QUALITY-BASED PROTOCOL FOR MANAGEMENT OF MUSCULOSKELETAL INJURIES - A10-YEAR PROSPECTIVE OUTCOME STUDY

Musculoskeletal injuries in the workplace are recognized as a major he alth and economic problem; however, little has been done to develop st rategies that emphasize both quality and cost control. The purpose of this ten-year prospective investigation was to evaluate the use of qua lity-based standardized diagnostic and treatment protocols as part of an unbiased injury surveillance system. The program was evaluated in a public utility company with more than 5300 employees, and resulted in a measurable and long-term improvement in all outcome parameters meas ured: (1) The number of days lost from work and the number of new inju ries reported fell by 55 and 51%, respectively. (2) The average time l ost per injury dropped by 40%. (3) The number of surgeries performed d ecreased by 67%, and the operative success rate increased dramatically . (4) Finally, as an added benefit, there was a 60% reduction in expen ditures for lost time and replacement wages, resulting in a cumulative ten-year savings of more than 4.1 million dollars. The program accomp lished the goal of ensuring quality care in a prospective concurrent f ashion. As an additional benefit, the program also reduced unjustified lost time and compensation costs through early functional return, eff icient use of diagnostic studies, and avoidance of surgery whenever po ssible. Future emphasis on health-care delivery in the workers' compen sation setting should concentrate on high-quality medical care, which will, in turn, lead to secondary cost savings.