Thomas M. Wickizer

Alcohol Interventions for Trauma Patients Treated in Emergency Departments and Hospitals: A Cost Benefit Analysis

Objective:To determine if brief alcohol interventions in trauma centers reduce health care costs. Summary Background Data:Alcohol-use disorders are the leading cause of injury. Brief interventions in trauma patients reduce subsequent alcohol intake and injury recidivism but have not yet been widely implemented. Methods:This was a cost-benefit analysis. The study population consisted of injured patients treated in an emergency department or admitted to a hospital. The analysis was restricted to direct injury-related medical costs only so that it would be most meaningful to hospitals, insurers, and government agencies responsible for health care costs. Underlying assumptions used to arrive at future benefits, including costs, injury rates, and intervention effectiveness, were derived from published nationwide databases, epidemiologic, and clinical trial data. Model parameters were examined with 1-way sensitivity analyses, and the cost-benefit ratio was calculated. Monte Carlo analysis was used to determine the strategy-selection confidence intervals. Results:An estimated 27% of all injured adult patients are candidates for a brief alcohol intervention. The net cost savings of the intervention was

Early opioid prescription and subsequent disability among workers with back injuries: the Disability Risk Identification Study Cohort.

89 per patient screened, or

Worker recovery expectations and fear-avoidance predict work disability in a population-based workers' compensation back pain sample

330 for each patient offered an intervention. The benefit in reduced health expenditures resulted in savings of

Completion rates of clients discharged from drug and alcohol treatment programs in Washington State

3.81 for every

The association between pain and disability

1.00 spent on screening and intervention. This finding was robust to various assumptions regarding probability of accepting an intervention, cost of screening and intervention, and risk of injury recidivism. Monte Carlo simulations found that offering a brief intervention would save health care costs in 91.5% of simulated runs. If interventions were routinely offered to eligible injured adult patients nationwide, the potential net savings could approach

ISSLS Prize Winner: Early Predictors of Chronic Work Disability : A Prospective, Population-Based Study of Workers With Back Injuries

1.82 billion annually. Conclusions:Screening and brief intervention for alcohol problems in trauma patients is cost-effective and should be routinely implemented.

Lumbar fusion outcomes in Washington State workers' compensation.

Study Design. Prospective, population-based cohort study. Objective. To examine whether prescription of opioids within 6 weeks of low back injury is associated with work disability at 1 year. Summary of Background Data. Factors related to early medical treatment have been little investigated as possible risk factors for development of long-term work disability among workers with back injuries. We have previously shown that about 1 of 3 of workers receive an opioid prescription early after a low back injury, and a recent study suggested that such prescriptions may increase risk for subsequent disability. Methods. We analyzed detailed data reflecting paid bills for opioids prescribed within 6 weeks of the first medical visit for a back injury among 1843 workers with lost work-time claims. Additional baseline measures included an injury severity rating from medical records, and demographic, psychosocial, pain, function, smoking, and alcohol measures from a worker survey conducted 18 days (median) after receipt of the back injury claim. Computerized database records of work disability 1 year after claim submission were obtained for the primary outcome measure. Results. Nearly 14% (254 of 1843) of the sample were receiving work disability compensation at 1 year. More than one-third of the workers (630 of 1843) received an opioid prescription within 6 weeks, and 50.7% of these (319 of 630) were received at the first medical visit. After adjustment for pain, function, injury severity, and other baseline covariates, receipt of opioids for more than 7 days (odds ratio = 2.2; 95% confidence interval, 1.5–3.1) and receipt of more than 1 opioid prescription were associated significantly with work disability at 1 year. Conclusion. Prescription of opioids for more than 7 days for workers with acute back injuries is a risk factor for long-term disability. Further research is needed to elucidate this association.

Comparison of the Roland–morris Disability Questionnaire and Generic Health Status Measures: A Population-based Study of Workers’ Compensation Back Injury Claimants

Study Design. Prospective, population-based cohort study. Objectives. To examine whether worker demographic, pain, disability, and psychosocial variables, assessed soon after work-related back pain disability onset, predict 6-month work disability. Summary of Background Data. Greater age, pain, and physical disability, and certain psychosocial characteristics may be risk factors for prolonged back pain-related work disability, although many studies have been small, findings have been inconsistent, and some psychosocial variables have not been examined prospectively. Methods. Workers (N = 1,068) completed telephone interviews assessing demographic, pain, disability, and psychosocial variables 18 days (median) after submitting Workers’ Compensation back pain disability claims. Administrative measures of work disability 6 months after claim submission were obtained. Results. At 6 months, 196 workers (18.4%) were receiving work disability compensation. Age, race, education, and baseline pain and disability were significant predictors of 6-month disability. Adjusting for baseline demographics, pain, disability, and other psychosocial variables, high work fear-avoidance (odds ratio, 4.6; 95% confidence interval, 1.6–13.7) and very low recovery expectations (odds ratio, 3.1, 95% confidence interval, 1.5–6.5) were significant independent predictors. Conclusions. Among individuals with acute work-related back pain, high pain and disability, low recovery expectations, and fears that work may increase pain or cause harm are risk factors for chronic work disability.

DO TREATMENT RESTRICTIONS IMPOSED BY UTILIZATION MANAGEMENT INCREASE THE LIKELIHOOD OF READMISSION FOR PSYCHIATRIC PATIENTS

OBJECTIVES The primary goal of this study was to analyze completion rates of clients in drug and alcohol abuse treatment programs in Washington State and to assess the factors associated with treatment completion. A secondary goal was to examine the utility of a state information system as a source of evaluative data. METHODS Analyses were conducted of 5827 client records contained in the Washington State Substance Abuse Monitoring System, representing a census of public clients discharged during the last quarter of 1990 from all state-funded alcohol and drug treatment programs in four treatment modalities. Logistic regression was performed to determine the independent predictors of treatment completion. RESULTS Completion rates were highest for intensive inpatient alcohol treatment (75%) and lowest for intensive outpatient drug programs (18%). Factors associated with treatment completion included screening at a referral assessment center, education, age, ethnicity, and existence of a secondary drug problem. CONCLUSIONS The fit between clients and treatment programs may be an important factor explaining why some clients complete treatment and others drop out. State client information systems are an important source of data for analyzing treatment completion and other outcomes.

Activating communities for health promotion : a process evaluation method

&NA; A clearer understanding of how pain intensity relates to disability could have important implications for pain treatment goals and definitions of treatment success. The objectives of this study were to determine the optimal pain intensity rating (0–10 scale) cutpoints for discriminating disability levels among individuals with work‐related carpal tunnel syndrome (CTS) and low back (LB) injuries, whether these cutpoints differed for these conditions and for different disability measures, and whether the relationship between pain intensity and disability was linear in each injury group. Approximately 3 weeks after filing work injury claims, 2183 workers (1059 CTS; 1124 LB) who still had pain completed pain and disability measures. In the LB group, pain intensity rating categories of 1–4, 5–6, and 7–10 optimally discriminated disability levels for all four disability measures examined. In the CTS group, no pain intensity rating categorization scheme proved superior across all disability measures. For all disability measures examined, the relationship between pain intensity and disability level was linear in the CTS group, but nonlinear in the LB group. Among study participants with work‐related back injuries, when pain level was 1–4, a decrease in pain of more than 1‐point corresponded to clinically meaningful improvement in functioning, but when pain was rated as 5–10, a 2‐point decrease was necessary for clinically meaningful improvement in functioning. The findings indicate that classifying numerical pain ratings into categories corresponding to levels of disability may be useful in establishing treatment goals, but that classification schemes must be validated separately for different pain conditions.