Abstract
ContextThe use of clinical-practice guidelines is a suggested method for improving health outcomes by the earlier provision of necessary and effective medical interventions.ObjectiveTo quantify the influence of adherence to guideline-recommended interventions in the first week of treatment for an initial low back pain (LBP) injury on lost workdays.MethodsIn a retrospective cohort of California’s workers’ compensation claims data from May 2009 to May 2018, 41 diagnostic and treatment interventions were abstracted from the medical claims for workers with acute LBP injuries and compared with guideline recommendations. Lost workdays within 1-year post-injury were compared by guideline adherence using quantile regressions.ResultsOf the 59,656 workers who met the study inclusion criteria, 66.1% were male and the average (SD) age was 41 (12) years. The median number (IQR) of lost workdays was 27 (6–146) days. In the first week of treatment, 14.2% of workers received only recommended interventions, 14.6% received only non-recommended interventions, and 51.1% received both recommended and non-recommended interventions. Opioid prescriptions fell 86% from 2009 to 2018. Workers who received only guideline-recommended interventions experienced significantly fewer lost workdays (11.5 days; 95% CI: -13.9, -9.1), a 29.3% reduction, than workers who received only non-recommended interventions. The percentage of workers receiving only recommended interventions increased from 10.3% to 18.2% over the 9 years.Conclusion and relevanceWhen workers received guideline-recommended interventions, they typically returned to work in fewer days. The majority of workers received at least one non-recommended intervention, demonstrating the need for adherence to guideline recommendations. Fewer lost workdays and improved quality care are outcomes that strongly benefit injured workers.
Highlights
Overtreatment and low-value care cost the U.S healthcare system between $75.7 and $101.2 billion annually [1]
In a retrospective cohort of California’s workers’ compensation claims data from May 2009 to May 2018, 41 diagnostic and treatment interventions were abstracted from the medical claims for workers with acute low back pain (LBP) injuries and compared with guideline recommendations
The most common occupational injury is back strain [4], and occupational stressors are thought to contribute to low back pain (LBP) [5, 6]
Summary
Overtreatment and low-value care cost the U.S healthcare system between $75.7 and $101.2 billion annually [1]. One strategy to promote quality, value-based care is applying evidencebased medicine (EBM) to help guide treatment decisions. EBM integrates medical research with clinical expertise and patient values to support decision making based on the best available evidence [3]. In the U.S, state workers’ compensation (WC) systems have developed or adopted treatment guidelines to promote evidence-based care for occupational injuries. Considerable differences exist between evidence-based recommendations and current clinical practice for the treatment of LBP [7, 8]. Owens et al (2019) found that medical and total claim costs, which included payments for lost time (i.e., indemnity), decreased by $353 and $586, respectively, per unit of compliance with LBP guidelines in Workers’ Compensation Fund of Utah claims [11]
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