Timing makes a difference: early nurse case management intervention and low back pain.

PURPOSE OF STUDY

• To examine whether early nurse contacts influenced workers' satisfaction with their nurse case management, their healthcare, and the way the firm was treating their injury.* To examine whether early nurse contacts influenced self-reported measures of back pain and returns to work.

PRIMARY PRACTICE SETTING(S): Workers with low back pain resulting in workers' compensation claims.

METHODOLOGY AND SAMPLE

To quantify the influence of nurse case management on workers' satisfaction with their treatment by the firm and their healthcare provider, as well return to work, we follow 747 Marriott workers with incident episodes of low back pain in a prospective analysis. Predictors of outcomes include demographics, injury severity, and the timing of nurse case manager and work supervisor contacts.

RESULTS

While early contacts do not have much impact on satisfaction with the treatment by the healthcare provider, early nurse case management contacts improve worker satisfaction with the firm's treatment of their claim, increasing satisfaction by 0.5 standard deviations (on a 4-point scale). The change in odds ratio with respect to a contact during the first week after injury is 8, indicating a 50-percentage point increase in the likelihood of continual employment.

IMPLICATIONS FOR CM PRACTICE

Among workers with low back pain, early nurse case management contacts improved workers' satisfaction with their healthcare provider and their treatment by the firm. Contacts made during the first week after the injury were most valuable, but in our sample it did not matter when during that first week the contact was made (as long as it was within the first week).* Early nurse case management contacts substantially improved the odds of continual employment, dominating the influence of age, job satisfaction, and the expectation of a good recovery.