Assessing a whiplash management model: a population-based non-randomized intervention study.
OBJECTIVE
To evaluate the effectiveness of a multidisciplinary clinical management approach for whiplash-associated disorders (WAD) following a motor vehicle injury in Quebec.


METHODS
A clinical management model was implemented in 5 geographic regions of the Province of Quebec, Canada, in 7 hospitals and 19 clinics. A 2-group population-based parallel design was used to assess its effectiveness. All patients with a new whiplash injury seen in these 26 centers between March and September, 2001 were entered into the Whiplash Management Model (experimental group). A reference group included all subjects who had a whiplash injury during this same period but were not seen in these 26 intervention centers. All subjects were followed for up to a year. The outcome variables were time on compensation, time to file closure, and total direct costs.


RESULTS
A total of 288 patients with WAD were identified in the experimental group and 1,875 patients in the reference group. The rate of ending of compensation was significantly higher in patients who received the experimental treatment model than those receiving the reference treatment approach (rate ratio, RR: 3.2; 95% confidence interval, CI: 2.8-3.6). The rate of file closure was also significantly higher with the experimental treatment (RR: 1.5; 95% CI: 1.2-1.8). The average cost per patient was significantly reduced with the experimental intervention.


CONCLUSIONS
A coordinated whiplash management approach can lead to earlier return to work and lower costs for patients who have sustained a whiplash injury.
Suissa
Samy
S
Division of Clinical Epidemiology, Royal Victoria Hospital, McGill University Health Centre, Montreal, Quebec, Canada.
Giroux
Marc
M
Gervais
Marie
M
Proulx
Pierre
P
Desbiens
Claire
C
Delaney
Joseph Austin Christopher
JA
Delaney
Jac
J
Quail
Jacqueline
J
Stevens
Brian
B
Nikolaj
Sally
S
D000063:Accidents, Traffic; D000328:Adult; D017281:Cost of Illness; D005260:Female; D006801:Humans; D008297:Male; D018803:Models, Economic; D011379:Prognosis; D014911:Whiplash Injuries / Q000175:diagnosis / Q000191:economics* / Q000534:rehabilitation*