Secular trends in gabapentinoid dispensing by compensated workers with low back pain: a retrospective cohort study.

OBJECTIVES: The increase in gabapentinoid prescribing is paralleling the increase in serious harms. To describe the low back pain workers compensation population whose management included a gabapentinoid between 2010 and 2017, and determine secular trends in, and factors associated with gabapentinoid use. METHODS: We analysed claim-level and service-level data from the Victorian workers' compensation programme between 1 January 2010 and 31 December 2017 for workers with an accepted claim for a low back pain injury and who had programme-funded gabapentinoid dispensing. Secular trends were calculated as a proportion of gabapentinoid dispensings per year. Poisson, negative binomial and Cox hazards models were used to examine changes over time in incidence and time to first dispensing. RESULTS: Of the 17 689 low back pain claimants, one in seven (14.7%) were dispensed at least one gabapentinoid during the first 2 years (n=2608). The proportion of workers who were dispensed a gabapentinoid significantly increased over time (7.9% in 2010 to 18.7% in 2017), despite a reduction in the number of claimants dispensed pain-related medicines. Gabapentinoid dispensing was significantly associated with an opioid analgesic or anti-depressant dispensing claim, but not claimant-level characteristics. The time to first gabapentinoid dispensing significantly decreased over time from 311.9 days (SD 200.7) in 2010 to 148.2 days (SD 183.1) in 2017. CONCLUSIONS: The proportion of claimants dispensed a gabapentinoid more than doubled in the period 2010-2017; and the time to first dispensing halved during this period.

Work-related asthma surveillance in Washington State: time trends, industry rates, and workers' compensation costs, 2002-2016.

Objective: Washington State's work-related asthma (WRA) surveillance program utilizes workers' compensation (WC) data as its primary data source and has spanned a 15-year time period. This study analyses trends for WRA claim incidence rates compared to all WC claim incidence rates. WRA claim incidence rates and WC costs are analyzed by industry. Methods: Potential WRA cases were identified through the WC system and through direct provider report and classified by industry, age, and year of illness onset. WRA claim rates by industry and year were calculated using total work hours reported by employers covered by the WC system. Claim costs for accepted claims were compared by industry and year. Results: WRA claim incidence rates decreased 8.9% (95% CI: -10.6, -7.2) annually for the time period 2002-2016. The decline in WRA claim incidence rate is slightly faster than the incidence rate for all WC claims which had its steepest decrease from 2007 to 2010 at an estimated annual 8.4% decrease (95% CI: -11.8, -5.0). WRA claim rates were highest for workers in Public Administration, Manufacturing, and the Agricultural, Forestry, Fishing and Hunting industries. Median claim costs for WRA did not change significantly by year (p = 0.2, range $595-$1442) and the distribution of WRA WC claim costs by industry were highest in Manufacturing (21.3%) and Construction (16.4%) industries. Conclusion: WRA claim incidence rates are declining in Washington State. The cause for the decline is unclear. Workers across all industries in Washington remain at risk for WRA.

Why does the adverse effect of inappropriate MRI for LBP vary by geographic location? An exploratory analysis.

BACKGROUND: Early magnetic resonance imaging (eMRI) for nonspecific low back pain (LBP) not adherent to clinical guidelines is linked with prolonged work disability. Although the prevalence of eMRI for occupational LBP varies substantially among states, it is unknown whether the risk of prolonged disability associated with eMRI varies according to individual and area-level characteristics. The aim was to explore whether the known risk of increased length of disability (LOD) associated with eMRI scanning not adherent to guidelines for occupational LBP varies according to patient and area-level characteristics, and the potential reasons for any observed variations. METHODS: A retrospective cohort of 59,360 LBP cases from 49 states, filed between 2002 and 2008, and examined LOD as the outcome. LBP cases with at least 1 day of work disability were identified by reviewing indemnity service records and medical bills using a comprehensive list of codes from the International Classification of Diseases, Ninth Edition (ICD-9) indicating LBP or nonspecific back pain, excluding medically complicated cases. RESULTS: We found significant between-state variations in the negative impact of eMRI on LOD ranging from 3.4 days in Tennessee to 14.8 days in New Hampshire. Higher negative impact of eMRI on LOD was mainly associated with female gender, state workers' compensation (WC) policy not limiting initial treating provider choice, higher state orthopedic surgeon density, and lower state MRI facility density. CONCLUSION: State WC policies regulating selection of healthcare provider and structural factors affecting quality of medical care modify the impact of eMRI not adherent to guidelines. Targeted healthcare and work disability prevention interventions may improve work disability outcomes in patients with occupational LBP.

