Putting Patient-Reported Functional Health Status Instruments into Occupational Health Services Practice: A Controlled Trial of the Worker-Based Outcomes Assessment System (WBOAS).

摘要

The Intervention tested the effects of incorporating the Worker-based outcomes assessment system (WBOAS) into Occupational health services (OHS) practice at Fletcher Allen Health Care (FARC, Burlington VT). The WBOAS is a Work-related musculoskeletal disorders (WRMSD) treatment and secondary prevention improvement protocol designed to inform treatment by putting same-session (a) touchscreen-generated patient-reported outcomes trends graphics (contrasting initial, previous, and current visits on Physical and Behavioral health status, Pain symptoms and related attitudes, and Work role limitations) and (b) trends-based auxiliary treatment referral guidelines (for work site evaluation and redesign and for behavioral health care) into the hands of physical and occupational therapists (PT/OTs) and their patients. The study employed a prospective, parallel cohort, external control design--the strongest controlled trial frame possible given the impossibility, when the provider is integral to the intervention, of randomizing subjects same-site to test and control arms--and featured one Test and two Control site clinics. Subjects were F ARC employees with WRMSDs including strain/sprain, cumulative trauma (upper extremity, lower extremity, lower back), tendonitis, and carpal tunnel syndrome. Test site PT/OTs delivered Standard plus (WBOAS) care, i.e. Standard care augmented by same- session outcomes trends graphics (to set and re-set injury treatment and return-to-work goals) and trends-based referral guidelines (to initiate auxiliary worksite evaluation and redesign and/or behavioral health care). Control site PT/OTs delivered Standard care alone. Primary predictions were that, controlling for covariates such as patient-reported demographics, co-morbidities, injury severity, physical and behavioral health, work limitations, psychosocial profile, and work conditions, Test site subjects would exhibit higher rates of (I) clinical outcome.: treatment period Injury recovery (IR) and post-treatment period Re-injury avoidance (RA), (2) functional outcome: treatment period Return-to work (RTW) and post-treatment period Stay-at-work (SA W) success, and (3) Process outcome: post-treatment period evaluated Provider performance (PP) and Overall satisfaction (OS) with care, at no lower rate of (4) cost outcome: treatment or post-treatment period Cost-adjusted outcome (CaO). Secondary Predictions were that Test site subjects likewise would exhibit higher rates of (5) auxiliary care: treatment period referrals to Worksite evaluation and redesign (WSE, WSR) and to Behavioral health care (BHC).