New Podcast for Dorland Health/Case in Point

Recently I chatted with Anne Llewellyn, editor in chief of Dorland’s case management products (e.g., Case in Point Magazine), and gave her an update on how professionals can use disability management guidelines to better understand the time and treatment needed to treat complex conditions.

You can listen to a podcast of our conversation on the Dorland site. Click here to listen.

MDGuidelines Free to Medical Students

Most physicians routinely treat working adults, yet occupational health fundamentals are rarely included in medical school curricula.

To help future physicians understand these critical issues, we at Reed Group have decided to offer medical students free access to MDGuidelines, our extensive database of return-to-work durations and treatment plans for disability, workers’ compensation and other medically-related work absences.

Why are we choosing to spearhead this much-needed educational agenda?

What people do for a living, and their ability to continuously perform on the job, have a huge impact on their health. There is a large amount of evidence showing that time off work is almost immediately detrimental to patients, and that ‘disability’ is a complex and potentially chronic syndrome that is not being handled well by many physicians. Yet occupational medicine is still overlooked or underserved in most medical schools. MDGuidelines can help educate the next generation of physicians in a critical area in which they are not currently getting much training.

We also hope that MDGuidelines will be a resource to help medical students manage a specific patient’s injuries or illnesses with respect to return-to-work outcomes and to measure their performance against other real-world experiences.

Managing patient treatment to evidence-based guidelines is critical. In return to work, we have the added advantage of clear case data against which to benchmark. In the big picture, return to work is one of the best available measures of healthcare outcomes. Tomorrow’s physicians will be better armed to deliver quality care from having used this important resource in school.

If you’re a medical student and want to receive your free subscription, email freemdg@mdguidelines.com or call us (toll-free) 866.889.4449 or 720.379.6979.

Attending AAMC? Stop by our booth.

Are you attending the AAMC (Association of American Medical Colleges) 2009 Annual Meeting in Boston next week (Nov 6-11)?

Stop by Reed Group’s booth (#605) and say hi. We’ll be happy to give you a demo of MDGuidelines, our extensive database of return-to-work durations and treatment plans for disability, workers’ compensation and other medically-related work absences.

Workplace Absence of the Week: H1N1 Flu

With huge potential to cause workplace absences, H1N1 influenza is top of mind for most companies.

Influenza is an acute respiratory infection caused by one of three types of influenza viruses in the Orthomyoxoviridae family of viruses, which evolved from the combination of genes from human, pig, and bird flu. This strain has not been found in humans before, but its predecessor caused an international influenza outbreak (pandemic) more than 40 years ago (“2009-10 Influenza”).

The first cases of A H1N1 influenza were identified on April 2009, and by June 2009 the World Health Organization (WHO) declared the presence of a global pandemic (stage 6) after evidence of spreading in the southern hemisphere.

Initially, the severity of the 2009 outbreak was uncertain because most people are susceptible to this new strain of H1N1. Fortunately, most cases have been mild so far; the highest H1N1 flu-related morbidity and mortality rates have been reported among individuals of extreme ages, or those with other underlying medical conditions such as asthma, diabetes, obesity, heart disease, or a weakened immune system.

H1N1 flu symptoms are similar to those produced by other flu strains: fever, cough, sore throat, headache, body aches, chills, fatigue, vomiting, and diarrhea.

The H1N1 virus is susceptible to antiviral drugs, such as oseltamivir and zanamivir (neuraminidase inhibitors); sporadic cases of virus resistance have been reported. However, prevention of the transmission have been stressed has one of the best resources to fight the pandemic, with a combination of measures such has frequent hand washing; avoiding touch the own eyes, nose or mouth; minimizing social physical contact; avoiding crowded situations, and covering the nose and mouth with tissue or the upper sleeve when sneezing.

The efficacy of the use of a facemask to decrease the risk of virus transmission is difficult to assess, so its use is only recommended for persons at increased risk of severe illness from influenza, and in healthcare settings that involve contact with people who have an influenza-like illness (ILI). Individuals with an ILI (fever and at least cough or sore throat, and possibly other symptoms such as runny nose, headaches, body aches, chills, fatigue, vomiting and diarrhea) should stay home, avoid contact with other people as much as possible, and avoid travel, for at least 24 hours after the disappearance of fever, except to get medical care; fever should have disappeared without the use of antipyretic drugs.

