Can quality improvement activities encourage physicians to adopt best practices in the delivery of care? Evidence from a quality improvement project in Washington State

Much attention is being given to encouraging physicians to adopt “best practices” in the care they provide in order to improve patient outcomes. In July 2002, the WA State Department of Labor and Industries (DLI) initiated a major pilot, known as the Occupational Health Services (OHS) project, to encourage physicians to adopt occupational health best practices. 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) were 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 related to three occupational health best practices: (1) submission of the report of accident form within two business days to foster improved access to occupational health care; (2) physician-employer telephone communication to encourage the development of better strategies to return the worker to work; and (3) use of the activity prescription form to document medical problems, formulate a treatment plan and define work restrictions.

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 the incidence and duration of disability, (in workers' compensation injured workers who are out of work go on disability and receive wage replacement payments) and on medical and disability costs. 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 areas by physicians not enrolled in the pilot. Analysis indicated that the adoption of best practices varied by type of provider, with high volume providers (providers treating > 200 workers' compensation patients per year), hospital emergency departments (ERs), and occupational medicine physicians most likely to adopt the best practices. Further, it was found that the patients of physicians who more frequently adopted the best practices had significantly (p < .05) less lost work time, as represented by disability days for which wage replacement payments are received. Quality improvement interventions can foster the development of best practices, which in turn improves patient outcomes.