The burden of working time lost to compensable occupational injury and disease in Australia, 2012-17: a retrospective population-based study.

OBJECTIVES: To determine the national burden of working time lost to occupational injury and disease in Australia compensable by workers' compensation schemes; to characterise the distribution of time lost by age, sex, and injury and disease type. STUDY DESIGN: Retrospective population-based study; analysis of National Dataset for Compensation-based Statistics (NDS) data. SETTING, PARTICIPANTS: Granted workers' compensation claims by people aged 15-100 years including payment of wage replacement benefits for time off work lodged in Australia, 1 July 2012 - 30 June 2017. MAIN OUTCOME MEASURES: Working years lost (WYL) per annum (total number of years of wage replacement benefits paid to injured and ill workers), overall and by sex, age, and injury and disease type; WYL per 10 000 fulltime equivalent (FTE) years worked. RESULTS: A total of 755 330 eligible claims with complete data for analysis variables by people aged 15-100 years were identified, for compensable injuries and disease that led to 41 194 (95% confidence interval [CI], 41 020-41 368) WYL/year. The annual WYL number and rate were each higher for men (25 367 [95% CI, 25 230-25 503] WYL/year; 42.6 [95% CI, 42.1-43.1] WYL/10 000 FTE years) than for women (15 827 [95% CI, 15 720-15 935] WYL/year; 38.8 [95% CI, 38.2-39.4] WYL/10 000 FTE years). Workers aged 45-100 years made 66 742 claims per year (44.1% of all claims) but incurred 21 763 WYL/year (52.8% of all WYL). Traumatic joint and muscle injuries led to 16 494 WYL/year (40.0% of all WYL), musculoskeletal disorders to 8547 WYL/year (20.7%), mental health conditions to 5361 WYL/year (13.0%), fractures to 4276 WYL/year (10.4%), and wounds and lacerations to 3449 WYL/year (8.4%). CONCLUSIONS: Occupational injury and disease covered by workers' compensation result in lost working time in Australia equivalent to more than 41 000 fulltime jobs. Distribution of the burden reflects the greater labour force participation of men, slower recovery of older workers, and the impact of common occupational injuries and diseases. Population-based monitoring of lost working time could support effective occupational health surveillance and allocation of resources for protecting the health of Australian workers.

How Much Physiotherapy, Chiropractic, and Osteopathy Care Do Compensated Australian Workers with Low Back Pain Receive? A Retrospective Cohort Study.

OBJECTIVES: To identify the prevalence and frequency of physiotherapy, chiropractic, and/or osteopathy care in Australians with workers' compensation claims for low back pain (LBP). METHODS: We included workers with accepted workers' compensation claims longer than 2 weeks from the Australian states of Victoria, Queensland, South Australia, and Western Australia. Workers were grouped by whether they attended physiotherapy, chiropractic, and/or osteopathy in the first 2 years of their claim. Descriptive statistics and logistic regression were used to describe differences between groups. Descriptive statistics and negative binomial regression were used to describe differences in the number of attendances in each group. RESULTS: Most workers had at least one physical therapy attendance during the period of their claim (n = 23,619, 82.0%). Worker state, socioeconomic status, and remoteness were the largest contributing factors to likelihood of physical therapy attendance. Most workers only attended physiotherapy (n = 21,035, 89.1%, median of 13 times). Far fewer only attended chiropractic (n = 528, 2.2%, median of 8 times) or only osteopathy (n = 296, 1.3%, median of 10 times), while 1,750 (7.5%) attended for care with more than one type of physical therapy (median of 31 times). CONCLUSION: Most Australian workers with workers' compensation time loss claims for LBP attend physiotherapy at least once during their claims. State of claim is the strongest predictor of which physical therapy profession they attend, possibly due to regional availability. Workers who see a physiotherapist have significantly more attendances. Future research should explore the relationship between these patterns of care and claimant outcomes, including work disability duration.

Patterns of physiotherapy attendance in compensated Australian workers with low back pain: a retrospective cohort study.

