Presenteeism—defined as "reduced productivity at work due to health conditions"—increasingly is being recognized as a contributor to health costs for employers. More work is needed, though, to develop reliable tools to measure presenteeism and its economic impact, says a paper in the November Journal of Occupational and Environmental Medicine, the official publication of the American College of Occupational and Environmental Medicine.

In the article, Dee W. Edington and colleagues in the Health Management Research Center at the University of Michigan propose a three-year moratorium on additional studies related to presenteeism and productivity until these measurement issues are addressed.

In recent years, presenteeism has become a buzzword in occupational health studies. Research suggests that presenteeism is a costly source of lost productivity, and that steps to improve worker health can lead to measurable economic benefits.

While a number of tools have been developed to measure presenteeism, concerns have been raised about their validity. Edington and co-authors of the published paper pose some critical questions about current instruments for measurement of lost work time per individual: Is there one "best" way of measuring presenteeism? Are all instruments actually measuring the same quality? Can they be validated against objective measures of productivity?

They say these questions need to be answered before two other key issues are addressed—the expression of lost work time converted into lost productivity and the translation of lost productivity into dollar costs. Reliable tools for measurement, expression, and translation are needed to provide employers with valid estimates of the costs of presenteeism, and of the estimated savings from efforts to improve health, such as employee wellness plans.

While the general and intuitive concept of presenteeism has entered the mainstream, corporate leaders continue to be skeptical, the university researchers say. "If health-related presenteeism is truly an important construct, then the issues raised in this paper need to be addressed and resolved," they say in the published article.

Until more reliable tools are developed, Edington's group plans to suspend studies of presenteeism and its economic impact.

They present a list of limitations and assumptions to help guide further development and validation of tools for measuring presenteeism.

While that work is ongoing, they suggest that employers looking at the productivity impact of health problems focus on the population level, such as across a company or department, rather than the individual level.