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An Evidence-Based Care Model for Workers With Concussion

Thompson, Aaron MD, MPH; Chechulin, Yuriy MD, MPH; Bain, Donna PhD; Bayley, Mark MD

The Journal of Head Trauma Rehabilitation: September/October 2019 - Volume 34 - Issue 5 - p E10–E16
doi: 10.1097/HTR.0000000000000466
Original Articles
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Objective: To evaluate the impact of an evidence-based assessment program for people with workers' compensation claims for concussion on healthcare utilization and duration of lost time from work.

Setting: An assessment program for people with a work-related concussion was introduced to provide physician assessment focused on education and appropriate triage.

Participants: A total of 3865 people with accepted workers' compensation claims for concussion with dates of injury between January 1, 2014, and February 28, 2017.

Design: A quasiexperimental pre-/poststudy of healthcare utilization (measured by healthcare costs) and duration of time off work (measured by loss of earnings benefits) in a cohort of people with workers' compensation claims for concussion in the period prior to and following introduction of a new assessment program. Administrative data were retrospectively analyzed to compare outcomes in patients from the preassessment program implementation period to those in the postimplementation period.

Results: The assessment program resulted in reduced healthcare utilization reflected by a 14.4% (95% confidence interval, −28.7% to −0.8%) decrease in healthcare costs. The greatest decrease in healthcare costs was for assessment services (−27.9%) followed by diagnostic services (−25.7%). There was no significant difference in time off work as measured by loss-of-earnings benefits.

Conclusion: A care model for people with a work-related concussion involving an evidence-based assessment by a single physician focused on patient education resulted in significantly decreased healthcare utilization without increasing duration of time off work.

Faculty of Medicine, University of Toronto, Ontario, Canada (Drs Thompson and Bayley); and Workplace Safety and Insurance Board, Toronto, Ontario, Canada (Drs Thompson and Chechulin).

Corresponding Author: Aaron Thompson, MD, MPH, St Michael's Hospital, 30 Bond St, 4th Floor, Shuter Wing, Toronto, ON M5B 1W8, Canada (aaron.thompson@utoronto.ca).

The authors declare no conflicts of interest.

Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.