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Innovations in Occupational Health Care Delivery can Prevent Entry into Permanent Disability: 8-Year Follow-up of the Washington State Centers for Occupational Health and Education

Wickizer, Thomas M., PhD*; Franklin, Gary M., MD†,‡; Fulton-Kehoe, Deborah, PhD§

doi: 10.1097/MLR.0000000000000991
Original Article: PDF Only

Background: Long-term work disability is known to have an adverse effect on the nation’s labor force participation rate. To reduce long-term work disability, the Washington State Department of Labor and Industries established a quality improvement initiative that created 2 pilot Centers of Occupational Health and Education (COHE).

Objectives: To document the level of work disability in a sample of injured workers with musculoskeletal injuries and to examine (8-y) work disability outcomes associated with the COHE health care model.

Research Design: Prospective nonrandomized intervention study with nonequivalent comparison group using difference-in-difference regression models.

Subjects: Intervention group represents 18,790 workers with musculoskeletal injuries treated by COHE providers. Comparison group represents 20,992 workers with similar injuries treated within the COHE catchment area by non-COHE providers.

Measures: Long-term disability outcomes include: (1) on disability 5 years after injury; (2) received a state pension for total permanent disability; (3) received total disability income support through the Social Security Disability Insurance program; or (4) a combined measure including any one of the 3 prior measures.

Results: COHE patients had a 30% reduction in the risk of experiencing long-term work disability (odds ratio=0.70, P=0.02). The disability rate (disability days per 1000 persons) over the 8-year follow-up for the intervention and comparison groups, respectively, was 49,476 disability days and 75,832 disability days.

Conclusions: Preventing long-term work disability is possible by reorganizing the delivery of occupational health care to support effective secondary prevention in the first 3 months following injury. Such interventions may have promising beneficial effects on reversing the nation’s progressively worsening labor force participation rate.

This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

*Division of Health Services and Management and Policy, College of Public Health, The Ohio State University, Columbus, OH

Departments of Environmental and Occupational Health Sciences, Neurology and Health Services, University of Washington, Seattle

Washington State Department of Labor and Industries, Olympia

§Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA

The authors declare no conflict of interest.

Reprints: Thomas M. Wickizer, PhD, College of Public Health, 202 Cunz Hall, The Ohio State University, 1843 Neil Avenue, Columbus, OH 43210. E-mail:

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