ACOEM's New Medical Guidelines for Workers' Comp

Friday, September 17, 2010 | 0

By Kurt Hegmann, M.D. and Robert J. Barth, Ph.D.

In the fall of 2010, the American College of Occupational and Environmental Medicine (ACOEM) will release the Third Edition of its Occupational Medicine Practice Guidelines: Evaluation and Management of Common Health Problems and Functional Recovery in Workers. These Guidelines  have the goal of encouraging scientifically credible health care, especially for workers’ compensation. Previous editions have achieved international prominence, including having been officially adopted into the workers’ compensation regulations of California, Nevada, and New York.

In developing these Guidelines, ACOEM has placed an emphasis on all of the following considerations:

• Basing recommendations on rigorously researched scientific fact (rather than on tradition, authority, or prevailing practice patterns). This scientifically rigorous approach has been adopted in response to rising expectations for quality of care; increased expectations for good outcomes and medical safety; the need to stop over-utilization and to curb unproductive and even harmful health care; and the need to reflect advances in medicine based on the research that has the best scientific design.
• The quality of scientific research varies widely, and depends on many factors, including the size of patient populations studied, the rigor of quality controls placed on a study, its duration, and its data collection methods. The Guidelines strive to incorporate the most credible scientific evidence to guide clinicians toward the best, least dangerous health care.
• High quality research is not available for every aspect of clinical care. Therefore, the Guidelines utilize a system of placing value on the evidence that is available, thereby highlighting any shortcomings in the scientific basis for any recommendations.
• The process of compiling the Guidelines is driven primarily by the question: “What is the quality of the scientific evidence available, and what does the highest quality science indicate?”
  

• An approach to guideline development that is built upon the primary tenet of medicine – “first, do no harm.” That tenet calls for a conservative approach to health care.

• Promoting the best medical care for workers, and the best health outcomes (the emphasis on conservative and scientifically credible care is expected to lead to recommendations that promote the most reliably helpful health care).
• Promoting rapid utilization of the best care (it is hoped that a standardized set of scientifically supported recommendations will make treatment planning and benefit approval easier and more efficient).
• Promoting cost-effectiveness / lowering cost-burdens (scientific findings have repeatedly indicated that scientifically validated health care is actually less expensive than non-credible care).
• Reducing variation in health care and outcomes (e.g., historically, there have been wide geographical variations in the extent to which various treatment options are utilized, and associated variations in health outcomes.  Such variation highlights the need for standardized guidelines.)
• Helping clinicians diagnose more effectively (as well as treat more effectively). In this regard, the Guidelines provide scientifically validated recommendations for diagnostic protocols and testing, as well as for treatment.
• Returning to work and staying at work (RTW/SAW) are in the best interest of the patient. Being away from work reliably leads to a worse health outcome, as well as being detrimental to the patient in terms of finances and well-being. In addition to benefiting the patient, a RTW/SAW focus helps to keep workers’ compensation costs down and facilitates efficient management of claims. This focus requires expertise in restoration of job-related function to the patient. Unfortunately, most clinicians are not trained to focus on functional recovery. The Guidelines strive to provide consistent, scientifically validated methods for restoring function, and for a safe and timely return to work.
• Strong, transparent methodology. The Guidelines formulation process started with a transparent and rigorous methodology, which adheres to general principles of credible science.
• Thorough review of scientific literature. The Guidelines strive to offer a well-documented review of all available scientific literature and a subsequent grading system that accurately judges the veracity and credibility of each study. This involves an attempt to consider the complete body of evidence related to various treatments – not simply evidence in support of targeted or preferred treatments.