Greenwood J G, Wolf H J, Pearson R J, Woon C L, Posey P, Main C F
West Virginia Workers' Compensation Fund, Charleston.
J Occup Med. 1990 Oct;32(10):1047-52.
A major issue in the field of workers' compensation is cost containment, not only of medical costs, but of extended disability costs as well. For a 9-month period in 1985 to 1986, the West Virginia Workers' Compensation Fund tested an early intervention case management approach begun within 2 weeks after injury and found it not to be cost effective. In a controlled study of 284 reported back injuries among underground coal miners, medical costs increased with the case management intervention, although only to the extent of the added costs of the intervention, and disability costs and time lost from work did not decrease. Permanent partial disability awards, litigation rates, number of hospitalizations, and return to work were similar between both the experimental and control groups. Regression analyses of 25 factors identified factors most highly predictive of disability and medical costs, but in predicting extended disability, although the factors were 100% sensitive, they were only 43.6% specific. The case management approach was insufficient to prevent extended disability or to lower medical costs.
工伤赔偿领域的一个主要问题是成本控制，不仅要控制医疗成本，还要控制长期残疾成本。在1985年至1986年的9个月期间，西弗吉尼亚州工伤赔偿基金对受伤后两周内开始的早期干预病例管理方法进行了测试，发现该方法不具有成本效益。在一项对284名地下煤矿工人报告的背部损伤进行的对照研究中，病例管理干预使医疗成本增加，尽管仅增加到干预的额外成本程度，残疾成本和工作时间损失并未减少。实验组和对照组之间的永久性部分残疾赔偿金、诉讼率、住院次数和重返工作情况相似。对25个因素的回归分析确定了对残疾和医疗成本预测性最高的因素，但在预测长期残疾方面，尽管这些因素的敏感性为100%，但其特异性仅为43.6%。病例管理方法不足以预防长期残疾或降低医疗成本。