ABSTRACT: Workers with low back pain (LBP) frequently seek care from physiotherapists. We sought to identify patterns of physiotherapy attendance and factors associated with these patterns in Australian workers with accepted compensation claims for LBP. We included workers with accepted workers' compensation claims for LBP from 4 Australian states between 2011 and 2015. We used trajectory modelling to identify distinct groups of workers based on the number (ie, volume) of monthly physiotherapy attendances over a 2-year period from claim acceptance. Descriptive statistics and logistic regression models were used to compare the characteristics of the groups. A small but significant proportion attend numerous times over a long period. 79.0% of the sample (N = 22,767) attended physiotherapy at least once in the 2 years after claim acceptance. Among these, trajectory modelling identified 4 distinct patterns of attendance. Most (N = 11,808, 51.9%) recorded a short-term low-volume pattern, 26.8% (n = 6089) recorded a short-term high-volume pattern, 14.3% (n = 3255) recorded a long-term low-volume pattern, and 7.1% (n = 1615) recorded a long-term high-volume pattern. Workers from Victoria (OR 0.34, 99% CI 0.31, 0.37), South Australia (OR 0.69, 99% CI 0.60, 0.80), and Western Australia (OR 0.79, 99% CI 0.69, 0.88) were significantly less likely to attend physiotherapy than workers from Queensland. Victorian workers were significantly more likely to be in one of the 2 long-term trajectory groups (OR 8.17, 99% CI 6.86, 9.73; OR 18.68, 99% CI 13.57, 25.70). In conclusion, most compensated Australian workers with LBP attend physiotherapy. Significant interjurisdictional differences between attendance patterns suggests that policy may play an important role in healthcare delivery.

Capture, Coding, and Reporting of Health Care and Medicine Information in Australian Workers' Compensation Systems.

OBJECTIVE: This study aims to characterize the approaches to collecting, coding, and reporting health care and medicines data within Australian workers' compensation schemes. METHODS: We conducted a cross-sectional survey of data and information professionals in major Australian workers' compensation jurisdictions. Questionnaires were developed with input from key informants and a review of existing documentation. RESULTS: Twenty-five participants representing regulators (40%) and insurers (60%) with representation from all Australian jurisdictions were included. Health care and medicines data sources, depth, coding standards, and reporting practices exhibited significant variability across the Australian workers' compensation schemes. CONCLUSIONS: Substantial variability exists in the capture, coding, and reporting of health care and medicine data in Australian workers' compensation jurisdictions. There are opportunities to advance understanding of medicines and health service delivery in these schemes through greater harmonization of data collection, data coding, and reporting.

Time off work following psychological injury among health and social care workers: a population-based retrospective cohort study in New South Wales, Australia.

OBJECTIVE: This study aimed to determine the disability duration and burden of compensated time loss in the health and social care (HSC) sector following psychological injury. METHODS: A retrospective cohort study was conducted using data from the New South Wales workers' compensation system. The median weeks disability duration and total weeks of working time lost (WWL) per 1000 workers were compared between the HSC sector and all other industries, and between specific occupational groups in the HSC sector, using accelerated failure time models. RESULTS: HSC workers had a median (IQR) disability duration of 12.4 (3.3-40.0) weeks, which was less than the 15.3 (4.3-48.3) weeks observed in other industries. Within the HSC sector, ambulance officers had the longest disability duration at 31.1 (6.1-104.0) weeks and highest WWL at 15 734 weeks per 1000 workers. Conversely, nurses and midwives had the shortest disability duration at 8.0 (2.0-25.8) weeks, while other healthcare workers had the lowest WWL (17.0). Controlling for other determinants, ambulance officers had the highest likelihood of longer disability duration (time ratio (TR) 2.14; 95% CI 1.64 to 2.78), followed by social workers (TR 1.46; 95% CI 1.20 to 1.79) and administrators and managers (TR 1.41; 95% CI 1.15 to 1.71). Older age, female sex, full-time employment and working in small organisations correlated with extended disability duration. CONCLUSION: There is considerable variation in the duration and burden of work disability due to psychological injury across occupational groups in the HSC sector. Findings suggest the need for occupation-specific workplace rehabilitation and psychological support to reduce the impact of psychological injury on HSC workers and improve return-to-work outcomes.

Development and initial application of a harmonised multi-jurisdiction work injury compensation database.