The Rise and Fall of the Occupational Health and Safety Agency for Healthcare (OHSAH) in British Columbia, Canada.

OBJECTIVE: This paper describes why the Occupational Health and Safety Agency for Healthcare (OHSAH) in British Columbia (BC) was created in 1998, factors contributing to its closure in 2010, and its contributions to healthcare occupational health and safety (OHS). METHODS: This study applies an inductive approach consisting of 16 in-depth, confidential, semi-structured interviews with key informants, supplemented by a quantitative analysis of WorkSafeBC reports on injury and claim rates before, during, and following OHSAH's closure. RESULTS: Injuries and claims declined during OHSAH's early years and increased by 59% following OHSAH's closure. Multiple factors contributed to the closure. CONCLUSION: There is value to reconstituting a healthcare OHS agency.

Implementation of an Opioid Guideline Impacts on Opioid Prescriptions, Adverse Outcomes, and an Association with a State Opioid-Related Fatalities.

OBJECTIVE: The aim of this study was to determine the efficacy of an evidence-based opioid guidelines-based program implemented at the largest worker's compensation insurer in Utah. METHODS: All new claims, including surgeries, were included. Pre- and post-intervention comparisons included percentage of claims treated with an opioid, provision of a second opioid prescription, opioid use above 50 mg morphine equivalent dose (MED), opioid use more than 90 mg MED, and opioid use over 90 days. RESULTS: There were significant (P < 0.001) reductions in all primary outcomes, with a reduction in MEDs in the 18 months after implementation totaling 65,502 mg. CONCLUSION: This program significantly reduced the usage of opioids among acute claims. The year of program implementation, Utah experienced a 19.8% reduction in opioid-related fatalities, which may be partly related to the reduction in MEDs. Regardless, this study suggests that the implementation of an evidence-based guideline is impactful and feasible.

Factors Associated With Return-to-Work Following Cervical Spine Surgery in Non-Worker's Compensation Setting.

STUDY DESIGN: This study retrospectively analyzes prospectively collected data. OBJECTIVE: Here in this study we aim to determine the factors which impact a patient's ability to return to work (RTW) in the setting of cervical spine surgery in patients without worker's compensation status. SUMMARY OF BACKGROUND DATA: Surgical management of degenerative cervical disease has proven cost-effectiveness and shown significant improvement in quality of life. However, the ability to RTW is an important clinical outcome for preoperatively employed patients. METHODS: All adult patients undergoing elective surgery for cervical degenerative disease at our institution are enrolled in a prospective, web-based registry. A multivariable Cox proportional hazards regression model was built for time to RTW. The variables included in the model were age, sex, smoking status, occupation type, number of levels operated on, ASA grade, body mass index, history of diabetes, history of coronary artery disease (CAD), history of chronic obstructive pulmonary disease (COPD), anxiety, depression, myelopathy at presentation, duration of symptoms more than 12 months, diagnosis, type of surgery performed, and preoperative Neck Disability Index, EuroQol Five Dimensions, and Numeric Rating Scale pain scores for neck pain and arm pain scores. RESULTS: Of the total 324 patients with complete 3-month follow-up data 83% (n = 269) returned to work following surgery. The median time to RTW was 35 days (range, 2-90 d). Patients with a labor-intensive occupation, higher ASA grade, history of CAD, and history of COPD were less likely to RTW. The likelihood of RTW was lower in patients with a diagnosis of disc herniation compared with cervical stenosis, patients undergoing cervical corpectomy compared laminectomy and fusion and patient with longer operative time. CONCLUSION: Our study identifies the various factors associated with a lower likelihood of RTW at 3 months after cervical spine surgery in the non-worker's compensation setting. This information provides expectations for the patient and employer when undergoing cervical spine surgery. LEVEL OF EVIDENCE: 3.

Association of Opioid, Anti-Depressant, and Benzodiazepines With Workers' Compensation Cost: A Cohort Study.

BACKGROUND: Antidepressants, benzodiazapines, and opioid medications are used to manage the pain, anxiety, or depression associated with workplace injuries. OBJECTIVE: To evaluate the impact of these medications on workers' compensation costs and time lost from work. METHODS: A cohort of 22,383 indemnity claims from 2008 to 2013 were evaluated for the association of prescribed medications on claim cost and delayed claim closure controlling for confounders. RESULTS: Claims with anti-depressant, opioid, or benzodiazepine prescriptions were 2.24 (95% CI: 2.00 to 2.51), 1.14 (95% CI: 1.02 to 1.27), and 1.38 (95% CI: 1.23 to 1.54) times more likely to remain open at the end of the study. CONCLUSION: The concurrent treatment of pain, depression or anxiety, and occupational injuries are associated with large increases in claim cost and delayed return to work.

