A New Method of Assessing the Impact of Evidence-Based Medicine on Claim Outcomes

Abstract

The compliance score described in this paper may be a useful tool for determining the impact of worker's compensation treatment guidelines on claim outcomes.

Technical Quality and Clinical Acceptability of a Utilization Review Guideline for Occupational Conditions: ODG® Treatment Guidelines by the Work Loss Data Institute

“…Of note, panelists rated the clinical validity of all five guidelines as uncertain (Nuckols et al, 2005). In the years since this evaluation was completed, California and many other U.S. states have implemented utilisation review procedures based on guidelines with the aim of improving the appropriateness of care while lowering costs (Texas Department of Insurance, 2014; Colorado Department of Labor and Employment, 2016;Hunt et al, 2016;Pennsylvania Department of Labor and Industry, 2016;State of California Department of Industrial Relations, 2016;Washington State Department of Labor and Industries, 2016). Meanwhile, the number of guidelines that address multiple diverse occupational disorders in workers' compensation settings has declined; the ODG has become the most widely used guideline for utilisation review for occupational disorders.…”

“…Meanwhile, the number of guidelines that address multiple diverse occupational disorders in workers' compensation settings has declined; the ODG has become the most widely used guideline for utilisation review for occupational disorders. It is used in many U.S. states as well as in other nations (Hunt et al, 2016;Work Loss Data Institute, 2016). A recent study examined the relationship between the adherence to recommendations in ODG and medical care expenditures, and found that patients with adherence scores in the bottom half of the distribution had 13.2 per cent longer duration claims and 37.9 per cent higher medical care costs than patients with adherence scores in the top half of the distribution (Hunt et al, 2016).…”

“…It is used in many U.S. states as well as in other nations (Hunt et al, 2016;Work Loss Data Institute, 2016). A recent study examined the relationship between the adherence to recommendations in ODG and medical care expenditures, and found that patients with adherence scores in the bottom half of the distribution had 13.2 per cent longer duration claims and 37.9 per cent higher medical care costs than patients with adherence scores in the top half of the distribution (Hunt et al, 2016). An investigator on the current research team evaluated ODG's technical quality in 2013 as part of a review of 13 guidelines on the use of opioids for chronic pain.…”

Early Drug Prescription Patterns as Predictors of Final Workers Compensation Claim Costs and Closure

“…Our previous studies have shown that anxiolytic, sedative hypnotic, antidepressant, and antipsychotic medications are associated with high claim costs and delayed return to work. 2,3,21 Our findings in the current article reveal that gabapentin and antidepressants are more consistent predictors of adverse claims outcomes with regard to cost and time lost from work at both 3 and 6 months after injury than other drug classes.…”

Prevention, Medical Management, and Adjudication of Workplace Injuries

“…These efforts have been successful both within single employer environments and among multiple employers. [25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43] Because they were introduced at the same general time in the JHWCP or constantly refined, the relationship between any one of the programs and changes in medical and indemnity payments over time was difficult to assess. We did not study changes in the rates of workers' compensation lost-time claims for specific conditions such as carpal tunnel syndrome or low back disorders which would have been beyond the scope of this overall assessment of the program.…”