ABSTRACT
Physicians who treat injured workers with painful conditions face complex challenges that require skills beyond those of a clinician. To address these challenges effectively, physicians need to understand the logic of workers' compensation systems and the interests of the various participants in the systems. They must be prepared to interface constructively between their patients and the workers' compensation carrier and attend to a multitude of administrative issues. In the present article, the authors provide an extended case history with commentary to illustrate the challenges that physicians face and the ways they can respond to these challenges.
Subject(s)
Chronic Pain/therapy , Occupational Diseases/therapy , Workers' Compensation , Humans , Pain Management , Pain MeasurementABSTRACT
Washington State workers' compensation has researched applying managed care in workers' compensation through a series of research projects. In 1995 and 1996, the managed care project evaluated the impact of managed care on medical outcomes, patient satisfaction, and the cost control of medical care and disability. The managed care project also evaluated the long-term outcome of the cases by reviewing the participants 2 years after the injury. Finally,the managed care project evaluated the satisfaction of the employer with managed care. The Department of Labor and Industries Centers of Occupational Health and Education project currently is evaluating the impact of an occupational medicine-directed,education-oriented, protocol-guided pilot project.
Subject(s)
Managed Care Programs/organization & administration , Workers' Compensation/organization & administration , Cost Control/methods , Health Care Costs , Humans , Managed Care Programs/economics , Outcome and Process Assessment, Health Care , Patient Satisfaction , Washington , Workers' Compensation/economicsABSTRACT
In this article, we review the evolution and application of evidence based medicine and the results of the literature reviews and syntheses incorporated in the second edition of the guidelines. Our intent is to disseminate this information to practitioners treating injured workers and those managing and financing such care and disability management. Use of proven diagnostic, causality, testing,and treatment methods should markedly improve the quality of occupational medical care and make that care more cost effective.
Subject(s)
Evidence-Based Medicine , Occupational Medicine/standards , Workers' Compensation/standards , Humans , Musculoskeletal Diseases/diagnosis , Musculoskeletal Diseases/therapy , Occupational Diseases/diagnosis , Occupational Diseases/therapy , Practice Guidelines as Topic , United StatesABSTRACT
OBJECTIVE: The American College of Occupational and Environmental Medicine has updated the treatment guidelines in its Elbow Disorders chapter through revision processes begun in 2006. This abbreviated version of that chapter highlights some of the evidence and recommendations developed. METHODS: Comprehensive systematic literature reviews were accomplished with article abstraction, critiquing, grading, evidence table compilation, and guideline finalization by a multidisciplinary expert panel and extensive peer-review to develop evidence-based guidance. Consensus recommendations were formulated when evidence was lacking and often relied on analogy to other disorders for which evidence exists. A total of 108 high- or moderate-quality trials were identified for elbow disorders. RESULTS: Guidance has been developed for 13 major diagnoses and includes 270 specific recommendations. CONCLUSION: Quality evidence is now available to guide treatment for elbow disorders, particularly for lateral epicondylalgia.