Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Caulfield Pain Management and Research Centre, Caulfield Hospital, Caulfield, Victoria, Australia.
John Walsh Centre for Rehabilitation Research, Kolling Institute, Faculty of Medicine and Health, University of Sydney.
Injury. 2020 Oct;51(10):2199-2208. doi: 10.1016/j.injury.2020.07.002. Epub 2020 Jul 3.
People who sustain road traffic injuries often have poor health outcomes. While outcomes are often worse in people with a compensation claim, especially in fault-based schemes versus no-fault schemes, few studies have directly compared outcomes across scheme types.
To compare health and work outcomes between people who had no compensation claim, a fault-based claim, or "no-fault" transport or workers compensation claim after hospitalisation for a road traffic injury.
Participants aged >=18 years admitted to hospital in New South Wales or Victoria for >24 hours were recruited in two separate prospective cohort studies (N=1,034). People who died or sustained minor or very severe injuries were excluded. Groups included Compulsory Third Party (fault-based, n=128), no-fault Transport Accident Commission (TAC; n=454) and workers compensation claimants (n=73), or no claim (n=226). Outcomes at six, 12- and 24-months post-injury included health [SF-12 Mental Component Score (MCS) and Physical Component Score (PCS)], and return to work for people working pre-injury. Multivariable mixed effects linear and logistic regressions, adjusting for demographic and injury covariates, examined differences in health and work outcomes between claimant groups, with fixed effects of time and random effects of participant ID.
Health status was better in people with a no-fault TAC claim (MCS: m=50.62, 95%CI:49.62,51.62; PCS: m=40.49, 95%CI:39.46,41.52) or no claim (MCS: m=49.99, 95%CI:49.62,51.62; PCS: m=44.36, 95%CI:43.00,45.72), than people with a workers compensation (MCS: m=45.73, 95%CI:43.46,48.00; PCS: m=38.94, 95%CI:36.59,41.30) or fault-based CTP claim (MCS: m=41.34, 95%CI:39.54,43.13; PCS: m=35.64, 95%CI:33.78,37.49). Relative to fault-based CTP claimants, the odds of returning to work were higher for people with no claim (AOR=6.84, 95%CI:1.73,27.05) but did not differ for no-fault TAC (AOR=1.21, 95%CI:0.36,4.05) or workers compensation claimants (AOR=0.83,95%CI: 0.17,3.99). While people with a fault-based CTP claim had poorer mental and physical health and return to work after injury, they showed greater improvements in mental health, and similar levels of improvement in physical health and work participation over time to the other groups.
The patterns of health and work across scheme types provide important insights against which we can contrast the effects of future scheme designs on client outcomes.
道路交通事故受伤者的健康状况往往较差。虽然在有赔偿要求的人群中，尤其是在过错制方案与无过错制方案中，结果往往更差，但很少有研究直接比较不同方案类型的结果。
比较因道路交通事故住院后无赔偿要求、过错赔偿要求或“无过错”交通或工人赔偿要求的人群的健康和工作结果。
在新南威尔士州或维多利亚州住院超过 24 小时的年龄>=18 岁的参与者在两项独立的前瞻性队列研究中被招募（N=1,034）。排除死亡或受伤轻微或非常严重的人。包括强制性第三方（过错制，n=128）、无过错交通事故委员会（TAC；n=454）和工人赔偿索赔者（n=73）或无索赔（n=226）的人群。受伤后 6、12 和 24 个月的结果包括健康[SF-12 心理成分评分（MCS）和身体成分评分（PCS）]和受伤前工作的人重返工作岗位。多变量混合效应线性和逻辑回归，调整人口统计学和损伤协变量，检查索赔人群之间健康和工作结果的差异，具有时间的固定效应和参与者 ID 的随机效应。
与工人赔偿（MCS：m=45.73，95%CI：43.46，48.00；PCS：m=38.94，95%CI：36.59，41.30）或过错制 CTP 索赔者（MCS：m=41.34，95%CI：39.54，43.13；PCS：m=35.64，95%CI：33.78，37.49）相比，TAC 无过错索赔者（MCS：m=50.62，95%CI：49.62，51.62；PCS：m=40.49，95%CI：39.46，41.52）或无索赔者（MCS：m=49.99，95%CI：49.62，51.62；PCS：m=44.36，95%CI：43.00，45.72）的健康状况更好。与过错制 CTP 索赔者相比，无索赔者重返工作岗位的可能性更高（AOR=6.84，95%CI：1.73，27.05），但 TAC 无过错索赔者（AOR=1.21，95%CI：0.36，4.05）或工人赔偿索赔者（AOR=0.83，95%CI：0.17，3.99）并无差异。虽然过错制 CTP 索赔者在受伤后心理健康和重返工作岗位的情况较差，但随着时间的推移，他们在心理健康方面的改善更大，在身体康复和工作参与方面的改善水平与其他群体相似。
不同方案类型的健康和工作模式提供了重要的见解，我们可以用这些见解来对比未来方案设计对客户结果的影响。
