The influence of a continuum of care model on the rehabilitation of compensation claimants with soft tissue disorders.
METHODS
Population-based before-and-after design with concurrent control group.


OBJECTIVE
As continuums of care have been little studied, we evaluated the impact of the Workers' Compensation Board of Alberta (WCB-Alberta) model on sustained return to work, satisfaction with care, and cost.


BACKGROUND
Musculoskeletal conditions, such as back pain, continue to be leading causes of disability and work loss. From 1996 through 1997, the WCB-Alberta implemented a continuum of care model to guide rehabilitation service delivery for claimants with soft tissue injury. The model was designed as a decision-making tool to promote a consistent, evidence-based approach to care within the jurisdiction.


METHODS
The model was implemented province-wide so the entire population of workers insured by the WCB-Alberta was studied. Data were extracted from the WCB-Alberta administrative database from 2 years before implementation (1994-1995) to 5 years after (1996-2000). An intervention group was created from patients filing soft tissue injury claims for the low back, ankle, knee, elbow, and shoulder. The comparison group was formed of workers experiencing fractures or other traumatic non-soft tissue injuries. Satisfaction was measured through surveys. Primary outcome was cumulative days receiving wage replacement benefits. Multivariable Cox regression was used to determine the model's effect.


RESULTS
Over the entire study period, 70,116 claimants filed soft tissue injury claims while 101,620 claimants experienced non-soft tissue injuries. Significant improvement was observed in intervention group return-to-work outcomes after model implementation (hazard ratio = 1.54). Median duration of benefits decreased from 13 to 8 days. Little change was seen in the control group's disability duration (median duration, consistently 10 days). The majority of claimants were satisfied with care received. Cost savings over a 2-year full implementation period was $21.5 million (Canadian).


CONCLUSIONS
Implementation of a soft tissue injury continuum of care involving staged application of various types of rehabilitation services appears to have resulted in more rapid and sustained recovery.
Stephens
Brian
B
Departments of Public Health Sciences, University of Alberta, Workers' Compensation Board Alberta Millard Health, Edmonton, Alberta, Canada.
Gross
Douglas P
DP
D000328:Adult; D000416:Alberta; D019090:Case Management / Q000191:economics; D002684:Chiropractic / Q000191:economics; D003266:Continuity of Patient Care / Q000191:economics*; D003284:Contract Services / Q000191:economics; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D004185:Disability Evaluation; D004651:Employment; D005260:Female; D017048:Health Care Costs; D006801:Humans; D008297:Male; D008875:Middle Aged; D009140:Musculoskeletal Diseases / Q000191:economics* / Q000534:rehabilitation*; D017060:Patient Satisfaction; D026761:Physical Therapy Specialty / Q000191:economics; D011159:Population Surveillance; D015397:Program Evaluation; D016016:Proportional Hazards Models; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome; D014942:Workers' Compensation / Q000191:economics*