Improving the quality care in workers' compensation through a communitywide intervention: Did the IOM get it right?

Widespread efforts are now being initiated to improve the quality of health care, based upon the recommendations of the Institute of Medicine's Crossing the Quality Chasm report. One such effort is an ongoing quality improvement project in Washington State in the workers' compensation area. In July 2002, the WA State Department of Labor and Industries (DLI) initiated a major pilot known as the Occupational Health Services (OHS) project. The purpose of the OHS project was to improve the quality of care and outcomes for injured workers treated through the workers' compensation program. Two pilot sites were selected, one near Settle the other in Spokane, WA. Through these pilots, Centers of Occupational Health and Education (COHE) have been developed to oversee the delivery of care, provide health services coordination, offer ongoing training to physicians, and monitor treatment for high risk patients. As part of the pilot, quality indicators were developed for three conditions that lead to much disability in workers' compensation, back sprains, carpal tunnel syndrome, and fractures. The DLI incorporated a pay-for-performance component in the initiative. Physicians adhering to the quality indicators receive additional payment depending upon the service provided. Over 350 community physicians in both pilot sites are participating in the project.

A comprehensive evaluation of the OHS quality improvement initiative is being conducted by researchers at the University of Washington. The evaluation is examining the effect of the COHE intervention on medical costs, disability costs (in workers' compensation injured workers who are out of work receive wage replacement payments), incidence of disability and duration of disability. The evaluation is based upon approximately 34,000 cases representing 18,000 workers treated through the two COHE pilots and 16,000 comparison-group cases representing patients treated within the pilot target areas by physicians who did not enroll in the pilot. The evaluation is comparing the intervention and comparison-groups with regard to costs and disability outcomes, controlling for patient age, sex, type of injury, type of provider, industry, size of employer, and baseline-year physician costs. This quality improvement intervention was associated with significant cost savings (p < .01) on the order of $400 to $570 per claim. The majority of these cost savings represent savings in disability payments. By aligning payment with activities that enhanced the quality of workers' compensation health care, and by providing organizational support for care delivery, the OHS project reduced worker disability and generated substantial cost savings.