Article Abstract:
Hospital workers are at particularly high risk for occupational injuries. In an effort to reduce the duration of disability from these injuries, one hospital instituted an early, aggressive medical management program. This study assessed the effectiveness of that program, which was designed to enhance three factors: patient investment in the problem; early assessment of all factors that might delay return to work; and effective communication between employer and physician. The disabled employees were referred to a physiatrist, a specialist in physical functioning and rehabilitation medicine. This physician had primary responsibility for management of the patient's treatment, although he could refer patients to orthopedists or other specialists if appropriate. In terms of employee investment, the employee, after consultation with the physiatrist, was told the nature of his injuries and was asked to develop a plan for return to work. Aggressive medical treatment was applied to all physical problems that would delay return to work. Treatment, rehabilitation, and return to work issues were discussed regularly with the employer. The program shortened the time out from work by 33 percent compared to the previous year before the program was begun. Patients who were managed by the physiatrist averaged 3.9 fewer days out of work. This study demonstrates that referral to a specialist in physical medicine and rehabilitation as early as two days after injury can significantly decrease the duration of the employee's disability. The findings may be particularly important for the treatment of employees with low-back pain. (Consumer Summary produced by Reliance Medical Information, Inc.)
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Article Abstract:
There is a need to find methods to control the escalating costs of health care in the United States. This study was undertaken to assess the costs of treating the same type of injury by two provider groups. Back-related injuries, as treated by a medical (MD) or chiropractic (DC) provider, were studied to compare the ''total cost per case'' for the two groups. Data were obtained from the Workers's Compensation Fund of Utah (WCFU). Injuries that occurred in 1986 were extracted in 1988, two years later, to allow for extended loss. A total of 3,062 cases, from 7,551 files that were reviewed, formed the study group. The data were abstracted on the basis of the International Classification of Diseases, 9th Rev. (ICD9) and the Chiropractic Current Procedural Terminology (CCPT) codes. The variables compared between the MD and the DC provider groups were: (1) patient age; (2) number of diagnoses after the primary diagnosis for each patient; (3) number of treatments; (4) number of days of care; (5) number of days worker received compensation payments; (6) cost of compensation; (7) cost for clinical care; (8) total cost of care; and (9) the average cost per office visit. Results of data comparisons indicated that DCs saw patients more frequently, a practice which tended to raise costs. Chiropractic care, however, was ultimately less expensive than medical care, and patients of DCs incurred significantly less compensation costs. (Consumer Summary produced by Reliance Medical Information, Inc.)
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Article Abstract:
The various costs of low back pain can be classified as either direct costs, such as medical charges and reimbursement of lost wages, or indirect costs, such as claim processing, lost production time, and training of replacement workers. In order to determine the current cost per case of compensable low back pain in the United States, an analysis was made of the claims of one insurance company during 1986. The average or mean cost per case was $6,807; the median cost, which is the figure situated in the middle of the range, was $391. The wide disparity between the mean and median reflects the study's finding that 25 percent of the cases accounted for 95 percent of the costs. Medical costs represented 31.5 percent of the total cost, and indemnity costs represented 67.2 percent. The estimated total cost of compensable low back pain cases in the United States in 1986 was $11.1 billion. In light of this high cost, measures to control the incidence of low back pain in the work place may well be cost-effective. (Consumer Summary produced by Reliance Medical Information, Inc.)
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