Brief report: Population-based reversal of the adverse impact of opioids on disability in Washington State workers' compensation.

BACKGROUND: Evidence has associated opioid use initiated early in a workers' compensation claim with subsequent disability. In 2013, the Washington State Department of Labor and Industries (DLI) implemented procedures based on new regulations that require improvement in pain and function to approve opioids beyond the acute pain period. METHODS: We measured opioid prescriptions between 6 and 12 weeks following injury, an indicator of persistent opioid use. Actuarial data for the association of any opioid use versus no opioid use with development of lost time payments are reported. RESULTS: Prior authorization with hard stops led to a sustained drop in persistent opioid use, from nearly 5% in 2013 to less than 1% in 2017. This reduction was also associated with reversal of the increased lost work time patterns seen from 1999 to 2010. CONCLUSIONS: Prior authorization targeted at preventing transition to chronic opioid use can prevent and reverse adverse time loss development that has occurred on a population basis concomitant with the opioid epidemic.

Medical Care Spending and Labor Market Outcomes: Evidence from Workers' Compensation Reforms.

Medical care represents an important component of workers' compensation benefits with the potential to improve health and post-injury labor outcomes, but little is known about the relationship between medical care spending and the labor outcomes of injured workers. We exploit the 2003--2004 California workers' compensation reforms which reduced medical spending disproportionately for workers incurring low back injuries. We link administrative claims data to earnings records for injured workers and their uninjured coworkers. We find that workers with low back injuries experienced a 7.6 percent post-reform decline in medical care, and an 8.1 percent drop in post-injury earnings relative to other injured workers.

Significant Decreasing Trend in Low Back Injuries in a Beverage Company.

BACKGROUND: Work-related injuries in the U.S. have steadily declined over the past three decades. OBJECTIVE: The aim of this study was to compare trends of the most frequently injured body parts from a beverage company over an 8-year study period (2008 to 2015). METHOD: Work-related injury claims with more than 3 days of missed work (N = 20,203) were classified into body part groups, including low back, knee, shoulder, and all other(s). Descriptive statistics and linear models were used to evaluate trends over time. RESULTS: The total number of injuries decreased from 6.57 per 100 to 3.79 per 100 employees from 2008 to 2015. Proportion of low back injuries decreased from 22.0% to 15.4% (P < 0.001) over the study period. Proportionally, knee(s), shoulder(s), and all other injuries increased, but the changes did not reach statistical significance. CONCLUSION: Low back injuries decreased at a faster rate than knee, shoulder, and all other injuries.

Preoperative Opioid Use is a Predictor of Poor Return to Work in Workers' Compensation Patients After Lumbar Diskectomy.

STUDY DESIGN: A retrospective cohort. OBJECTIVE: The aim of this study was to determine the impact of preoperative opioid use in workers' compensation (WC) patients undergoing lumbar diskectomy (LD). SUMMARY OF BACKGROUND DATA: The prevalence of back pain among opioid users approached 60%. Long-term opioid dependence in spine surgery patients is roughly 20%. Despite pervasive use, there is no evidence to support long-term opioid analgesic use for back pain. METHODS: Ten thousand five hundred ninety-two patients received compensation from the Ohio Bureau of Workers' Compensation for a lumbar disc herniation between 2005 and 2012. Patients with spine comorbidities, smoking history, or multilevel surgery were excluded. Preoperatively, 566 patients had no opioid use, 126 had short-term opioid use (STO), 315 had moderate opioid use (MTO), and 279 had long-term opioid use (LTO). The primary outcome was whether subjects returned to work (RTW). RESULTS: Seven hundred twelve (55.4%) patients met our RTW criteria. There was a significant difference in RTW rates among the no opioid (64.1%), MTO (52.7%), and LTO (36.9%) populations. Multivariate logistic regression analysis found several covariates to be independent negative predictors of RTW status: preoperative opioid use [P < 0.01; odds ratio (OR) = 0.54], time to surgery (P < 0.01; OR = 0.98 per month), legal representation (P < 0.01; OR = 0.57), and psychiatric comorbidity (P = 0.02; OR = 0.36). Patients in the LTO group had higher medical costs (P < 0.01), rates of psychiatric comorbidity (P < 0.01), incidence of failed back surgery syndrome (FBSS) (P < 0.01), and postoperative opioid use (P < 0.01) compared with the STO and no opioid groups. CONCLUSION: Preoperative opioid use was determined to be a negative predictor of RTW rates after LD in WC patients. In addition, long-term preoperative opioid use was associated with higher medical costs, psychiatric illness, FBSS, and postoperative opioid use. Even a short or moderate course of preoperative opioids was associated with worse outcomes compared with no use. For WC patients undergoing LD, judicious use of preoperative opioid analgesics may improve clinical outcomes and reduce the opioid burden. LEVEL OF EVIDENCE: 3.

