Using evidence based medicine to drive better outcomes
Worker’s compensation is something most employers dread. We’ve all seen the billboards and daytime TV ads for law firms. Getting better work comp outcomes for the employer means getting workers a fast recovery and preventing litigation with associated costs. For employees, it means getting a fast and complete recovery; no one want to be hurt at work.
Using evidence
There are numerous data points to inform program optimization:
- OSHA 300 Log
- Lost time claims represent the most significant injuries followed by restricted time claims
- Insurance claims data
- Most common injuries by injury mechanism or body part
- Most costly injuries
- Trends in claims closure
Does your workplace collect data on near misses – the injuries that could of happened but didn’t?
Once there is some internal data collected it can be compared to external benchmarks. OSHA log data can be compared to BLS data by industry at the national and state level. Is the overall injury rate higher than average? If so you might need better injury prevention services. Is your DART rate tracking high while overall injuries are average? In this scenario it might be useful to look at MDGuidelines or ODG to see if there are delays in return to unrestricted duty compared to return-to-work benchmark data. Delays can result from more serious injuries which directs focus to prevention. Alternatively, there might be problems in the access to or delivery of medical care you injured employees. The solutions vary by the cause so understanding your data is key to successful intervention.
Tertiary prevention
The premise of tertiary prevention is to limit the impact of disability. An example would be cutting wheelchair ramps into a sidewalk. The sidewalk again becomes accessible to an injured worker. By looking at the worker retention or lack thereof an employer can make decisions about job and workplace modifications to increase accessibility which in some ways ties back into primary prevention.
Doing the right thing to accommodate a newly disabled worker is certainly ethical but is it the best we could have done?
Secondary prevention
The idea behind secondary prevention is to mitigate the disability that results from an injury through optimal care during recovery. To continue the analogy above, timely access to high quality care might result in a worker recovering in a way that the worker doesn’t end up in a wheel chair after breaking his leg. Treatment guidelines adherent care offers the best opportunity to optimize recovery. Savvy employers might also consider the use of nurse case managers. Having an advocate to navigate the complexities of our health system can help to ameliorate some of the ill-effects of the social determinants of health.
This begs the question; what if there is more we could have done?
Primary prevention
The underpinning of primary prevention is designing work systems such that injuries don’t occur. We’ve incrementally improved the life of the injured worker above with improved prevention efforts. Firing up the time machine and adding a guard rail to the scaffold he fell from is one possible attempt at primary prevention of the injury.
Of course time travel is an impractical way to react to injuries so employers need to take a proactive approach using data to prioritize hazard controls and optimize the protection of workers through multidisciplinary approaches. Returning home from work no worse than when we left for work is an admirable goal for each day but is there any further improvement to be made?
Bonus round- wellness
Looking beyond the prevention of injury is the promotion of health. This is an emerging field but there is already evidence that the workplace can be a part of the promotion of health. Large companies are investing in making their workforce healthier which adds another layer of strategy to prevention.
Results
How much value might a work place derive from preventing one serious injury?
One of the most important things to recognize is that many of the drivers of poor worker’s compensation outcome are controllable. Secondly, many drivers of poor worker’s compensation outcome are non-medical in nature and thus actionable by the employer. Lastly, employers and employees alike benefit from better outcomes.
Free external resources to explore further:
https://resources.iaiabc.org/A-How-To-Guide-for-Injury-and-Work-Disability-Prevention