Objectives: Workers' compensation schemes provide funding for wage replacement and healthcare for injured and ill workers. In Australia, workers' compensation schemes operate independently in different jurisdictions, making comparisons of health service use challenging. We sought to develop and deploy a new database of health service and income support data, harmonising data from multiple Australian workers' compensation jurisdictions. Methods: We worked with workers' compensation authorities from six Australian jurisdictions to combine claims, healthcare, medicines and wage replacement data for a sample of compensated workers with claims for musculoskeletal conditions. We designed a structured relational database and developed a bespoke health services coding scheme to harmonise data across jurisdictions. Results: The Multi-Jurisdiction Workers' Compensation Database contains four data sets: claims, services, medicines and wage replacement. The claims data set contains 158,946 claims for low back pain (49.6%), limb fracture (23.8%) and non-specific limb conditions (26.7%). The services data set contains a total of 4.2 million cleaned and harmonised services including doctors (29.9%), physical therapists (56.3%), psychological therapists (2.8%), diagnostic procedures (5.5%) and examinations and assessments (5.6%). The medicines data set contains 524,380 medicine dispenses, with 208,504 (39.8%) dispenses for opioid analgesics. Conclusions: The development of this database presents potential opportunities to gain a greater understanding of health service use in the Australian workers' compensation sector, to measure the impact of policy change on health services and to provide a method for further data harmonisation. Future efforts could seek to conduct linkage with other data sources.

The Association Between Continuity of Care With a Primary Care Physician and Duration of Work Disability for Low Back Pain: A Retrospective Cohort Study.

OBJECTIVES: The aims of the study are to determine the continuity of care (CoC) provided by primary care physicians among workers with low back pain, to identify factors associated with CoC, and to investigate whether CoC is associated with working time loss. METHODS: Continuity of care was measured with the usual provider continuity metric. Ordinal logistic regression models examined factors associated with CoC. Quantile regression models examined the association between working time loss and CoC. RESULTS: Complete CoC was observed in 33.8% of workers, high CoC among 37.7%, moderate CoC in 22.1%, and low CoC in 6.4%. In workers with more than 2-months time loss, those with complete CoC had less time off work. CONCLUSIONS: Higher CoC with a primary care physician is associated with less working time loss and this relationship is strongest in the subacute phase of low back pain.

The health impacts of a 4-month long community-wide COVID-19 lockdown: Findings from a prospective longitudinal study in the state of Victoria, Australia.

OBJECTIVES: To determine health impacts during, and following, an extended community lockdown and COVID-19 outbreak in the Australian state of Victoria, compared with the rest of Australia. METHODS: A national cohort of 898 working-age Australians enrolled in a longitudinal cohort study, completing surveys before, during, and after a 112-day community lockdown in Victoria (8 July- 27 October 2020). Outcomes included psychological distress, mental and physical health, work, social interactions and finances. Regression models examined health changes during and following lockdown. RESULTS: The Victorian lockdown led to increased psychological distress. Health impacts coincided with greater social isolation and work loss. Following the extended lockdown, mental health, work and social interactions recovered to an extent whereby no significant long-lasting effects were identified in Victoria compared to the rest of Australia. CONCLUSION: The Victorian community lockdown had adverse health consequences, which reversed upon release from lockdown. Governments should weigh all potential health impacts of lockdown. Services and programs to reduce the negative impacts of lockdown may include increases in mental health care, encouraging safe social interactions and supports to maintain employment relationships.

Changes in work and health of Australians during the COVID-19 pandemic: a longitudinal cohort study.

