Rand Report Outlines Pros, Cons of ODG

Friday, September 15, 2017 | 0

Nonprofit research organization Rand Corp. evaluated the Official Disability Guidelines and gave ODG a mainly favorable review, although researchers also questioned the methods used to develop the workers’ comp medical treatment guidelines.

Phil LeFevre

“Strengths include an expansive scope, clearly written recommendations, frequent updating, regular and extensive input from clinicians and a well-designed tool for applying recommendations,” the Rand researchers said in a new report.

A panel of eight expert clinicians reviewed ODG as part of Rand's evaluation and found that material in 41 of 47 medical topics was clinically valid, “reflecting a relatively high degree of confidence in its clinical acceptability,” Rand said. Those topics include chapters on low back pain; shoulder injuries; carpal tunnel syndrome; forearm, wrist, and hand injuries; and fitness for duty. The validity of the remaining six topics was “uncertain.”

On the other hand, the report identified weaknesses, including inadequate information about the selection process for medical evidence on which the guidelines are based. There is also a lack of documentation to show that the teams that developed ODG chapters were free of conflicts of interest, Rand said.

ODG is published by Work Loss Data Institute, a private company that in January was purchased by Hearst and is now part of MCG Health within the Hearst Health Network. ODG is used as a workers’ comp medical treatment guideline in states including Tennessee, Ohio and Texas.

Other states, such as California, have adopted a competing guideline, the American College of Occupational and Environmental Medicine guidelines published by Reed Group as the MD Guidelines.

The Rand report on ODG was commissioned by Insurance and Care New South Wales, or Icare, in Australia. The report was released this summer, followed by WLDI's announcement in August that Icare NSW had adopted ODG to support medical treatment decisions. Icare NSW is the New South Wales government's insurance and care services provider.

Icare asked Rand to evaluate only ODG, and not other guidelines, said Rand researcher Dr. Teryl Nuckols, the report’s lead author.

The new report follows a Rand Corp. evaluation in 2004 of five sets of workers’ comp treatment guidelines for the California Department of Industrial Relations. Since then, ODG has become the most widely used guideline for utilization review in workers’ comp, Rand said, but has not been re-evaluated.

Phil LeFevre, managing director for ODG from MCG Health, said the new Rand report was “absolutely” good news for ODG.

Scores from one assessment, A Measurement Tool to Assess Systematic Reviews, or AMSTAR, were all fair to outstanding, he noted, and he described the clinical validity score of 87% as “excellent.”

“Rand recommended use of ODG, and the funding body (Icare NSW) proceeded with implementation,” LeFevre said.

The shortcomings in WLDI’s guideline development process pointed to by Rand are similar to those identified by the National Guideline Clearinghouse. The clearinghouse, which guideline developers participate in voluntarily, last year removed ODG because the guidelines did not meet new, stricter standards.

The Work Loss Data Institute's chief competitor pointed to the flaws that Rand did find in ODG. Joseph Guerriero, senior vice president of MD Guidelines at Reed Group, said he doesn’t understand why WLDI doesn’t correct the problems that have been identified with ODG.

“I want them to fix what’s wrong,” Guerriero said.

A Reed Group analysis of the Rand study questions why overall favorable ratings were given to ODG “despite notable limitations to the methods used to develop the guidelines.”

Another weakness identified by Rand was a lack of input from workers with occupational conditions in the development of ODG. LeFevre said the guideline development process includes an opportunity for public comment, but injured workers have never provided feedback.

Following its acquisition by Hearst, WLDI has maintained its advisory board for ODG. In addition, WLDI now has support from MCG’s technical staff, which may allow the company to answer questions raised in the Rand report, LeFevre said.

Representatives of workers’ compensation divisions in Tennessee, Ohio and Texas each said that they are reviewing the report but offered little additional comment.

“Our objective is to have the appropriate guidelines for our program, and part of that is to review the guidelines on an ongoing basis,” said Troy Haley, director of administrative legal services in the Tennessee Bureau of Workers’ Compensation, speaking on behalf of BWC Administrator Abbie Hudgens.

“Our medical department is reviewing the report, but we don't at this point plan any action in response to the report,” said spokeswoman Melissa Vince with the Ohio Bureau of Workers' Compensation.