title: Prevention of work-related disability.
abstract: BACKGROUND
  The cost of work-related injury is large and is rising in many states. Managed care providers are being asked to assist with solutions, particularly in the area of facilitating return to work. Kaiser Permanente of the Northwest responded by developing the Kaiser on-the-job program, which includes processes to facilitate the primary, secondary, and tertiary prevention of work-related disability.
  
  
  METHODS
  This paper describes the role that managed care can play in the prevention of work-related disability through consultation, training, immunization programs, and targeted screening and case management interventions. A quality and case management system is described, which gives physicians feedback on modified work and time-off authorization by diagnosis.
  
  
  RESULTS
  The results demonstrate statistically significant decreasing physician-authorized average time loss for low back cases from 1991 through 1995 (17.8 disability days per case in 1991 and 15 per case in 1995, P = .01). According to Oregon State Accident Insurance Fund (SAIF Corporation) data, the Kaiser on-the-job average total claims cost was reduced 33% for disabling cases as compared to two other health care organizations (P = .002).
  
  
  CONCLUSIONS
  The methods utilized here to prevent work-related disability appear effective. They are relevant to many managed care program models and their efforts to improve workplace health and productivity.
authors.affiliation: Kaiser Permanente Northwest, Portland, OR 97210, USA.
authors.forename: A
authors.initials: A
authors.lastname: Feldstein
authors.forename: V
authors.initials: V
authors.lastname: Breen
authors.forename: N
authors.initials: N
authors.lastname: Dana
mesh_terms: D000062:Accidents, Occupational / Q000517:prevention & control*; D019090:Case Management / Q000458:organization & administration; D004185:Disability Evaluation; D006279:Health Maintenance Organizations / Q000458:organization & administration*; D006801:Humans; D009786:Occupational Health Services / Q000458:organization & administration*; D009922:Oregon; D011314:Preventive Health Services / Q000458:organization & administration*; D011322:Primary Prevention / Q000458:organization & administration; D016730:Program Development; D015397:Program Evaluation; D014942:Workers' Compensation; D014947:Wounds and Injuries / Q000150:complications / Q000517:prevention & control*