BACKGROUND: Engagement in work is an important determinant of health. In response to the COVID-19 pandemic, public health measures imposed to reduce viral transmission resulted in large-scale loss of work during the early stages of the pandemic, contributing to declined mental and physical health. As the pandemic unfolded, the Australian economy began to recover and some people could return to work, whilst localised lockdowns resulted in further loss of work for others. The long-term health effects of work loss remain unexplored within the COVID-19 pandemic context, in addition to whether any health effects are persistent upon returning to work. METHODS: A prospective longitudinal cohort study of 2603 participants across Australia monitored changes in health and work between March and December 2020, with participants completing surveys at baseline and 1, 3 and 6 months later. Outcomes described psychological distress, and mental and physical health. Linear mixed regression models examined associations between changes in health and experiences of work loss, and return to work, over time. RESULTS: Losing work during the early stages of the pandemic was associated with long-term poorer mental health, which began to recover over time as some returned to work. Physical health deteriorated over time, greater for people not working at baseline. Being out of work was associated with poorer mental health, but better physical health. These effects were larger for people that had recently lost work than for people with sustained work loss, and retaining employment played a protective role. Generally, returning to work resulted in poorer physical health and improvements in mental health, although this depended on the broader context of changes in work. CONCLUSIONS: Work cessation during the pandemic led to poor health outcomes and had long-lasting effects. Returning to work benefits mental health but may reduce physical activity in the short-term. We encourage the provision of accessible mental health supports and services immediately following loss of work, and for people with prolonged forms of work loss. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry: ACTRN12620000857909 .

Regional Differences in Time Off Work After Injury: A Comparison of Australian States and Territories Within A Single Workers' Compensation System.

Purpose Time off work after workplace injury varies by compensation system. While often attributed to features of the compensation system, unaccounted regional factors may drive much of the effect. In this study, we compare disability durations by state and territory of residence within a single national workers' compensation system. Large differences would indicate that factors other than compensation system settings are responsible for system effects observed in previous studies. Methods We applied crude and adjusted Cox proportional hazards models to compare disability durations by state and territory of residence. Confounders included factors known to influence disability duration. Durations were left-censored at two weeks and right-censored at 104 weeks. Results We analysed N = 31,641 claims. In both crude and adjusted models, three of the seven states and territories significantly differed from the reference group, New South Wales. However, two of the three were different between crude and adjusted models. Regional effects were relatively small compared to other factors including insurer type, age, and type of injury. Conclusions Regional factors influence disability duration, which persist with adjustment for demographic, work, insurer type, and injury confounders. However, the effects are inconsistently significant and fairly small, especially when compared to the effect of confounders and system effects found in previous studies. Regional factors likely only account for a small share of the difference in disability duration between compensation systems.

Variation in General Practice Services Provided to Australian Workers with Low Back Pain: A Cross-Jurisdictional Comparative Study.

PURPOSE: To compare the frequency of General Practitioner (GP) services and the time between first and last GP services (service duration) provided to workers with low back pain (LBP) between four Australian workers' compensation jurisdictions. METHODS: Retrospective cohort study using service level data collated from the Australian states of Western Australia, South Australia, Victoria and Queensland. Negative binomial regression was used to compare GP service volume between jurisdictions in workers with accepted LBP compensation claims. Quantile regression was used to compare GP service duration. Models were adjusted for sociodemographic factors and occupation. Analyses were repeated in four cohorts with progressively more restrictive cohort definitions to account for the influence of jurisdictional policy variation in employer excess, service delivery and maximum time-loss benefit duration. RESULTS: The study sample included 47,185 time-loss claims accepted between July 2010 and June 2015, that were linked with 452,391 GP services. Workers with LBP in Queensland recorded significantly fewer GP services funded and recorded significantly shorter average service duration than in other states. This pattern of jurisdictional variation was evident in all four cohorts, but was attenuated when cohorts excluded short- and long duration claims. In the final, most restricted cohort statistically significant adjusted incidence rate ratios of 1.47-1.60 were observed in Victoria, South Australia and Western Australia, while these states recorded additional service duration of 4.3-20.7 weeks at the median. CONCLUSION: There is significant variation in provision of GP services to injured workers with LBP between four Australian workers' compensation jurisdictions. Administrative requirements for time-based provision of work capacity certificates by medical practitioners may be contributing to service variation.

Returning to the Workplace During the COVID-19 Pandemic: The Concerns of Australian Workers.

