title: Evaluating Clinical Practice Guidelines Based on Their Association with Return to Work in Administrative Claims Data.
abstract: OBJECTIVE
  To examine the association between non-adherence to clinical practice guidelines (CPGs) and time to return to work (RTW) for patients with workplace injuries.
  
  
  METHODS
  Secondary analysis of medical billing and disability data for 148,199 for shoulder and back injuries from a workers' compensation insurer.
  
  
  METHODS
  Cox proportional hazard regression is used to estimate the association between time to RTW and receipt of guideline-discordant care. We test the robustness of our findings to an omitted confounding variable.
  
  
  METHODS
  Collected by the insurer from the time an injury was reported, through recovery or last follow-up.
  
  
  RESULTS
  Receiving guideline-discordant care was associated with slower RTW for only some guidelines. Early receipt of care, and getting less than the recommended amount of care, were correlated with faster RTW. Excessive physical therapy, bracing, and injections were associated with slower RTW.
  
  
  CONCLUSIONS
  There is not a consistent relationship between performance on CPGs and RTW. The association between performance on CPG and RTW is difficult to measure in observational data, because analysts cannot control for omitted variables that affect a patient's treatment and outcomes. CPGs supported by observational studies or randomized trials may have a more certain relationship to health outcomes.
authors.affiliation: Department of Health Care Policy, Harvard Medical School, Boston, MA.
authors.forename: Eric T
authors.initials: ET
authors.lastname: Roberts
authors.affiliation: Department of Population Health Sciences, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI.
authors.forename: Eva H
authors.initials: EH
authors.lastname: DuGoff
authors.affiliation: Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
authors.forename: Sara E
authors.initials: SE
authors.lastname: Heins
authors.affiliation: University of Illinois at Chicago School of Public Health, Chicago, IL.
authors.forename: David I
authors.initials: DI
authors.lastname: Swedler
authors.affiliation: METRC Coordinating Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
authors.forename: Renan C
authors.initials: RC
authors.lastname: Castillo
authors.affiliation: Johns Hopkins Hospital, Baltimore, MD.
authors.forename: Dorianne R
authors.initials: DR
authors.lastname: Feldman
authors.affiliation: Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: Stephen T
authors.initials: ST
authors.lastname: Wegener
authors.affiliation: Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
authors.forename: Vladimir
authors.initials: V
authors.lastname: Canudas-Romo
authors.affiliation: Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
authors.forename: Gerard F
authors.initials: GF
authors.lastname: Anderson
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D019567:Back Injuries / Q000628:therapy; D005260:Female; D006801:Humans; D007345:Insurance Claim Review / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D060051:Occupational Injuries / Q000628:therapy*; D009790:Occupations; D017410:Practice Guidelines as Topic; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D062707:Return to Work / Q000706:statistics & numerical data*; D017678:Sex Distribution; D000070599:Shoulder Injuries / Q000628:therapy; D015599:Trauma Severity Indices; D014481:United States; D014942:Workers' Compensation / Q000706:statistics & numerical data*; D055815:Young Adult
keywords: Administrative data uses; biostatistical methods; clinical practice guidelines; observational data