The optimum duration for all job classes is 7 days.

To read more about H1N1, go to MDGuidelines.com.

Do Your Return-to-Work Durations “Measure Up”?

With millions of dollars at stake, employers, insurers and third-party administrators carefully track return-to-work durations (the length of time employees are absent due to short-term disability, long-term disability, workers’ compensation and FMLA).

But simply tracking those numbers isn’t enough. How can your organization use its data to know whether you’re doing all you can to quickly get employees back to work and health?

Our new data analytics service can give you a no-cost way to benchmark your return-to-work data against Reed Group’s extensive MDGuidelines database of more than two million cases.

Our new MDGuidelines Measure Up service will provide — at no charge — benchmarks in seven categories:

• Overall Average (statistical mean)
• Gender
• Age Group
• Job Class (indicating degree of physical demands, typically U.S. Dept. of Labor classifications)
• Co-morbid Conditions (additional health problems that extend recovery times)
• Program Type (short-term disability, long-term disability, workers’ compensation)
• Geographic Area

Benchmarking return-to-work durations is absolutely critical for companies that want to reduce the huge cost of employee absence, improve productivity and help employees quickly get back to normal, productive endeavors. MDGuidelines Measure Up will show employers and others whether they’re doing a great job or whether and where they need to improve.

Data must be sent to Reed Group in an easy-to-use standard file format; no personal or HIPAA-controlled data will be required. Participants will get a written benchmarking report and, if they choose, additional consultation from Reed Group experts on what their results mean and how they can use the benchmarks to improve.

To request our no-cost MDGuidelines Measure Up benchmarking report, contact John Nelson, director of guidelines, Reed Group, at 303.404.6600 or email jnelson@rgl.net.

Comorbid Conditions Mean More Time Off the Job

Why do some employees take much longer to recover than predicted by the average return-to-work duration for their conditions? There are many reasons why this can happen, but one of the most important to look at is the existence of comorbid conditions.  Comorbid conditions are other existing medical factors that can greatly extend the time needed to recover.

Experienced case managers know that a diabetic employee with a lacerated toe will probably take longer to heal and require more care than a non-diabetic employee. Common comorbid conditions besides diabetes include clinical depression, obesity, arthritis, high blood pressure, back or spinal problems and asthma.

Our new MDGuidelines Predictive Modeling Tool allows case managers to factor in comorbid conditions when determining return-to-work durations. If you’d like to see a demonstration, please contact John Nelson, director of sales, Guidelines at 866.889.4449 or jnelson@reedgroup.com.

Chronic Pain and Return to Work

The August/September issue of Case in Point Magazine ran an excellent article by Mary Harris on how to identify and manage the variables of chronic pain in return-to-work situations.

In her article, Ms. Harris talks about the role that fear, depression and anxiety often play in making it harder for employees with chronic pain to return to work. She also discusses the range of therapeutic intervention available to treat these psychosocial comorbid conditions.

Ms. Harris’ real-world expertise as a case manager is soundly backed up by our data at MDGuidelines. So much so, that we formulate our data to show both physiological return-to-work durations as well as normative durations that include psychosocial components. When case managers address both the physical and the psychosocial aspects therapeutically, employees often return to work sooner, thus avoiding the additional depression related to loss of work and the social contacts from employment.

In her article, Ms. Harris also talks about the time when despite all planning and effort, an employee cannot return to their former job because the employer cannot accommodate their work restrictions. “When this occurs,” she says “I find that it is useful to view this as a fork in the road, not the end of the road.”

I find this to be a wise and caring approach. At Reed Group, we sometimes see durations data that is skewed a bit longer than it should otherwise be because of the reluctance of employers and/or case managers to recognize that an injured employee will simply not ever be able to return to their former work. Regarding the situation as a “fork” and not an “end,” as Ms. Harris says, can make a huge difference in when and how that difficult decision is made.

To read “The Forest For the Trees: How To Identify the Variables of Chronic Pain To Achieve Holistic Return to Work” by Mary Harris, MS, CRC, click here. Then scroll down to “Case in Point Highlights” and click on “Read This Month’s Issue” and go to page 35.

