Stephens Brian, Gross Douglas P
Departments of Public Health Sciences, University of Alberta, Workers' Compensation Board Alberta Millard Health, Edmonton, Alberta, Canada.
Spine (Phila Pa 1976). 2007 Dec 1;32(25):2898-904. doi: 10.1097/BRS.0b013e31815b64b6.
Population-based before-and-after design with concurrent control group.
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.
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.
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.
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).
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.
基于人群的前后对照设计，并设有同期对照组。
由于对连续护理的研究较少，我们评估了阿尔伯塔省工人赔偿委员会（WCB-阿尔伯塔）模式对持续重返工作岗位、护理满意度和成本的影响。
肌肉骨骼疾病，如背痛，仍然是残疾和工作损失的主要原因。从1996年到1997年，WCB-阿尔伯塔实施了连续护理模式，以指导软组织损伤索赔人的康复服务提供。该模式被设计为一种决策工具，以促进在该辖区内采用一致的、基于证据的护理方法。
该模式在全省范围内实施，因此对WCB-阿尔伯塔承保的全体工人进行了研究。数据从实施前2年（1994 - 1995年）到实施后5年（1996 - 2000年）从WCB-阿尔伯塔行政数据库中提取。干预组由提出下背部、脚踝、膝盖、肘部和肩部软组织损伤索赔的患者组成。对照组由经历骨折或其他创伤性非软组织损伤的工人组成。通过调查来衡量满意度。主要结局是领取工资替代福利的累计天数。使用多变量Cox回归来确定该模式的效果。
在整个研究期间，70116名索赔人提出了软组织损伤索赔，而101620名索赔人经历了非软组织损伤。在模式实施后，干预组的重返工作岗位结局有显著改善（风险比 = 1.54）。福利的中位持续时间从13天降至8天。对照组的残疾持续时间几乎没有变化（中位持续时间一直为10天）。大多数索赔人对所接受的护理感到满意。在全面实施的两年期间节省的成本为2150万加元（加拿大）。
实施涉及分阶段应用各种类型康复服务的软组织损伤连续护理似乎导致了更快和更持续的康复。
