companies were interviewed about the role of supervisors to prevent workplace disability after injuries. From interview notes, 305 employee statements were extracted for analysis. An affinity mapping process with an expert panel produced 11 common themes: accommodation, communicating with workers, responsiveness, concern for welfare, empathy/support, validation, fairness/respect, follow-up, shared decision-making, coordinating with medical providers, and obtaining coworker support of accommodation. Interpersonal aspects of supervision may be as important as physical work accommodation to facilitate return to work after injury.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1023/a:1024997000505DOI Listing
September 2003
-->