Workplace Injury of the Week: Rotator Cuff Tear

If you know a lot of tennis or baseball players, you probably know someone who’s torn their rotator cuff.

Rotator cuff tears also are common in those who perform overhead work (e.g., warehouse workers, laborers, carpenters, painters, construction workers).

Men are twice as likely as women to sustain them, mostly because more men work in heavy-labor jobs.

The rotator cuff is a group of four muscles that surround the ball-like humeral head of the upper arm. The tendons of these muscles come under stress from repeated activities that require lifting and rotating the arm. Any abnormalities of the shoulder joint can aggravate the stress, especially joint looseness (laxity), rubbing of the front edge of the shoulder blade (acromion) on the rotator cuff (impingement syndrome), bone spurs, and bursitis. As the tendons become irritated, inflammation develops (tendinitis). Circulation to the rotator cuff decreases with age and the tendons themselves degenerate over time. Eventually, this can lead to weakening and even tears in the rotator cuff.

Tears are described as either partial thickness tears or complete rupture, depending on the amount of tissue damage. Partial tears do not go all the way through the cuff, although a large surface area may be involved. Complete tears create a gap in the cuff with concomitant loss of function.

Conservative treatment of small rotator cuff tears (less than 3 cm) of short duration (less than 6 to 12 months) results in a good return to normal functioning for 40% to 90% of individuals (Felsenstein). However, the rehabilitation process may take 6 months or longer and requires an ongoing commitment to a home exercise program to prevent recurrence. Younger individuals are more likely to regain complete function than older individuals. However, athletes are not always able to return to previous levels of competition, especially after a full-thickness rotator cuff tear.

The median return-to-work duration for rotator cuff tear is 72 days.

Are You Ready to Deal With Employee Absenteeism?

Shepell·fgi, a Canadian provider of workplace health and productivity solutions, surveyed 100 Canadian organizations and concluded in a June 4, 2009 report that “that far too many supervisors and managers in the Canadian workplace are not equipped to deal with employee health, productivity, absenteeism, disability, and employees returning to work after an absence.”

Recommendations from the survey were as follows:

Seward said organizations should do the following:

• Establish preventative measures to include proactive promotion of EAP-based employee needs, both at the broader organizational level and at the workgroup level.
• Establish regular and formal manager/supervisor training to identify and respond to declining productivity and changes in employee behaviour.
• Support managers and supervisors with absence data, and also absence trending data, so managers will know when to intervene when it comes to employee absence.
• Support managers and supervisors with better and more consistent, return-to-work processes.

Absence management data is, of course, what we do at MDGuidelines and we have plenty of evidence-based, physician-reviewed data to show that managing absence cases to optimal return-to-work guidelines is beneficial both for companies and for helping employees return more quickly to healthy, productive endeavors.

You can read Shepell-fgi’s summary article and download the report from here.

Workplace Injury of the Week: Low Back Pain

Low back pain is not a specific injury or disease, but this symptom ranks second only to upper respiratory infections as a cause of lost work productivity. With 2.4 million people excused from work and 13 million visits to the doctor each year, low back pain accounts for approximately 175.8 million days of restricted activity annually in the US.

The symptom is usually described as discomfort in the lumbosacral region of the back that may or may not radiate to the legs, hips and buttocks. The pain may be due to a variety of causes, and many individuals may never receive a clear diagnosis for the cause of the pain.

Although low back pain may be caused by medical conditions such as infection or cancer, the vast majority of low back pain cases are attributed to mechanical or musculoskeletal conditions. These conditions incude lumbosacral muscle and ligament strains and sprains; disorders of the intervertebral discs and associated joints such as degeneration.

Risk Factors:
An initial episode of back pain typically occurs between 30 and 40 years of age. The likelihood increases with age. Overall deconditioning also is likely to contribute to low back pain. Added stress to the back from any cause such as obesity, pregnancy or unnatural curvature or disease of the spine can increase the risk for back pain. Occupational risk factors include lifting objects while twisting or without properly bending the legs, heavy pushing or pulling, and vibrational stresses. A family history may predispose individuals to some causes of back pain, such as degenerative disc disease.

The mean return-to-work duration for low back pain is 46 days, but this can vary widely depending on treatment and other case management factors.

Want to know more? Read more about this common workplace injury and see typical disability durations and other physician-reviewed information at MDGuidelines.