Cerebrovascular/cardiovascular diseases and mental disorders due to overwork and work-related stress among local public employees in Japan.

In Japan, overwork-related disorders occur among local public employees as well as those in private businesses. However, to date, there are no studies reporting the state of compensation for cerebrovascular/cardiovascular diseases (CCVD) and mental disorders due to overwork or work-related stress among local public employees in Japan over multiple years. This report examined the recent trend of overwork-related CCVD and mental disorders, including the incidence rates of these disorders, among local public employees in Japan from the perspective of compensation for public accidents, using data from the Japanese Government and relevant organizations. Since 2000, compared to CCVD, there has been an overall increase in the number of claims and cases of compensation for mental disorders. Over half of the individuals receiving compensation for mental disorders were either in their 30s or younger. About 47% of cases of mental disorders were compensated due to work-related factors other than long working hours. The incidence rate by job type was highest among "police officials" and "fire department officials" for compensated CCVD and mental disorders cases, respectively. Changes in the trend of overwork-related disorders among local public employees in Japan under a legal foundation should be closely monitored.

Evaluation of Industrial Compensation to Cardiologists in 2015.

The categorization and characterization of pharmaceutical and device manufacturers or group purchasing organization payments to clinicians is an important step toward assessing conflicts of interest and the potential impact of these payments on practice patterns. Payments have not previously been compared among the subspecialties of cardiology. This is a retrospective analysis of the Open Payments database, including all installments and payments made to doctors in the calendar year 2015 by pharmaceutical and device manufacturers or group purchasing organization. Total payments to individual physicians were then aggregated based on specialty, geographic region, and payment type. The Gini Index was further employed to calculate within each specialty to measure income disparity. In 2015, a total of $166,089,335 was paid in 943,744 payments (average $175.00 per payment) to cardiologists, including 23,372 general cardiologists, 7,530 interventional cardiologists, and 2,293 cardiac electro-physiologists. Payments were mal-distributed across the 3 subspecialties of cardiology (p <0.01), with general cardiology receiving the largest number (73.5%) and total payments (62.6%) and cardiac electrophysiologists receiving significantly higher median payments ($1,662 vs $361 for all cardiologists; p <0.01). The Medtronic Company was the largest single payer for all 3 subspecialties. In conclusion, pharmaceutical and device manufacturers or group purchasing organizations continue to make substantial payments to cardiac practitioners with a significant variation in payments made to different cardiology subspecialists. The largest number and total payments are to general cardiologists, whereas the highest median payments are made to cardiac electrophysiologists. The impact of these payments on practice patterns remains to be examined.

Prolonged Preoperative Opioid Therapy in Patients With Degenerative Lumbar Stenosis in a Workers' Compensation Setting.

STUDY DESIGN: Retrospective cohort study. OBJECTIVE: To investigate the impact of prolonged opioid use in the preoperative treatment plan of degenerative lumbar stenosis (DLS). SUMMARY OF BACKGROUND DATA: Patients undergoing operative treatment for DLS with concomitant opioid use represent a clinically challenging population. The relative paucity of data on the relationship between preoperative opioid use and clinical outcomes in the workers' compensation (WC) population necessitates further study of this unique population. METHODS: We identified 140 Ohio WC patients who underwent lumbar decompression and had received preoperative opioid prescriptions between 1993 and 2013. Our study cohorts were formed based on opioid use duration, which included short-term use (<3 months) and long-term use (>3 months). Our primary outcome was if patients were able to make a stable return to work (RTW). A multivariate regression analysis was used to determine the impact of the duration of preoperative opioid use on return to work rates. We also compared many secondary outcomes after surgery between both groups. RESULTS: Patients on opioids less than 3 months had a significantly higher RTW rate compared with those who used opioids longer than 3 months [25/60 (42%) vs. 18/80 (23%); P = 0.01]. A logistic regression was performed to examine the effect of preoperative opioid therapy duration on RTW status. Our regression model showed that opioid use greater than 3 months remained a significant negative predictor of RTW (OR: 0.35, 95% CI: 0.13-0.89; P = 0.02). Patients who remained on opioid therapy longer than 3 months cost the Ohio Bureau of Workers' Compensation $70,979 more than patients who were on opioid therapy for less than 3 months (P < 0.01). CONCLUSION: Prolonged preoperative opioid use was associated with poor clinical outcomes after lumbar decompression. These results suggest that a shorter course of opioid therapy and earlier surgical intervention may improve outcomes and lower postoperative morbidity in patients with DLS. LEVEL OF EVIDENCE: 3.

