Quantifying Economic & Health Effects of Psychosocial Workplace Exposures

描述（由申请人提供）：候选人：我是一名社会流行病学家，专注于了解工作场所在塑造短期和长期人口健康差异方面的作用。这个应用程序的总体培训目标是加强我在社会和 职业流行病学，并接受经济学和工作场所干预培训。这将使我能够实现我的长期目标，成为一名独立的学者，进行旨在改善心理社会工作条件的现场干预，具有改善工人健康和向雇主展示经济效益的双重目的。为了实现这一长期目标，我为培训期间设定了四个短期目标，每个目标都有一套相关的培训活动：1）通过实践经验和导师团队的指导，熟练掌握干预措施的设计、部署和评估; 2）通过一系列课程，熟练掌握卫生经济学和组织研究; 3）开发一个具有心理社会职业暴露和经济成果优势的研究组合; 4）根据研究结果和指导培训，开发和试点工作场所干预措施。 工作环境：我将有机会使用位于马萨诸塞州剑桥市的哈佛大学主校区的知识能力和设施，该校区包括人文和科学领域各种强大的学术部门和设施，以及位于美国科学研究设施最集中的地区之一朗伍德医学区的哈佛公共卫生学院波士顿校区。我将有充分的机会从几个部门和中心在整个大学，包括在人口与发展研究中心的丰富和专业发展的机会;社会和行为科学系和环境卫生系在HSPH;丹娜-法伯癌症研究所中心为社区为基础的研究;和哈佛催化剂，研究孵化器和培训计划。 调研：几十年的研究已经产生了大量和越来越多的证据，记录了工作场所心理社会暴露的健康后果，这一类别包括骚扰，欺凌，虐待，歧视和工作家庭冲突。这些暴露在卫生保健环境中尤其普遍，并已被发现可预测多种急性和慢性工人健康结果，包括伤害，心血管疾病，睡眠中断和精神健康状况不佳。一些研究还将这些风险与营业额等业务成果联系起来。然而，量化此类风险的实际经济影响的研究有限。我们的第一个目标是量化的幅度，方向和意义的心理社会工作环境和经济成果之间的关系，整体和个人利益相关者，如付款人和卫生系统，在急性护理医院设置。我们的第二个目标是确定心理社会工作环境和经济成果之间的关系，以及工人健康在调解上述协会的作用，在急性护理和长期护理环境是一致的程度。这种比较将是重要的，在未来的理解，在急性护理医院试行的心理干预措施，可以适应长期护理环境，反之亦然。拟议的研究的贡献是生产的证据记录不良心理社会职业暴露的潜在经济后果。通过形成性研究，了解医疗保健领导者的经济优先事项，然后使用严格的经济方法对社会心理暴露与这些指标之间的关联进行建模，我们希望量化医疗保健组织通过改善社会心理工作环境可能获得的潜在竞争优势。这一贡献是重要的，因为改善心理社会工作条件不仅有利于雇主的利益，而且还可能同时有利于工人的健康。因此，研究结果将代表职业健康计划和医疗保健组织的激励措施。如果我们的项目的目标得以实现，社会心理暴露的经济影响得到更好的量化，未来的社会心理工作场所干预研究可能更有可能衡量和报告干预措施对经济终点的影响。这一纳入以及随后对结果的传播，可能会进一步促进各组织采取减少工作场所健康危害的措施，增加现有工作场所心理社会干预措施的影响。这项研究还将为今后的干预研究奠定基础，这些研究旨在通过改善心理社会工作环境，同时改善工人的健康和雇主的经济成果。

DESCRIPTION (provided by applicant): Candidate: I am a social epidemiologist focused on understanding the role of the workplace in shaping short- and long-term disparities in population health. The overall training goal of this application is to augment my prior training in social and occupational epidemiology with training in economics and worksite interventions. This will allow me to achieve my long-term goal of becoming an independent scholar conducting worksite interventions aimed at improving psychosocial working conditions, with the dual purpose of improving worker health and demonstrating economic benefits to the employer. To work toward that long-term goal, I have set four short-term goals for the training period, each with a set of associated training activities: 1) develop proficiency in intervention design, deployment and evaluation through hands-on experience and mentorship from my mentor team; 2) develop proficiency in health economics and organizational studies through a series of courses; 3) develop a research portfolio with strengths in psychosocial occupational exposures and economic outcomes; 4) develop and pilot a worksite intervention based on study findings and mentored training. Environment: I will have access to the intellectual capacity and facilities at the main campus of Harvard University in Cambridge, Massachusetts which encompasses a wide variety of strong academic departments and facilities in the humanities and sciences, and at the Boston campus of Harvard School of Public Health (HSPH), located in the Longwood Medical Area, one of the most concentrated areas of scientific research facilities in the United States. I will have full access to enrichment and professional development opportunities from several Departments and Centers across the University, including at the Center for Population and Development Studies; the Department of Social and Behavioral Sciences and the Department of Environmental Health at HSPH; the Dana-Farber Cancer Institute Center for Community-based Research; and the Harvard Catalyst, a research incubator and training program. Research: Decades of research have produced a large and growing body of evidence documenting health consequences of workplace psychosocial exposures, a category including harassment, bullying, abuse, discrimination, and work-family conflict. These exposures are especially prevalent in health care settings and have been found to predict multiple acute and chronic worker health outcomes, including injury, cardiovascular disease, sleep disruption, and poor mental health. Some studies have also linked these exposures with business outcomes such as turnover. However, there has been limited research that quantifies the actual economic impact of such exposures. Our first aim is to quantify the magnitude, direction, and significance of relationships between the psychosocial work environment and economic outcomes, overall and for individual stakeholders such as payers and health systems, in the acute care hospital setting. Our second aim is to determine the extent to which relationships between psychosocial work environments and economic outcomes, and the role of worker health in mediating the preceding associations, are consistent across acute-care and long-term care environments. Such comparisons will be important in future understanding of ways in which psychosocial interventions piloted in acute care hospitals can be adapted for long-term care settings and vice versa. The contribution of the proposed research is production of evidence documenting the potential economic consequences of adverse psychosocial occupational exposures. Through formative research to understand economic priorities of health care leaders, and then modeling of associations between psychosocial exposures and those metrics using rigorous economic methodology, we hope to quantify the potential competitive advantage that health care organizations may gain by improving the psychosocial work environment. This contribution is significant because improvement to psychosocial working conditions may not only benefit employers' outcomes of interest, but also may simultaneously benefit worker health. Thus, findings would represent an alignment of incentives for occupational health programs and for health care organizations. If the aims of our project are achieved and the economic implications of psychosocial exposures are better quantified, future psychosocial workplace intervention studies may be more likely to measure and report effects of interventions on economic endpoints. That inclusion, and subsequent dissemination of results, may further promote organizations' adoption of workplace health hazard reductions, increasing the impact of existing psychosocial workplace interventions. The study will also lay the groundwork for future intervention studies aimed at simultaneously improving worker health and employers' economic outcomes through improvement in the psychosocial work environment.