This was an observational study involving an audit of 288 randomly-selected claimant files from 4 insurance providers in NSW, Australia between March and October 2016. Data extracted included demographic, claim and injury details, use of health services, and insurer and health professional practices related to the guidelines. Analyses involved descriptive statistics and correlation analysis.
Median time for general practitioner medical consultation was 4 days post-injury and 25 days for physical treatment (e.g. physiotherapy). Rates of x-ray investigations were low (21.5%) and most patients (90%) were given active treatments in line with the guideline recommendations. The frequency of other practices recommended by the guidelines suggested lower guideline adherence in some areas such as; using the Quebec Task Force classification (19.9%); not using specialised imaging for WAD grades I and II (e.g. MRI, 45.8%); not using routine passive treatments (e.g. manual therapy, 94.0%); and assessing risk of non-recovery using relevant prognostic tools (e.g. Neck Disability Index, 12.8%). Over half of the claimants (59.0%) were referred to other professionals at 9-12 weeks post-injury, among which 31.2% were to psychologists and 68.8% to specialists (surgical specialists, 43.6%; WAD specialists, 20.5%). Legal representation and lodgment of full claim were associated with increased number of medical visits and imaging (ρ 0.23 to 0.3; p < 0.01).
There is evidence of positive uptake of some guideline recommendations by insurers and health professionals; however, there are practices that are not compliant and might lead to poor health outcomes and greater treatment cost. Organisational, regulatory and professional implementation strategies may be considered to change practice, improve scheme performance and ultimately improve outcomes for people with WAD.
这是一项观察性研究,涉及对新南威尔士州4家保险公司的288份随机选择的索赔人档案进行审计,2016年3月至10月澳大利亚。提取的数据包括人口统计,索赔和伤害细节,卫生服务的使用,以及与准则相关的保险公司和健康专业实践。分析涉及描述性统计和相关分析。
全科医生医疗咨询的中位时间为受伤后4天,物理治疗(例如物理治疗)为25天。X线检查的比率较低(21.5%),大多数患者(90%)接受了符合指南建议的积极治疗。指南推荐的其他做法的频率表明,在某些领域的指南依从性较低,例如;使用魁北克工作队分类(19.9%);不使用WADI级和II级的专业成像(例如MRI,45.8%);不使用常规被动治疗(如手动治疗,94.0%);并使用相关预后工具(例如颈部残疾指数,12.8%)。超过一半的索赔人(59.0%)在受伤后9-12周被转介给其他专业人员,其中31.2%是心理学家,68.8%是专家(外科专家,43.6%;WAD专家,20.5%)。法律代表和完整索赔的提出与医疗就诊和成像次数的增加有关(ρ0.23至0.3;p<0.01)。
有证据表明,保险公司和健康专业人员积极采纳了一些指南建议;然而,有些做法不合规,可能导致不良的健康结果和更高的治疗成本.组织,监管和专业实施策略可以被考虑改变实践,提高方案绩效,并最终改善WAD患者的结果。