Dupuytren's Contracture.

Dupuytren's disorder is considered a genetic disorder and therefore not covered under workers' compensation. Personal risk factors include workers of Northern European descent and workers that are older than 50 years. However, new evidence has shown that certain occupational activities may increase the risk of developing this disorder. This article is a review of the literature with a case study. Work-related and personal risk factors are explored, as well as interventions and return to work recommendations.

Vertebroplasty and Return to Work for Thoracolumbar Fractures Within the Workers' Compensation Population.

STUDY DESIGN: Retrospective cohort study. OBJECTIVE: Analyze efficacy of vertebroplasty and its affect on return to work (RTW) in a workers' compensation (WC) population SUMMARY OF BACKGROUND DATA.: Vertebroplasty remains a controversial treatment modality for vertebral compression fractures (VCFs). No studies have analyzed use of vertebroplasty in the clinically distinct WC population. METHODS: A total of 371 Ohio WC subjects were identified who sustained VCFs and were treated with either vertebroplasty or conservative medical therapy between 1993 and 2013 using Current Procedural Terminology procedural and International Classification of Diseases, Ninth Revision diagnosis codes. Subjects with a prior smoking history, prior thoracolumbar surgery or comorbidities, or underwent decompression and/or fusion within 3 months after injury were excluded. Forty-six subjects had undergone vertebroplasty within 1 year of injury and were therefore included in the vertebroplasty group. The remaining 325 subjects received spinal orthosis and formed the control group. The primary outcomes were whether subjects returned to work at early and late time points. Early RTW was defined as returning to work within 3 months and remaining at work for more than 6 months of the following year. Late RTW was defined as returning to work within 2 years and remaining at work for more than 6 months of the following year. Secondary outcomes included opioid use, all-cause mortality, and additional VCFs. RESULTS: Approximately 37% (17/46) of vertebroplasty group made an early RTW, compared with 35.4% (115/325) of control group (P = 0.835). Regarding late RTW, only 54.3% (25/46) of vertebroplasty group made a sustainable RTW, compared with 70.8% (230/325) of subjects in control group (P = 0.025). In addition, the vertebroplasty group was associated with significantly higher postoperative opioid use. CONCLUSION: Vertebroplasty may not be an effective treatment modality for VCFs in the WC population when RTW is the primary goal. LEVEL OF EVIDENCE: 3.

Decompression Versus Decompression and Fusion for Degenerative Lumbar Stenosis in a Workers' Compensation Setting.

STUDY DESIGN: A retrospective cohort study. OBJECTIVE: The aim of this study was to compare outcomes in Workers' compensation (WC) subjects receiving decompression alone versus decompression and fusion for the indication of degenerative spinal stenosis (DLS) without deformity or instability. SUMMARY OF BACKGROUND DATA: The use of a fusion procedure during lumbar decompression for DLS alone remains controversial. We hypothesize that WC subjects receiving fusion and decompression will return to work less and incur greater medical costs than subjects receiving decompression alone. METHODS: Three hundred sixty-four Ohio WC subjects were identified who underwent primary decompression (DC) or primary decompression and fusion (DC + F) for DLS alone between 1993 and 2013. Our primary outcome was if patients were able to make a stable return to work (RTW). The authors classified subjects as RTW if they returned within 2 years after surgery and remained working for more than 6 months. A number of secondary outcomes were collected and analyzed. RESULTS: The DC cohort had a significantly higher RTW rate [36% (83/227) vs. 25% (54/212); P = 0.01]. A logistic regression was performed to identify independent variables that predicted RTW status. Our regression model showed that fusion with operative decompression remained a significant negative predictor of RTW status (P = 0.04; odds ratio: 0.58, 95% confidence interval: 0.34-0.99). Within the DC cohort, the rate of postoperative instability and subsequent fusion was 8%. Furthermore, subjects who received an adjunctive fusion cost of the Ohio BWC on average, $46,115 more in costs accrued over 3 years after their index surgery compared with subjects who received a decompression alone. CONCLUSION: Overall, fusion with decompression had a significantly negative impact on clinical outcomes in WC subjects with DLS. These results demonstrate the high risk of postoperative morbidity associated with fusion procedures and underscore the need to strongly reevaluate the use of fusion for DLS without instability in the WC population. LEVEL OF EVIDENCE: 3.

