CATHOLIC HEALTH INITIATIVES
By BETSY TAYLOR
Bryan Isaacson, a boiler engineer at a Tacoma, Wash.-lumber mill, was using an industrial drill on a piece of metal when the bit caught, jerking his arm around and tearing his rotator cuff.
Franciscan Health System's Port Clinic near the docks in Tacoma, Wash.
He visited Franciscan Health System's Port Clinic located on the docks in the busy port city that same May day, where it was quickly determined he needed an off-site MRI, followed by surgery, recovery and therapy to help his shoulder heal.
Patricia Garcia, a physician assistant in occupational medicine at the clinic, helped Isaacson through the process. Providers promptly filed a claim about his injury with the state, outlined his next medical steps and communicated with his employer. They determined Isaacson could first receive wage replacement income while recuperating away from work and then be assigned to light physical tasks back on the job, such as visually inspecting machines and driving to pick up parts.
The quick response to filing Isaacson's claim and efforts to get Isaacson back to work that he is medically capable of doing as he heals has been a help to him. He received wage replacement income more quickly than he expected, and said he appreciated the coordination between clinicians and his employer to get him back on the job. "I enjoy work, and when I'm not working, I can't stand it," Isaacson said. He said he appreciated that he didn't have to remain idle and off work with too much time to think about his injury. "It's a vicious cycle," he said.
Best practices
Franciscan Health System, working with the Washington State Department of Labor & Industries — which serves as the administrator of the state workers' compensation system — is leading a new center in western Washington to improve injured workers' outcomes and reduce work-related disability. This new center is a coalition of health care organizations whose health care providers, including staff at the Port Clinic, commit to using best practices in occupational medicine.
The new center is one of six in Washington. The centers aim to expand access to occupational health expertise to better protect the health and welfare of workers, improve health care delivery and provide better outcomes for injured workers. This past summer, Washington's Department of Labor & Industries renewed its contracts with four existing Centers of Occupational Health and Education, and announced two new centers, including the one led by Franciscan. Another sponsored through Seattle-based Group Health Cooperative will provide services to injured workers at 11 clinics also in western Washington and one in Spokane. The state's goal is that all injured workers have access to one of the centers by 2015.
Reconditioning vs. deconditioning
A state-funded pilot program creating the first two centers began in 2002. It provided financial incentives to encourage health care providers to adopt occupational health best practices and provided support to improve care coordination.
Dr. Paul Darby, the medical director for the new Franciscan Health System-led Center of Occupational Health & Education of Western Washington, explained how work-related injuries used to be handled, and the shift in Washington state. "What typically would happen is a patient would come in with a work injury, file a (workers' compensation) claim and more often than not, the (health care) provider would take them off work for a week or two just on the provider's own initiative, thinking that rest would be helpful, or the patient would actually ask: 'Doc, can you give me a week off so I can rest?' And that was done as a matter of course."
But in the field of occupational medicine, clinicians found this wasn't always the best approach for patients, Darby said. Taking people off work led "to a rise in long-term permanent injury, a rise in people not going back to work," he explained. While sometimes workers need to stay off work as they heal, if an injured worker stays home for too long, the person may become deconditioned and depressed. Darby said an injured person may develop a "disability conviction," which is an outlook that the person cannot do anything productive, or contribute to their welfare or society's welfare because the person feels "disabled."
Hopping to
The centers educate health care providers to use best practices with injured workers they treat. These include submitting a report of the accident to the state within 48 hours of seeing a patient. The provider also completes an activity prescription form at the intake visit (and when a patient's status changes), which outlines the specific work and activities a patient can do without risk of reinjury. The provider communicates with the injured employee and the employer about when the employee can return to work and what jobs the employee is able to perform during a recovery period. Darby explained that employers often are willing to modify job duties while a worker heals from an injury.
"After being off work for three months, the probability that any particular employee will go back to work of any type is only 50 percent," said Darby, citing data based on a major employer's compensation claims in the mid-1990s. However, Washington has found that its approach, using the occupational health centers to encourage the best practices, reduces disability days.
In the December 2011 issue of Medical Care, the American Public Health Association journal, seven researchers from Labor & Industries, the College of Public Health at Ohio State University, and the University of Washington's Department of Environmental and Occupational Health Sciences analyzed more than 100,000 workers' compensation claims filed from July 2001 through June 2007. The claims included those filed through the centers and others not filed through the centers. The study found that injured workers treated by health care providers operating under the occupational medicine best practices had 19.7 percent fewer disability days than other injured workers, and a reduction in total disability and medical costs of $510 per claim.
Diana Drylie, occupational health services manager for Labor & Industries, said the approach has drawn interest from other states and other countries. "It's a collaboration," she said, and one that workers like for its efforts to help them recover from injury or illness. It puts them back to work as they're able and returns them to full pay. "It has to be the insurer, the provider, businesses and labor all working together and agreeing on what we want to do and how we want to do it," she said.