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Occupational Health Services Project in Washington State

This study examines the Occupational Health Services Project in Washington State, focusing on improving the quality of care for injured workers. It discusses the challenges, strategies, and preliminary data from the project, highlighting the potential benefits of effective disability prevention in the workplace.

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Occupational Health Services Project in Washington State

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  1. Improving the Quality of Care for Injured Workers in Washington State: The Occupational Health Services Project Thomas Wickizer, Ph.D., M.P.H. University of Washington May 2, 2003

  2. IOM Crossing the Quality Chasm Recommendations • Design of more effective organizational support for care processes • Create an infrastructure to support evidence-based practice • Use information technology more effectively • Align payment incentives to support quality • Improve workforce training

  3. Bad News Good News Disability Prevention:Bad News--Good News • Workers who remain on disability for longer than 2-3 months have greatly reduced chance of returning to work • Effective occupational health care can reduce the likelihood of long-term disability

  4. 0 1 2 3 4 5 6 7 8 9 10 11 12 Changes in Disability Status among Injured Workers in WA State 100 80 Key to disability preventionis to intervene early. 60 % Workers Receiving Disability Payments 40 20 0 Time Loss Duration (months)

  5. WA State MCP: Differences in Medical and Disability Costs (n=2,217) Cost per claim Disability costs werepaid in usual way and were not undercapitated payment. Fewer workers went on disability (14.7% vs 19.2%) and cost per worker on disability was less ($2,332 versus $3,466). Data based on 9-monthfollow up.

  6. Occupational Health Services (OHS) Project • WA State Occupational Health Services (OHS) Project initiated in 1998 to: • Improve quality and outcomes of occupational health care • Enhance patient and employer satisfaction • OHS is not “managed care” • No restrictions placed on provider choice

  7. System Redesign through OHS • Quality indicators • Financial and nonfinancial incentives • Community-based pilot centers of occupational health and education (COHE): • Provide quality improvement activities • Case coordination • CME, provider mentoring, academic detailing • Tracking patient care & feed back data to providers • Identify and provide care for high-risk cases

  8. OHS-COHE Organization Dep’t of Labor& Industries UW ResearchTeam COHE Business/LaborAdvisory Group PilotCommunity Community Physicians Two COHEs: Seattle and Spokane. Seattle COHE operational June 2002;Spokane COHE operational April 2003.

  9. Selected Quality Indicators • Submission of report of accident (ROA) • “% claims for with ROA received within 2 business days of first office visit” • Two-way communication with employer • “% of claims for which two-way communication between provider and employer about return to work is accomplished at first visit when worker off work or expected to be off work” • Assessment of impediments to return to work • “% of workers on time loss who have received assessment or referral for assessment of impediments to return to work by 4 weeks of work loss” • Condition-specific quality indicators • “nerve conduction studies to corroborate presence/absence of CTS if time loss > 2 weeks or surgery is being considered”

  10. Quality Impediment Poor quality Ineffective disability prevention Administrative delays Poor communication Inadequate reimbursement & misaligned incentives Lack of patient care tracking data OHS Strategies Track patient care through quality indicators, CME, provider mentoring Time-linked clinical mgt. action, 4-week in-depth assessment of barriers to RTW, occ-health best practices Decrease time to claim authorization by improving timely submission of ROA and provider documentation of work-relatedness Case coordination, improve provider-employer communication Financial incentives linked to quality indicators Develop information technology to track patients Quality Impediments and OHS Strategies

  11. Challenges In Implementing Community- Wide Quality Improvement Initiatives • Development of information technology • Complex and more costly than often anticipated • Physician recruitment • Small % of physicians treat large portion of workers’ compensation patients • Forging cross-institutional relationships in competitive markets • Provider organizations focus on short-term financial interests

  12. Preliminary Data from Process Evaluation • Seattle pilot COHE began operation in June 2002. Between June and December 2002: • 88 providers were recruited • OHS physicians served as attending doctor for 2,670 injured workers • 55% of pilot physicians met submission of report of accident 2-day benchmark as compared to 8% the previous year

  13. Conclusions • Community-wide quality improvement interventions can address important impediments to quality in WC • Key is to develop strategies that: • Provide effective disability prevention • Identify cases at risk for long-term disability • Challenges include: • Physician recruitment • Development of information technology • Forging cross-institutional relationships • WC may present strong “business case for quality” • Preventing disability offers immediate financial payback

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