Compensation claims for occupational noise induced hearing loss between 1998 and 2008: yearly incidence rates and trends in older workers.

OBJECTIVES: To estimate yearly incidence rates for occupational noise induced hearing loss (ONIHL) claims and to describe occupational factors in relation to age for incident cases in Victoria, Australia, between 1998 and 2008. METHODS: All compensation claims lodged for deafness between 1 July 1998 and 30 June 2008 in the working population covered by the Victorian compensation scheme were analysed. Denominators were provided from 1999-2000 and incidence rates were expressed per 100,000 workers for each financial year. RESULTS: Overall, 81.2% of the 4,518 claims lodged were accepted. Successful claimants were predominantly males (96.5%) and claimants aged 56 to 65 years formed half the overall claims. The number of accepted claims was almost five times higher in 2007-08 than 1998-99. The highest rise was in claimants aged 56 years and above, particularly in those after retirement age. The number of claims and yearly incidence rates (IR) more than doubled over the period (240 claims and IR of 15.1 per 100,000 workers in 1999-2000 versus 669 claims and IR of 34.2 in 2007-08) with a sharp increase from 2004-05 to almost double within one single year and remained at high levels afterwards. CONCLUSION: The dramatic increase in eligible claims may reflect an increase in awareness of entitlements among workers eligible to make a successful claim. This awareness may be the result of increased opportunities for screening coinciding with changes in regulations. Older workers who worked in smaller workplaces may also be targeted by services providers as they combine occupational noise induced hearing loss (ONIHL) and presbycusis (hearing loss due to age), but this hypothesis needs further evaluation.

Improving occupational injury surveillance by using a severity threshold: development of a new occupational health indicator.

BACKGROUND: Hospital discharge data are used for occupational injury surveillance, but observed hospitalisation trends are affected by trends in healthcare practices and workers' compensation coverage that may increasingly impair ascertainment of minor injuries relative to severe injuries. The objectives of this study were to (1) describe the development of a severe injury definition for surveillance purposes and (2) assess the impact of imposing a severity threshold on estimated occupational and non-occupational injury trends. METHODS: Three independent methods were used to estimate injury severity for the severe injury definition. 10 population-based hospital discharge databases were used to estimate trends (1998-2009), including the National Hospital Discharge Survey (NHDS) and State Inpatient Databases (SID) from the Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality. Negative binomial regression was used to model injury trends with and without severity restriction and to test trend divergence by severity. RESULTS: Trend estimates for occupational injuries were biased downwards in the absence of severity restriction, more so than for non-occupational injuries. Imposing a severity threshold resulted in a markedly different historical picture. CONCLUSIONS: Severity restriction can be used as an injury surveillance methodology to increase the accuracy of trend estimates, which can then be used by occupational health researchers, practitioners and policy-makers to identify prevention opportunities and to support state and national investments in occupational injury prevention efforts. The newly adopted state-based occupational health indicator, 'Work-Related Severe Traumatic Injury Hospitalizations', incorporates a severity threshold that will reduce temporal ascertainment threats to accurate trend estimates.

Contrasting patterns of care for musculoskeletal disorders and injuries of the upper extremity and knee through workers' compensation and private health care insurance among union carpenters in Washington State, 1989 to 2008.

BACKGROUND: Musculoskeletal symptoms and disorders (MSDIs) are common reasons for visits to medical providers in the general population and they are common work-related complaints. Prior reports raise concerns as to whether declines in workers' compensation (WC) rates represent true improvement in occupational health and safety or shifting of care to other payment systems. METHODS: By linking administrative records, we compared patterns of WC claims and private health care utilization for disorders of the upper extremity (UE) and knee among a large cohort of union carpenters over a 20-year period. RESULTS: As WC claim rates declined, private health care utilization increased. The increase was muted somewhat but sustained when adjusting for other patterns of health care utilization. CONCLUSIONS: Findings suggest the decline of WC claim rates do not solely represent improved occupational safety in this population, but also a considerable shifting of care to their private insurance coverage over time.