Purpose To determine the nature and prevalence of workers' concerns regarding workplaces reopening during the pandemic. To identify characteristics of workers and industries where particular concerns are more common. Method Prospective cohort study of 1063 employed Australian adults, enrolled at the start of the pandemic. Data on attitudes to workplaces reopening were collected 1 July-30 September 2020. The frequency of concerns describes infection risk and changes to work and impact on home life. Regression models examined associations between demographic and industry factors with reopening concerns. Results More than four in five (82.4%) of workers reported concerns about workplace infection risk. Just over half (53.4%) reported concerns about impacts to work and home life. Concerns were more prevalent for workers reporting psychological distress, financial stress, and among those exclusively working from home. Concerns regarding infection risk were common for workers in health care (IRR 1.16, 95% CI [1.01, 1.33]), retail (IRR 1.31, 95% CI [1.06, 1.61]), and accommodation/food service industries (IRR 1.25, 95% CI [1.01, 1.55]). Concerns regarding changes to work and home life were more common for female workers (IRR 1.24, 95% CI [1.07, 1.43]), and partners/spouses with dependent children (IRR 1.44, 95% CI [1.16, 1.79]). Conclusion Concerns of COVID-19 infection in the workplace are common. Many workers are also concerned about changes to their work and home life. The prevalence of concerns is related to the nature of work and responsibilities at home. Actions that reduce risk of workplace transmission, coupled with effective communication of infection controls, may alleviate worker concerns whilst recognising workers' family and social circumstances.

Health service use of Australian unemployment and disability benefit recipients: a national, cross-sectional study.

BACKGROUND: Healthcare is funded and delivered separately from income support programs such as unemployment and disability benefits. Greater understanding of the health service use (HSU) of benefit recipients would support more effective design and delivery of health and income support programs. This study aimed to characterise the HSU of disability and unemployment benefit recipients relative to people earning wages, while controlling for personal, household and health-related factors associated with HSU in benefit recipients. METHODS: A cross-sectional national survey of 9110 working age Australian adults in three groups: (1) 566 receiving the disability support pension (DSP); (2) 410 receiving unemployment benefits; and (3) 8134 earning wages. Outcomes included prevalence and frequency of health professional consultations, hospital attendance and admission in the past 12 months, as well as medication and supplement use in the past 2 weeks. Analyses compared DSP and unemployment benefit recipients to wage earners using prevalence ratios and incident rate ratios, adjusted for predisposing, enabling and need factors that may affect HSU. RESULTS: In adjusted regression models, both DSP and unemployment benefit recipients were significantly more likely than wage earners to have consulted psychologists and social workers. DSP recipients also reported a significantly higher prevalence of consultations with General Practitioners (GPs), specialist physicians and podiatrists.. Both groups reported significantly more frequent consultations with GPs and DSP recipients with specialists. No differences were observed between groups for hospital attendance or admission, or supplement use in fully adjusted models, though the DSP group reported more prevalent medication use than wage earners. Inclusion of confounders including self-assessed health, disability severity, health insurance status, and financial resources attenuated the relationship between benefit receipt and HSU, however significant associations were still observed. CONCLUSIONS: People receiving unemployment and disability insurance benefits use significantly more health services than wage earners. A range of personal and clinical characteristics explained much, but not all, of the association between greater HSU and benefit receipt. Greater coordination between health and income support systems may improve health, reduce HSU and improve work ability in unemployed and working age people.

The Impact of Work Loss on Mental and Physical Health During the COVID-19 Pandemic: Baseline Findings from a Prospective Cohort Study.

Purpose To determine if losing work during the COVID-19 pandemic is associated with mental and physical health status. To determine if social interactions and financial resources moderate the relationship between work loss and health. Methods Participants were Australians aged 18 + years that were employed in paid work prior to the COVID-19 pandemic who responded to an online or telephone survey from 27th March to 12th June 2020 as part of a prospective longitudinal cohort study. Outcome measures include Kessler-6 score > 18 indicating high psychological distress, and Short Form 12 (SF-12) mental health or physical health component score < = 45 indicating poor mental or physical health. Results The cohort consisted of 2,603 respondents, including groups who had lost their job (N = 541), were not working but remained employed (N = 613), were working less (N = 660), and whose work was unaffected (N = 789). Three groups experiencing work loss had greater odds of high psychological distress (AOR = 2.22-3.66), poor mental (AOR = 1.78-2.27) and physical health (AOR = 2.10-2.12) than the unaffected work group. Poor mental health was more common than poor physical health. The odds of high psychological distress (AOR = 5.43-8.36), poor mental (AOR = 1.92-4.53) and physical health (AOR = 1.93-3.90) were increased in those reporting fewer social interactions or less financial resources. Conclusion Losing work during the COVID-19 pandemic is associated with mental and physical health problems, and this relationship is moderated by social interactions and financial resources. Responses that increase financial security and enhance social connections may alleviate the health impacts of work loss. Registration Australian New Zealand Clinical Trials Registry: ACTRN12620000857909.

