Improving quality, preventing disability and reducing costs in workers' compensation healthcare: a population-based intervention study.

Background: Problems of poor quality and high costs are worse in the workers' compensation system than in the general medical care system, yet relatively little work has been done to improve performance in workers' compensation healthcare.

Objective: To evaluate the effect of a quality improvement intervention that provided financial incentives to providers to encourage adoption of best practices, coupled with organizational support and care management activities, aimed at reducing work disability for patients treated within the Washington State workers' compensation system.

Research Design: Prospective nonrandomized intervention study with nonequivalent comparison group using difference-in-difference models to estimate the effect of the intervention.

Participants: Two cross-sections of data representing 33,910 workers' compensation claims filed in the baseline (preintervention) period from July 2001 to June 2003 and 71,696 claims filed in the postintervention period from July 2004 to June 2007 were analyzed. 46,928 (44%) of these 105,606 claims represent patients treated by over 275 providers recruited through Centers of Occupational Health and Education (COHEs) at 2 pilot regional sites.

Measures: Outcomes, measured at 1-year follow-up, included work disability status, number of disability days, disability cost, and medical cost.

Results: COHE patients were less likely to be off work and on disability at 1 year postclaim receipt (OR=0.79, P=0.003). The average COHE patients experienced a reduction in disability days of 19.7% (P=0.005) and a reduction in total disability and medical costs of $510 per claim (P<0.01). For patients with back sprain, the reduction in disability days was 29.5% (P=0.003). Patients treated by providers who more often adopted occupational health best practices had, on average, 57% fewer disability days (P=0.001) compared with patients treated by providers who infrequently adopted best practices.

Conclusions: Financial incentives, coupled with care management support, can improve outcomes, prevent disability, and reduce costs for patients receiving occupational healthcare. Owing to important disability prevention capacity, workers' compensation healthcare may be especially fertile ground for continued quality improvement innovation.