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Case Study - Concord General Hospital, Sydney Jul 27th, 2014
grphicEmployers, insurers and workers’ groups have expressed a growing interest in return-to-work (RTW) interventions after injury or illness. As disability management is increasingly being integrated into employers’ and insurers’ mandates, there has been a focus on workplace-based RTW interventions.

Some injuries take longer to heal due to the nature of the injury and management. We have generally found three types of disability groups have come to light over the years.

The first is the short duration claim where the patient has a well-defined acute episode (i.e. flu, strain or sprain). These cases will return to work often with minimal intervention.

The second (and often most difficult) group represents the patients with sub-acute or progressive diseases or injuries. This population often needs help with ensuring the medical interventions are enough to progress back to health. They may need help in finding their way through the health care maze and psychosocial issues can be a major barrier to RTW.

The third group are those with terminal or debilitating diseases, such as Chronic Pain, Cancer or Multiple Sclerosis, that may eventually prevent return to work.


Concord General Hospital in Sydney is a self insurer, who in 2003-4 found themselves with a huge number of open claims (~300), and a spate of very difficult cases who went on to have chronic pain syndromes. The organisation felt they were failing injured workers and that something needed to change.

The initial step was to change their existing rehabilitation policy. They developed a database to track workers from notification to finalisation. They developed resources such as suitable duties lists for a majority of departments, and increased the role of managers in the rehabilitation process. They also took steps to increase the level of communication by having regular meetings between supervisors and managers of major departments to review claims and provide comparative data.

The consensus was that the first 4 weeks after an incident/injury was the answer, – after that you start to lose control! They instigated a rapid assessment and early intervention process, which included an assessment psychosocial risk (i.e. Yellow Flags). The idea was that high risk individuals needed to be identified in the first week/s. Nothing different needed to be done; only it needed to be done earlier. It was also important that the GP was in control of the whole process through consultation and approval.

The first question to answer was; “can these high risk individuals be found early, and if so, do they actually costs more?” Injured workers filled out a psychosocial risk questionnaire and were followed through until they returned to work with a final certificate. Each injured worker was categorised and claim costs were reviewed and compared across the high, medium and low risk groups.

The answer to Question 1 appeared to be a resounding YES! (see image)


The next question was then “what can be done about it?” Concord’s approach was to; (a) activate an independent Vocational Rehab Provider within first 2 weeks; (b) complete an independent psychological assessment, and subsequent treatment within 2 weeks; (c) complete an independent Medical Consultation within 4 weeks; (d) have the file reviewed if not returned to work within 4-6 weeks.

The emphasise of the above approach did not appear to do anything different to what usually happens, it simply did it much earlier in the management process.

The results were quite impressive; primarily there was a 25% reduction in the costs of each ‘high risk’ claim. This equated to a $4331.00 saving per high risk claim. (see image)



Implications:

There is a significant difference between the 20% in the “high risk” category and the other 80% who manage pretty well with ‘usual care’.

Psychosocial risk factors (i.e. ‘Yellow Flags’) predict the cost of a workers compensation claim within 48 hours regardless of what or where the injury occurs.

The provision of an early and aggressive assessment and intervention, lead by a trusted GP can reduce costs in high risk claims.


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