An ergonomics program designed to reduce the incidence of upper extremity work related musculoskeletal disorders.

In 1992, the Johns Hopkins Hospital and University initiated a program aimed at the early diagnosis and treatment of potential upper extremity work related musculoskeletal disorders (UEWMSDs), ergonomic assessment and abatement of work areas where individuals with UEWMSDs are employed, as well as the identification and correction of areas throughout the hospital and university where UEWMSDs could possibly occur. The program resulted in an initial increase in the number and cost for the treatment of UEWMSDs. Subsequently, there was a significant decrease in the number of UEWMSDs reported and virtual elimination of the need to use surgical procedures to correct these conditions. This article suggests that a coordinated program of medical care, ergonomic assessment, and intervention can be efficacious in the primary, secondary, and tertiary prevention of UEWMSD.

The effect of managed care on surgical rates among individuals filing for workers' compensation.

This work evaluates the imposition of managed care techniques on the rate of claims and surgeries utilizing a pre- versus post-program analysis. The purpose was to ascertain whether managed care techniques--specifically, an ergonomic program, medical treatment guide-line, nurse case management, and utilization of a preferred provider organization consisting of academic physicians--would reduce the rate of the claims and surgery in a population of predominantly health care and university workers. The claims frequency rate and surgical frequency rates per 1,000 employees and per 1,000 claims was significantly lower during the managed care period than during the year prior to the initiation of managed care. The distribution of surgical procedures, as well as the duration of disability in the years of injury, after the initiation of managed care (1993-1997) were different from those same parameters in the fiscal years prior to the initiation of managed care (1990-1992). The results suggest that even in the workers' compensation environment, where financial incentives encourage a higher claims and surgical frequency rate than do the fee-for-service or prepaid medical environments, managed care techniques can be successfully utilized. A unique feature of the study was the use of university-based physicians as a specific managed care technique to influence surgical rates.