The effects of a medical care utilization review program on back and neck injury claims

A number of quality-based evaluation and treatment protocols have been developed and marketed for the management of work-related musculoskeletal problems. Yet, little is known about their effectiveness in improving patient outcomes. We evaluated one such approach adopted by the Department of Labor and Industries, which insures approximately two-thirds of the non-federal workforce in Washington State. The outcomes of back and neck injury claims (primarily sprains and strains) filed in the 2 months after the program was fully operational were compared with two comparable groups of claims from the same base population filed before the program's availability. There were no statistically significant differences between groups in the number of days of work loss, medical costs, and permanent partial disability awards granted during the 2 years after injury. The quality-based program used as an adjunct to claims management failed to improve outcomes.