Assessment of a new tool to improve case manager identification of delayed return to work in the first two weeks of a workers' compensation claim.

OBJECTIVE: To determine whether the Plan of Action for a Case (PACE) tool improved identification of workers at risk of delayed return to work. DESIGN: Prospective cohort of workers with accepted workers' compensation claims in the state of New South Wales, Australia. INTERVENTIONS: The 41-item PACE tool was completed by the case manager within the first two weeks of a claim. The tool gathered information from the worker, employer and treating practitioner. Multivariate logistic regression models predicted work time loss of at least one and three months. RESULTS: There were 524 claimants with complete PACE information. A total of 195 (37.2%) had work time loss of at least one month and 83 (15.8%) had time loss of at least three months. Being male, injury location, an Orebro Musculoskeletal Pain Screening Questionnaire-Short Form score >50, having a small employer, suitable duties not being available, being certified unfit, and the worker having low one-month recovery expectations predicted time loss of over one month. For three months, injury location, a Short Form Orebro score >50, no return-to-work coordinator, and being certified unfit were significant predictors. The model incorporating PACE information provided a significantly better prediction of both one- and three-month outcomes than baseline information (area-under-the-curve statistics-one month: 0.85 and 0.68, respectively; three months: 0.85 and 0.69, respectively; both P < 0.001). CONCLUSION: The PACE tool improved the ability to identify workers at risk of ongoing work disability and identified modifiable factors suited to case manager-led intervention.

Step-downs reduce workers' compensation payments to encourage return to work: are they effective?

OBJECTIVE: To determine whether step-downs, which cut the rate of compensation paid to injured workers after they have been on benefits for several months, are effective as a return to work incentive. METHODS: We aggregated administrative claims data from seven Australian workers' compensation systems to calculate weekly scheme exit rates, a proxy for return to work. Jurisdictions were further subdivided into four injury subgroups: fractures, musculoskeletal, mental health and other trauma. The effect of step-downs on scheme exit was tested using a regression discontinuity design. Results were pooled into meta-analyses to calculate combined effects and the proportion of variance attributable to heterogeneity. RESULTS: The combined effect of step-downs was a 0.86 percentage point (95% CI -1.45 to -0.27) reduction in the exit rate, with significant heterogeneity between jurisdictions (I2=68%, p=0.003). Neither timing nor magnitude of step-downs was a significant moderator of effects. Within injury subgroups, only fractures had a significant combined effect (-0.84, 95% CI -1.61 to -0.07). Sensitivity analysis indicated potential effects within mental health and musculoskeletal conditions as well. CONCLUSIONS: The results suggest some workers' compensation recipients anticipate step-downs and exit the system early to avoid the reduction in income. However, the effects were small and suggest step-downs have marginal practical significance. We conclude that step-downs are generally ineffective as a return to work policy initiative.Postprint link: https://www.medrxiv.org/content/10.1101/19012286.

The Impact of Income Sources on Financial Stress in Workers' Compensation Claimants.

PURPOSE: Workers' compensation schemes usually recompense workers below their regular wage. This may cause financial stress, which has previously been associated with poorer health and work outcomes after injury. We sought to determine the level of financial stress experienced by injured workers and the influence of post-injury income source on financial stress. METHODS: Analysis of a cross-sectional national survey of 4532 adults who had been injured at work and had at least one day of workers' compensation paid. Financial stress at time of survey was measured on a scale of 1-10 and subsequently dichotomised at the top quartile for further analysis. The effect of current main income source on financial stress, adjusted for demographic and psychosocial confounders, was assessed using logistic regression. RESULTS: Sixty-nine percent of workers whose main income was social assistance or insurance and 54% whose main income was workers' compensation were experiencing financial stress. Relative to wages or salaries, workers with a main income from social assistance or insurance (odds ratio: 3.33, 95% CI 2.22-5.00) and workers' compensation (1.71, 1.31-2.24) had higher odds of financial stress. Workers with a main income of an aged pension or superannuation had lower odds of financial stress (0.52, 0.28-0.97). CONCLUSION: Injured workers receiving workers' compensation or social assistance benefits are vulnerable to increased financial stress. Given the potential negative consequences of financial stress on health, particularly mental health, this study suggests the need for careful consideration of income replacement benefits in the design of workers' compensation schemes.

