—Sir William Osler, M.D., 1949-1919
By Karen O’Hara
Assume you are 57 years old, a little overweight and have non-specific low back pain you believe is exacerbated by your job. Your hobbies are bowling and Woodworking.
Scenario 1:
You take a sick day and go see your primary care doctor. He recommends a non-steroidal anti-inflammatory medication and stretching exercises and waits to see how you do. You cut back on your hobbies, lose some weight, and keep working. Eventually, you get better.
Scenario 2:
You complain to your supervisor about your back pain and file a workers’ compensation claim. An occupational medicine physician examines you and recommends work restrictions, an NSAID, exercise, and physical therapy. You go through the course of treatment while on temporary alternative duty, enroll in a weight-loss program, take a leave from the bowling team, adjust your woodworking station, and gradually return to full function.
Scenario 3:
Your back is “killing” you. You despise your supervisor, are estranged from your spouse, and are embroiled in a disagreement with your siblings about how to handle your mother’s serious illness. You are depressed because you can’t enjoy your hobbies. You follow the same course of treatment as in Scenario 2. Your pain does not diminish instead you feel debilitated by it.
You undergo a series of diagnostic tests that rule out a specific reason for your pain. Four months later you are on the verge of transitioning from an acute state to a chronic one, a state in which you are statistically more likely to end up on narcotic medications, hire an attorney, and be designated as permanently partially disabled –generating considerable monetary and societal costs along the way.
The Question: Would the outcome be different in the third scenario if you were identified as “at risk” during the diagnostic process and your treatment plan addressed not just physical but functional and psycho-social aspects of your Situation?
RAND, Kaiser Undertake Carpal Tunnel Study
Kaiser Permanente and RAND Corporation will be conducting a five-year outcome study involving up to 800 patients with a new diagnosis of carpal tunnel syndrome (CTS), a common and costly work-related Complaint.
Based in Santa Monica, CA, RAND’s mission is to help improve policy and decision-making through research and analysis. According to Dr. Doug Benner of Kaiser Permanente, study subjects will answer, and 18 months later repeat, an extensive questionnaire to assess and develop responses to such key issues as:
- care quality in comparison to established metrics;
- progress toward return to function;
- factors that make a measurable difference in outcomes; and
- economic impacts on individuals, employers, and insurers with respect to earnings, benefit costs, and productivity loss.
The phone survey will incorporate dozens of quality indicators identified in a joint project involving Kaiser Permanente, RAND, and the California State Compensation Insurance Fund. It also will feature critical-to-quality (CTQ) patient satisfaction monitoring and bench-marking and SF-12 surveys. (The SF-12v2 is a 12-item subset of an SF-36v2TM survey that measures eight domains of health status. Refer to QualityMetric, Inc.: https://www.qualitymetric.com/health-surveys/the-sf-12v2-pro-health-survey/.)
“In workers’ compensation, with the exception of low back pain, we are so far behind the rest of health care in terms of data collection and analysis,” Dr. Benner said. “This project will help us identify areas where we can improve” and share findings related to the diagnosis and treatment of carpal tunnel syndrome.”
