title: Geographic variability of adherence to occupational injury treatment guidelines.
abstract: OBJECTIVE
  To determine the geographic variability and relationship between six occupational injury practice guidelines.
  
  
  METHODS
  Guidelines were developed by an expert panel and evaluated using workers' compensation claims data from a large, national insurance company (1999 to 2010). Percentage compliance for each guideline was adjusted for age and sex using linear regression and mapped by hospital referral region. Regions with the lowest compliance were identified, and correlations between guidelines were calculated.
  
  
  RESULTS
  Compliance to the unnecessary home care guideline showed the lowest geographic variation (interquartile range: 97.3 to 99.0), and inappropriate shoulder bracing showed the highest variation (interquartile range: 77.7 to 90.8). Correlation between the guidelines was weak and not always positive.
  
  
  CONCLUSIONS
  Different guidelines showed different degrees of geographic variation. Lack of correlation between guidelines suggests that these indicators were not associated with a single underlying health care quality or patient severity construct.
authors.affiliation: From the Department of International Health (Dr Trujillo) and Department of Health Policy and Management (Ms Heins, Drs Anderson and Castillo), Johns Hopkins Bloomberg School of Public Health, Baltimore, Md.
authors.forename: Antonio J
authors.initials: AJ
authors.lastname: Trujillo
authors.forename: Sara E
authors.initials: SE
authors.lastname: Heins
authors.forename: Gerard F
authors.initials: GF
authors.lastname: Anderson
authors.forename: Renan C
authors.initials: RC
authors.lastname: Castillo
mesh_terms: D000701:Analgesics, Opioid / Q000627:therapeutic use; D019567:Back Injuries / Q000628:therapy*; D001915:Braces / Q000706:statistics & numerical data; D002140:California; D019983:Guideline Adherence; D006699:Home Care Services / Q000706:statistics & numerical data; D006801:Humans; D038801:International Classification of Diseases; D015146:Midwestern United States; D060051:Occupational Injuries / Q000628:therapy*; D019637:Orthopedic Procedures / Q000706:statistics & numerical data; D026741:Physical Therapy Modalities / Q000706:statistics & numerical data; D017410:Practice Guidelines as Topic; D000070599:Shoulder Injuries; D015144:Southeastern United States; D015206:Southwestern United States; D013256:Steroids / Q000008:administration & dosage; D019564:Unnecessary Procedures; D014942:Workers' Compensation / Q000706:statistics & numerical data
chemical_list: D000701:Analgesics, Opioid; D013256:Steroids