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PubMed1990

Identifying families at high risk of cardiovascular disease: alternative work site approaches.

By examining coverage, concordance, and costs, this project evaluated four methods of cardiovascular disease (CVD) risk screening at a work site with 1821 central office employees of an energy company in Houston, Tex. Screening methods included a health risk appraisal mail questionnaire (HRA), an HRA plus brief physical assessment, an analysis of medical claims data, and an analysis of absenteeism data. Coverage ranged from 99% of employees for the absenteeism method to about 30% for the HRA method. Combining the first three screening methods, 18% of families had at least one member with a CVD or related diagnosis or one of four major CVD risk factors. The absenteeism method yielded 12.1% of the central office employees with 9 or more days absent. Although the absenteeism method identified high-cost families, only 9% had a heart disease or related diagnosis. This lack of concordance also occurs with other methods. For example, only 9.4% of families identified with the claims data were also identified by the HRA. Therefore, the methods identify different groups of high-risk families. Findings are discussed in relation to costs and other factors important to firms' selection of screening methods.

Absenteeism↗
PubMed1995

Silicosis and workers' compensation in New Jersey.

The employer is expected to maintain responsibility for health care expenses and lost income that result from occupational injury and illness through the workers' compensation insurance system. However, financial support for individuals with occupational illnesses, especially those with long latency, is often from sources other than workers' compensation. Silicosis, a well defined, chronic, occupational lung disease, can be viewed as a sentinel for the inadequacy of the public policy to compensate workers for chronic occupational lung disease. Three hundred twenty-nine patients with confirmed silicosis were identified by the silicosis surveillance program in the New Jersey Department of Health using source data from 1979 through 1992. One hundred seventy-seven of these individuals provided information on the status of any compensation claims against their employer. Only 31% of these patients stated that a claim had been filed; 84% of those whose claims were settled were awarded payments. Severity of radiologic findings was not associated with the likelihood of filing a claim or with being awarded a payment; whereas, smoking was associated with these outcomes. The implications of these findings for the health care system are discussed.

Aged↗
PubMed1996

The increased incidence on Mondays of work-related sprains and strains.

Insurance-industry researchers have shown an increase on Mondays of lost-time sprain and strains said to be work-related, but thought to be fraudulent claims for off-the-job weekend injuries. We examined this issue among civilian employees of the Department of the Navy, using data from claims for injuries occurring between 1989 and 1994. We found that the rate of Monday sprains and strains significantly exceeded the expected rate and that such claims were significantly more likely to be made by claimants who were craftsmen and mechanics, who reported an injury to the back or trunk, who were supervisors, or who did not have college degrees. We estimate that 22% of claims for Monday-occurring sprains and strains are possibly fraudulent and that their cost to the Department of the Navy during the 6 years studied was $38 million. For the entire federal government, cost for such claims during this period may have exceeded $250 million.

Adult↗
PubMed1997

A descriptive study of recurrent low back pain claims.

This is the first large-scale study of US workers that describes the demographic and cost differences between recurrent and nonrecurrent low back pain (LBP) disability claimants, using data from a large workers' compensation insurer. Persons with at least one LBP claim in 1990 and one or more additional claims in 1990 to 1996 were defined as recurrent. Persons with at least one LBP claim in 1990 but no subsequent claims were defined as nonrecurrent. Fourteen percent of claimants were recurrent. The percentage of recurrent claimants who were male (77.2%) was higher than the percentage that were female (22.8%). This difference was more pronounced in the younger age groups. The median total cost for recurrent LBP claims in 1990 was 4% greater than for nonrecurrent 1990 LBP claims, whereas the mean cost was 48% less. Most studies of LBP recurrence among US workers have followed single-corporation employees. Our rate of recurrence was lower than these previously reported rates. However, analysis of independent workers' compensation insurance company data may provide a more accurate assessment of LBP claim recurrence among US workers.

Adult↗
PubMed1997

The financial impact of changes in personal health practices.

The impact of changes in health practices on medical claims costs between 1985-1987 and 1988-1990 was examined among 796 employees. Employees completed a health risk appraisal in 1985 and 1988 and were categorized into health risk levels. High-cost status and high-risk status were significantly associated at both times. The percentage of employees with high-risk status decreased from 31.8% to 25.3% between 1985 and 1988 (P < 0.01). Changes in average costs and the percentage with high-cost status followed the risk change. The largest increase in average costs occurred in employees who moved from low-risk to high-risk status. The greatest reduction in average costs occurred in employees who moved from high-risk to low-risk status. Median costs were not as sensitive to risk change. The findings provide strong evidence that improving individual health status is associated with financial benefits.

