创新型职业保健服务模式可预防永久性残疾：华盛顿州职业健康与教育中心八年随访研究
Innovations in Occupational Health Care Delivery Can Prevent Entry into Permanent Disability: 8-Year Follow-up of the Washington State Centers for Occupational Health and Education.
机构信息
Division of Health Services and Management and Policy, College of Public Health, The Ohio State University, Columbus, OH.
Departments of Environmental and Occupational Health Sciences, Neurology and Health Services, University of Washington, Seattle.
出版信息
Med Care. 2018 Dec;56(12):1018-1023. doi: 10.1097/MLR.0000000000000991.
BACKGROUND
Long-term work disability is known to have an adverse effect on the nation's labor force participation rate. To reduce long-term work disability, the Washington State Department of Labor and Industries established a quality improvement initiative that created 2 pilot Centers of Occupational Health and Education (COHE).
OBJECTIVES
To document the level of work disability in a sample of injured workers with musculoskeletal injuries and to examine (8-y) work disability outcomes associated with the COHE health care model.
RESEARCH DESIGN
Prospective nonrandomized intervention study with nonequivalent comparison group using difference-in-difference regression models.
SUBJECTS
Intervention group represents 18,790 workers with musculoskeletal injuries treated by COHE providers. Comparison group represents 20,992 workers with similar injuries treated within the COHE catchment area by non-COHE providers.
MEASURES
Long-term disability outcomes include: (1) on disability 5 years after injury; (2) received a state pension for total permanent disability; (3) received total disability income support through the Social Security Disability Insurance program; or (4) a combined measure including any one of the 3 prior measures.
RESULTS
COHE patients had a 30% reduction in the risk of experiencing long-term work disability (odds ratio=0.70, P=0.02). The disability rate (disability days per 1000 persons) over the 8-year follow-up for the intervention and comparison groups, respectively, was 49,476 disability days and 75,832 disability days.
CONCLUSIONS
Preventing long-term work disability is possible by reorganizing the delivery of occupational health care to support effective secondary prevention in the first 3 months following injury. Such interventions may have promising beneficial effects on reversing the nation's progressively worsening labor force participation rate.
背景
众所周知，长期工作残疾会对国家的劳动力参与率产生不利影响。为了减少长期工作残疾，华盛顿州劳工和工业部建立了一项质量改进计划，创建了 2 个试点职业健康和教育中心（COHE）。
目的
记录患有肌肉骨骼损伤的受伤工人样本中的工作残疾水平，并研究与 COHE 医疗模式相关的（8 年）工作残疾结果。
研究设计
前瞻性非随机干预研究，使用差值差分回归模型进行非等效比较组比较。
受试者
干预组代表 18790 名接受 COHE 提供者治疗的肌肉骨骼损伤工人。对照组代表 20992 名在 COHE 集水区内接受非 COHE 提供者治疗的具有类似损伤的工人。
测量
长期残疾结果包括：（1）受伤后 5 年残疾；（2）获得国家永久性完全残疾养恤金；（3）通过社会保障残疾保险计划获得全部残疾收入支持；或（4）包括上述 3 个指标中的任何一个的综合指标。
结果
COHE 患者长期工作残疾的风险降低了 30%（优势比=0.70，P=0.02）。干预组和对照组在 8 年的随访期间，残疾率（每 1000 人残疾天数）分别为 49476 残疾天和 75832 残疾天。
结论
通过重新组织职业保健服务的提供，可以预防长期工作残疾，以支持受伤后头 3 个月内的有效二级预防。这种干预措施可能对扭转国家劳动力参与率逐渐恶化的趋势产生有益的影响。
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