A standardized approach to care combined with an aggressive worksite safety program resulted in a 46 percent reduction in the rate of workers' injury-related surgeries, according to a Hopkins study published earlier this year in The Journal of Occupational and Environmental Medicine. While the surgery rate per 1,000 workers fell sharply, the rate of workers' compensation claims per 1,000 employees also dropped significantly, suggesting a managed care approach reduced the actual number of accidents, according to lead author Edward J. Bernacki, director of the Division of Occupational and Environment Medicine.

"These findings suggest that comprehensive occupational health programs not only reduce the number of accidents but also the number of surgeries for patients who are injured on the job," Bernacki said.

For the study, researchers examined 1990-97 claims data from workers at JHMI who reported work-related injuries and were treated under the Johns Hopkins Self-Insured Workers' Compensation Program. Hopkins initiated a managed care approach to occupational health in 1993. Program features included covering repetitive stress disorders under Workers' Compensation, implementing a workplace ergonomics program, eliminating unsafe work conditions or behaviors, assigning nurse case managers for close follow-up of patients, referring all patients to full-time faculty physicians for initial evaluation and using standardized guidelines for treatment. Prior to the shift to managed care in 1993, contracted part-time physicians outside Hopkins were used to perform initial case evaluation.

After the shift to managed care, the claims rate decreased, going from 177 per 1,000 workers in 1992 to 152 in 1993, 132 in 1994, 110 in 1995, 115 in 1996, and 101 in 1997.

A similar decrease was seen in the rate of surgeries within 12 months of job injury. The mean number of surgeries per 1,000 workers for the period 1990 through 1992 was 1.24, compared to a mean of 0.72 after the implementation of managed care.

The researchers found that 17 percent of patients who underwent surgery returned to work within six months of surgery prior to the managed care initiative. Eighty-five percent of patients returned to work within six months of surgery if a Hopkins surgeon did the operation. Implementation of managed care benefited both groups of patients, but patients treated by Hopkins physicians continued to fare better. While 60 percent of surgery patients returned to work within months following surgery by non-Hopkins surgeons, 94 percent were back at the job after being operated on by Hopkins doctors.

"These findings suggest that in addition to care management and workplace improvements, the high levels of skills and experience you find among physicians in major academic medical centers have much to do with improving patient outcomes," Bernacki says.