Absenteeism↗
PubMed1998

Occupational upper extremity disorders in the federal workforce. Prevalence, health care expenditures, and patterns of work disability.

Upper extremity disorders (UEDs) account for a significant number of work-related illnesses in the US workforce. Little information exists on the distribution of UEDs, their associated health care and indemnity costs, or patterns of work disability. The study presented is an analysis of upper extremity claims within the federal workforce. In this study, the universe consisted of all claims accepted by the US Department of Labor, Office of Workers' Compensation Programs (OWCP), from October 1, 1993, through September 30, 1994. A total of 185,927 claims of notices of injury were processed during the study period, and of these, 8,147 or 4.4% had an UED diagnosis coded according to the International Classification of Diseases, Clinical Modification (ICD-9-CM). 5,844 claims involved a single UED diagnosis and were the only claims field by these employees between October 1, 1990, and September 30, 1994. These single claims with single diagnoses comprised the sample for further analysis. Mononeuritis and enthesopathies of the upper limb were the most common diagnoses, accounting for 43% and 31% of the claims, respectively. Women had a higher proportion of carpal tunnel syndrome, "unspecified" mononeuritis, and "unspecified" enthesopathies. The majority of claimants for both the mononeuritis- and enthesopathy-related diagnoses were between 31 and 50 years of age, received only health care benefits, and did not incur wage loss. Health care costs for mononeuritis and enthesopathy claims were $12,228,755 (M = $2,849). Carpal tunnel syndrome (CTS) and enthesopathy of the elbow were the most costly diagnoses, accounting for 57% and 16% of the total, respectively. Surgical services represented the highest expenditures in CTS claims. Physical therapy accounted for the majority of health care costs for enthesopathy cases. The mean number of workdays lost for CTS and enthesopathy claims were 84 and 79, and the average indemnity costs were $4,941 and $4,477, respectively. These findings indicate that while UEDs represent a relatively small percentage of all workers' compensation cases, the health care and indemnity costs are considerable. Also mean duration and pattern of work disability revealed that these disorders can result in chronic work disability similar to that observed in low back pain. The results highlight the need to determine whether interventions that account for the majority of costs significantly impact long-term outcomes. There is also a need to identify risk factors for prolonged disability in those who experience problems with delayed recovery.

Adolescent↗
PubMed1998

Non-fatal workplace violence workers' compensation claims (1993-1996).

More is known about fatal workplace violence than non-fatal workplace violence (NFWV). This study provides descriptive information on the number and cost of NFWV claims filed with a large workers' compensation carrier. NFWV claims from 51 US jurisdictions were selected either by cause codes or by word search from the accident-description narrative. Claims reported in 1993 through 1996 were analyzed to report the frequency, cost, gender, age, industry, and nature of injury. An analysis of a random sample of 600 claims provided information on perpetrator type, cause of events, and injury mechanism. A total of 28,692 NFWV claims were filed during the study period. No cost was incurred for 32.5% of the claims, and 15.5% received payments for lost work. As a percentage of all claims filed by industry, schools had the highest percentage (11.4%) of NFWV claims, and banking had the highest percentage (11.5%) of cost. The majority of claims in the banking random sample group (93%) were due to stress. In the random sample, 90.3% of claims were caused by criminals (51.8%) or by patients, clients, or customers (38.5%). Only 9.7% were caused by an employee (9.2%) or a personal acquaintance of the employee (0.5%). Employers should acknowledge that NFWV incidents occur, recognize that the majority of perpetrators are criminals or clients rather than employees, and develop appropriate prevention and intervention programs.

Adult↗
PubMed1998

Comparison of workers' compensation costs for two cohorts of injured workers before and after the introduction of managed care.

