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Evaluating Clinical Practice Guidelines Based on Their Association with Return to Work in Administrative Claims Data
Eric T Roberts1, Eva H DuGoff2, Sara E Heins3
1Department of Health Care Policy, Harvard Medical School, Boston, MA.
Health Services Research
|September 15, 2015
Summary
Non-adherence to clinical practice guidelines (CPGs) showed inconsistent associations with return to work (RTW) after workplace injuries. Some guideline-discordant care correlated with slower RTW, while less care predicted faster recovery.
Area of Science:
- Occupational Health
- Health Services Research
- Clinical Epidemiology
Background:
- Clinical practice guidelines (CPGs) aim to standardize care for workplace injuries.
- Understanding factors influencing return to work (RTW) is crucial for patient recovery and economic impact.
Purpose of the Study:
- To investigate the association between adherence to CPGs and the time to RTW for patients with workplace injuries.
- To determine if deviations from CPGs impact RTW timelines.
Main Methods:
- Secondary analysis of medical billing and disability data for 148,199 shoulder and back injuries.
- Cox proportional hazard regression used to assess the link between guideline-discordant care and RTW.
- Robustness checks performed for omitted confounding variables.
Main Results:
- Guideline-discordant care showed varied associations with RTW, with some linked to slower recovery.
- Receiving less care than recommended and early care receipt were associated with faster RTW.
- Excessive physical therapy, bracing, and injections correlated with delayed RTW.
Conclusions:
- A consistent relationship between CPG adherence and RTW was not established.
- Observational data presents challenges in measuring the CPG-RTW association due to unobserved confounding variables.
- CPGs with stronger empirical support from trials may demonstrate clearer links to health outcomes.
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