Project Results

Public Policy Goal:

To bridge the gap between information and policy development in workers' compensation though the assessment, interpretation, and dissemination of data relating to the access and quality of healthcare provided to injured workers.

Project Objective:

To provide Workers' Compensation stakeholders with easy access to credible information, data and guidance about how to provide appropriate, high-quality care to individuals suffering work-related injuries and illnesses though the development of a state-based resource.

Project Description:

The Rhode Island Department of Labor and Training (DLT) established a model state technical resource center for the improvement of workers compensation medical care. The technical resource center was built upon the existing capabilities of DLT and the Dr. John E. Donley Rehabilitation Center, strong cooperative arrangements DLT maintains with stakeholder groups and the state's Workers' Compensation Advisory Council. With input from key stakeholder groups, the resource center intended to collect and disseminate data concerning the quality of workers' compensation medical care; provide technical support and assistance to health providers, workers, employers, insurers and other groups; conduct conferences and briefings on the issue for state policymakers; promote community-based initiatives to improve access to high-quality workers' compensation medical care; and establish internet-based and print materials for public information on the subject.

Key Findings or Accomplishments:

This project demonstrated that a state workers' compensation system can successfully collaborate on the design and collection of data related to the quality of health care delivered to injured workers. It further demonstrated that a Quality Improvement Model can be adopted and provides a format for the implementation of such a resource center to other jurisdictions. Some of the important activities and findings that lead to the successful development of such a center were:

• A detailed stakeholder leadership assessment was successfully conducted with the Workers' Compensation Advisory Council (WCAC) and other key leaders in the workers' compensation system;
• Five top "Quality Dimensions" and their "Indicators" of performance measurement of healthcare quality were established by consensus;
• While data exists for performance measurement of healthcare quality, this data is collected by a number of different entities using different metrics and with wide variations in infrastructure related to data collection;
• Measurement of some indicators can only be accomplished through survey data and there was no mechanism in place to gather this data;
• A pilot data collection effort was implemented using multiple surveys and data collection methods. Lessons learned in that effort include:
  • Injured workers rate the quality of the health care they received and their health care providers highly;
  • Health Care appears to be delivered promptly;
  • The use of the RI WC Medical Advisory Board (MAB) Protocols are used by a majority of health care providers (76%) and are not perceived as overly restrictive;
  • Return to work rates appear high and modified duty is used frequently;
  • Surveys reveal poor understanding of the RI Workers' Compensations System as it relates to obtaining health care. Only 46% of injured workers, 52% of employers and 56% of health care providers scored a "passing grade" (75% correct) on the knowledge portion of the survey;
  • Barriers exist in the collection of data from insurance carriers and billing data bases consisting of
    • Delays in responding to data calls,
    • No uniform way to identify and transmit data requested,
    • Not all data needed is electronically available.
    • Data was often held by another entity (eg. medical reviewing company)
    • Concerns about data confidentiality

Tools Developed:

• Quality Dimensions and Quality Indicators
•   Rhode Island Technical Resource Center - Stakeholder surveys
  • Employer Survey
  • Health Care Provider Survey
  • Injured Worker Survey

Reports and Publications:

Final Grant Report

Presentations:

Michael J. Follick, PhD, "Technical Resource Center at the Rhode Island Department of Labor and Training," Robert Wood Johnson Workers' Compensation Health Initiative Annual Meeting, September 6-7, 2001, Newport, RI.

Michael J. Follick, PhD, "Technical Resource Center at the Rhode Island Department of Labor and Training," International Association of Industrial Accident Board Commission Annual Convention, October 4-10, 2001, Portland, ME.

Future Plans for the Project:

The TRC intends to complete the steps outlined in the Quality Improvement Model and work with the policy-makers to utilize this data. Next steps include the following:

• Revise survey instruments, considering development of an instrument for surveying carriers
• Evolve the data collection process, including documenting the necessary specifications
• Review and revise the TRC database structure
• Administer surveys to full samples of IW, ER, HCP
• Conduct full sample data analyses
• Enhance educational efforts based on the results of the analyses
• Re-engineer DLT annual report to include quality as well as cost data,
• Focus on dissemination of results: web-site development; presentations to WCAC, and local, regional and national professional organizations; publish results in professional journals