A comprehensive safety and managed care initiative was instituted in 1991 at a large self-insured medical center in an effort to reduce workers' compensation costs. It features an on-site case management team, a preferred provider organization, and safety engineering efforts and ergonomic controls used proactively to aggressively identify and abate workplace hazards. Two worker populations were followed up longitudinally for three years before and after the initiative. Costs incurred by each cohort were compared. A 50% reduction in total expenditures was seen in the managed care cohort. The hospital component of the system saw a decrease in compensation of 62% for temporary total disability and 38% for permanent partial disability. Medical expenditures decreased 50%. Dramatic reductions in costs are achievable, without compromising quality of care, when managed care principles and safety efforts are emphasized.

Accidents, Occupational↗
PubMed1999

Distinctive emergency department usage for injury for workers' compensation cases in Utah in 1996.

To compare emergency department services paid by worker's compensation (WC) with services paid by other payers, a state database of 72,747 emergency department visits for injured adults (ages 21 to 54) in 1996 in Utah was analyzed. WC visits accounted for 21.6% (15,704) of all adult injury visits. The mean emergency department charge for WC visits was $282, and the admission rate was 17 per 1000 visits. The mean charge for other payers was $334, and the admission rate was 43 per 1000 visits. Differences were also found between these groups for Injury Severity Scores and diagnoses. In summary, WC emergency department usage was associated with less severe injuries than was emergency department usage for other payers in Utah in 1996.

Accidents, Occupational↗
PubMed1999

Occupational injuries reported to insurance companies in Norway from 1991 to 1996.

Occupational injuries represent a relatively high proportion of the total number of injuries in Norway and thereby deserve more attention than they are currently receiving. Occupational injury claims made to insurance companies in Norway from 1991 to 1996 were analyzed for determination of their patterns. The types of injury with the highest incidence rates among men were fractures; among women, the highest rates were for those for sprains. The injury rates were more than twice as high in young men as in young women; this difference declined with increasing age. Young men had an increased risk of finger injuries, compared with older age groups. The injury rates increased with increasing age, especially for fractures and contusions. A somewhat higher number of injuries per working day occurred in January and February than in the other months. Action should be taken to prevent fractures and contusions among older workers.

Adolescent↗
PubMedDate not supplied

A case management protocol: reducing unnecessary Medicare admissions in Florida.

The Florida Medicare quality improvement organization implemented a case management project with 20 acute care hospitals to reduce unnecessary Medicare admissions. The project called for hospitals to implement a protocol to assign patients to observation or inpatient admission status. Results of the project showed a 67% reduction in the denial rate for the participating facilities. This relative reduction in denial rates was nearly 3 times greater for the participating facilities as compared to the control facilities. The protocol can easily be adopted by hospitals.

Case Management↗
PubMed2005

Back pain claim rates in Japan and the United States: framing the puzzle.

STUDY DESIGN: This is a cross-national comparison of workers' compensation claims for back pain in Japan and the United States (US). OBJECTIVES: The main objective is to juxtapose rates of back pain claims in Japan and Washington state. Because the Washington state rate closely matches rates for other US states as well as the rate for the US as a whole, it is used to represent the US rate. A puzzle is to be framed: Why are back pain claim rates in Japan and the United States so disparate? SUMMARY OF BACKGROUND DATA: Occupational back pain is common among workers in both Japan and the United States. Wage compensation for time off work is also substantial in both countries and potentially induces time off work at least as much in Japan as in the United States. Accordingly, back pain claim rates in Japan seemingly would be on the same order of magnitude as rates in the United States. METHODS: Washington state rates are based on data from its state fund. Both Japan and Washington state rates are composed of the number of workers eligible to file worker compensation claims in a given year (denominator) and the number of back pain claims accepted during that year (numerator). Because rates may fluctuate from year-to-year, 5 years of data on rates are presented, 1995-1999. Central to the comparison are Japanese and Washington state rates of workers' compensation claims for back pain with more than 3 days compensated time loss from work. RESULTS: The back pain claim rate in 1999 was 60 times higher in Washington state than in Japan. The disparity in rates for the other years in the study (1995-1998) was similar. CONCLUSION: Back pain is common among workers both in Japan and the United States, but there is no simple or necessary relationship between that symptom and how it manifests itself in one country or another. Rather, the symptom is protean in its social manifestations. As for what shapes those manifestations-or, more specifically, what causes the startling disparity in back pain claim rates between Japan and the United States-that is a puzzle. Various solutions to the puzzle are discussed, but it remains essentially unsolved.

Back Pain↗