Evaluating Clinical Practice Guidelines Based on Their Association with Return to Work in Administrative Claims Data

Eric T Roberts; Eva H DuGoff; Sara E Heins; David I Swedler; Renan C Castillo; Dorianne R Feldman; Stephen T Wegener; Vladimir Canudas-Romo; Gerard F Anderson

doi:10.1111/1475-6773.12360

Evaluating Clinical Practice Guidelines Based on Their Association with Return to Work in Administrative Claims Data

Health Serv Res. 2016 Jun;51(3):953-80. doi: 10.1111/1475-6773.12360. Epub 2015 Sep 14.

Authors

Eric T Roberts¹, Eva H DuGoff², Sara E Heins³, David I Swedler⁴, Renan C Castillo⁵, Dorianne R Feldman⁶, Stephen T Wegener⁷, Vladimir Canudas-Romo⁸, Gerard F Anderson³

Affiliations

¹ Department of Health Care Policy, Harvard Medical School, Boston, MA.
² Department of Population Health Sciences, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI.
³ Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
⁴ University of Illinois at Chicago School of Public Health, Chicago, IL.
⁵ METRC Coordinating Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
⁶ Johns Hopkins Hospital, Baltimore, MD.
⁷ Johns Hopkins University School of Medicine, Baltimore, MD.
⁸ Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.

Abstract

Objective: To examine the association between non-adherence to clinical practice guidelines (CPGs) and time to return to work (RTW) for patients with workplace injuries.

Data sources/study setting: Secondary analysis of medical billing and disability data for 148,199 for shoulder and back injuries from a workers' compensation insurer.

Study design: Cox proportional hazard regression is used to estimate the association between time to RTW and receipt of guideline-discordant care. We test the robustness of our findings to an omitted confounding variable.

Data collection: Collected by the insurer from the time an injury was reported, through recovery or last follow-up.

Principal findings: Receiving guideline-discordant care was associated with slower RTW for only some guidelines. Early receipt of care, and getting less than the recommended amount of care, were correlated with faster RTW. Excessive physical therapy, bracing, and injections were associated with slower RTW.

Conclusions: There is not a consistent relationship between performance on CPGs and RTW. The association between performance on CPG and RTW is difficult to measure in observational data, because analysts cannot control for omitted variables that affect a patient's treatment and outcomes. CPGs supported by observational studies or randomized trials may have a more certain relationship to health outcomes.

Keywords: Administrative data uses; biostatistical methods; clinical practice guidelines; observational data.

Publication types

Observational Study

MeSH terms

Adult
Age Distribution
Aged
Back Injuries / therapy
Female
Humans
Insurance Claim Review / statistics & numerical data*
Male
Middle Aged
Occupational Injuries / therapy*
Occupations
Practice Guidelines as Topic*
Proportional Hazards Models
Retrospective Studies
Return to Work / statistics & numerical data*
Sex Distribution
Shoulder Injuries / therapy
Trauma Severity Indices
United States
Workers' Compensation / statistics & numerical data*
Young Adult

Abstract

Publication types

MeSH terms

Grants and funding