Development and Pilot Assessment of the PACE Tool: Helping Case Managers Identify and Respond to Risk Factors in Workers' Compensation Case Management.

Purpose The aim was to develop a tool to be applied by workers' compensation case managers to guide intervention and avoid delayed return to work. Methods The Plan of Action for a CasE (PACE) tool was developed based on a review of existing literature, focus groups with case managers and analysis of existing claims data. Combined with analysis of existing case manager practice, these sources were used to determine key constructs for inclusion in the tool to be aligned with the demands of case manager workload. Mapping of existing interventions was used to match risk identified by the tool with appropriate intervention. Results The final PACE tool consisted of 41 questions divided into Ready (worker), Set (employer) and Go (treating practitioner) categories. Questions in the tool were linked to appropriate case manager actions. Data collection was completed by case managers for 524 claims within the first 2 weeks of the claim being accepted. The most commonly identified risks for delayed RTW included both worker and employer expectations of RTW, as well as certification of capacity. Factor analysis identified two factors operating across the tool categories. Case managers reported benefits in using the tool, but reported it also increased their workload. Conclusions The PACE tool is a unique example of the implementation of risk identification in case management practice. It demonstrates that case managers are ideally placed to collect information to identify risk of delayed RTW. Future work will establish the impact of case-manager led intervention based on identified risks on outcomes for injured workers.

Psychological Distress in Workers' Compensation Claimants: Prevalence, Predictors and Mental Health Service Use.

Purpose To determine the prevalence and predictors of psychological distress among injured and ill workers and their mental health service use. Methods Cross-sectional national survey of adults with work-related musculoskeletal or mental health conditions, accepted workers' compensation claims and at least 1 day off work. Psychological distress was measured using the Kessler-6 scale. Mental health service use was measured using self-report. Results A total of 3755 workers were included in the study (Musculoskeletal disorder = 3160; Mental health condition = 595). Of these, 1034 (27.5%) and 525 (14.0%) recorded moderate and severe psychological distress, respectively. Multivariate ordinal logistic regression revealed that being off work, poor general health, low work ability, financial stress, stressful interactions with healthcare providers and having diagnosed mental health conditions had the strongest associations with presence of psychological distress. Of the subgroup with musculoskeletal disorders and psychological distress (N = 1197), 325 (27.2%) reported accessing mental health services in the past four weeks. Severe psychological distress, being off work, worse general health and requiring support during claim were most strongly associated with greater odds of service use. Conclusions The prevalence of psychological distress among workers' compensation claimants is high. Most workers with musculoskeletal disorders and psychological distress do not access mental health services. Screening, early intervention and referral programs may reduce the prevalence and impact of psychological distress.

Association between workers' compensation claim processing times and work disability duration: Analysis of population level claims data.

Delays in workers' compensation claim processing (CP) times have been associated with reduced recovery and delayed return-to-work. This study aimed to (1) determine the injury, worker, and workplace factors associated with CP delays and (2) investigate whether CP delays are associated with longer disability duration after adjusting for these factors. Retrospective cohort analysis of Australian workers' compensation claims was conducted from 1st July 2009 to 30th June 2016 for objective (1) and to 30th June 2014 for objective (2). CP times were derived by calculating differences in days between: injury and lodgement dates (lodgement); lodgement and decision dates (decision) and; injury and decision dates (total). All CP times were shorter for younger workers and those with fractures or traumatic injury, and longer for those with neurological or mental health conditions, and other diseases. Claims from self-insured employers had shorter decision times. With increasing lodgement, decision and total time there was significantly higher hazard of longer disability duration. Findings suggest the need for more efficient claims management to ensure fewer barriers to claim lodgement or approval. This in turn should reduce disability duration and ensure improved return-to-work outcomes.