We talked about the study “A New Method of Assessing the Impact of Evidence-Based Medicine on Claim Outcomes” before, but now that it has been published by the Journal of Occupational and Environmental Medicine we want to go into a little more detail of the methods and highlight the significance of the study, which provides further support for using evidence-based medicine to control claim costs and achieve better outcomes for workers.

Researchers reviewed just over 45,000 indemnity claims filed between 2008 and 2013 and looked at the impact on claim costs and duration based on how well the claims followed evidence-based guidelines. They developed a unique method to score how well claims complied with the Work Loss Data Institute’s Official Disability Guidelines, the selected guidelines for the study. They found evidence to support the idea that following the guidelines closely meant lower claims costs for the payer and better outcomes for the injured worker.

Claims were labeled, or “flagged” using the ODG flag standards. Green flags mean the procedure is recommended based on ODG recommendations. Yellow flags mean the procedure is common for that treatment but may need to be limited. Red flags means the procedure is rare for a work comp claim and the treatment may not be necessary and should be reviewed. Black flags means the procedure or treatment is not appropriate for that case and the request should likely be denied. They grouped claims that were green or yellow flags as those that had a higher ODG compliance score than black or red flags. They also rated claims based on medical complexity. They found that the non-compliant group had a 13.2 percent increase in claim duration and a 37.9 increased in medical costs. This discrepancy in duration and costs between claims that followed ODG more closely and those that did not was even more pronounced when it came to very complex claims. In comparing outcomes for the top 10 percent of medically complex claims, the low compliance group of claims saw an 18 percent increase in duration and a 38 percent increase in cost compared to the high compliance group of claims.

The researchers also found evidence that claims with more inappropriate treatments applied were those with significantly longer durations and higher costs, and that claims that were labeled red or black flags and were the least compliant with ODG standards saw the most inappropriate treatments. The average number of appropriate treatments was relatively similar for both groups.

Researchers say that this study is one of the only studies to look for a relationship between guideline adherence and duration and cost outcomes. They developed a standard way to score a claim’s compliance to the guidelines so that claims with varying body parts, treatments or complexity could be controlled and then compared next to each other to see if guideline adherence made a difference in duration and/or cost.

The study was funded by the AF Group and the article text can be found here. They used the Official Disability Guidelines as the evidence-based standard for their study but the authors acknowledge that some states are creating their own versions of evidence-based medical guidelines.