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Harber Philip MD MPH; Hsu, Paul BS; Fedoruk, M. Joseph MD
Journal of Occupational Medicine: October 1993

A decision analysis model was designed and implemented to facilitate job placement decisions. It identified relevant input parameters such as typical probability and severity of adverse outcomes for three targets—the worker himself or herself, the public, and productivity. In addition, specific factors that differentiate this specific decision instance from the “typical” are identified, including a person's specific health history, job site risk modifiers, and possible accommodation methods. Relevant societal values are also integrated, including relative importance of the three target groups (person, public, productivity) and discounting of the importance of future events. The system also includes a calculation engine to quantitatively integrate these input parameters for any number of events and modifiers to yield a single cost (expected negative utility value) for the instant situation. Cost represents risk of substantial harm, not financial cost. The decision analysis model is illustrated using a progressively more complex series of decision examples. In addition, the method of sensitivity analysis is applied, determining the extent to which the outcome is affected by varying the value assigned to an uncertain input parameter. This decision analysis approach is useful both as a heuristic (explaining the process) and as an aid in decision-making for a person with disabilities. The recently implemented Americans with Disabilities Act requires that a rational approach be utilized in such decisions, and such a model may facilitate this process.

©1993 The American College of Occupational and Environmental Medicine