CALIFORNIA BACK INJURIES AND TREATMENT GUIDELINES: EVIDENCE BASED MEDICINE (EBM) AND WORKERS’ COMPENSATION:  WHAT YOU NEED TO KNOW

California Workers’ Compensation has embraced Evidence Based Medicine (EBM) to dictate industrial medical care authorization.

Thus, when a EBM study is published, the Workers’ Compensation Community looks to its conclusions. The community looks to see the results are aligned with the Labor Code’s mandate to provide treatment to cure or relieve from the effects of an industrial injury.

Back Injury treatment was assessed in a recent EBM study.  They looked to see if  guidelines treatment achieved favorable results.  The results of such a study can shape both insurance company and medical office policy.

This article will discuss the study which looked at California back injury treatment in light of EBM-related guidelines.

What Is Evidence Based Medicine?

Evidence Based Medicine “…integrates medical research with clinical expertise and patient values to support decision making based on the best available evidence.” Gaspar FW, Thiese MS, Wizner K, Hegmann K. Guideline adherence and lost workdays for acute low back pain in the California workers’ compensation system. PLoS One. 2021 Jun 17;16(6):e0253268. doi: 10.1371/journal.pone.0253268. PMID: 34138937; PMCID: PMC8211224.

In other words, an Injured Worker’s treatment is geared more towards past research and study results. The Injured Worker’s treating physician’s clinical impressions are viewed as secondary. Thus, EBM-like treatment is provided in an algorithmic or formulaic fashion.

What Was the Study’s Purpose?

“The aim of this study was to determine the influence of adherence to guideline recommendations on lost workdays for workers with acute LBP(low back pain) claims in California’s WC system.” Gaspar FW, Thiese MS, Wizner K, Hegmann K. Guideline adherence and lost workdays for acute low back pain in the California workers’ compensation system. PLoS One. 2021 Jun 17;16(6):e0253268. doi: 10.1371/journal.pone.0253268. PMID: 34138937; PMCID: PMC8211224.

In other words, treatment currently can be in a number of modality forms.  Some are within guidelines, some treatment which is not recommended by guidelines and some others.  During an accepted claim, Injured Workers’ treatment are usually authorized.  Sometimes, authorized treatment can be ones that are outside of the guidelines.

What Is Guideline Treatment?   

Guideline treatment is based upon the “American College of Occupational and Environmental Medicine (ACOEM)’s Low Back Disorders Practice Guideline was used as the source of guideline recommendations [16]. ACOEM’s treatment guidelines have been adopted in California’s Medical Treatment Utilization Schedule (MTUS), which determines what is reasonable and necessary medical care.” Gaspar FW, Thiese MS, Wizner K, Hegmann K. Guideline adherence and lost workdays for acute low back pain in the California workers’ compensation system. PLoS One. 2021 Jun 17;16(6):e0253268. doi: 10.1371/journal.pone.0253268. PMID: 34138937; PMCID: PMC8211224.

What Is the Criticism of the Study? 

The study did not look at every back condition.  The study limited itself to very specific back conditions.  Thus, the results are very limited.  The danger of such a study it will be interpreted to apply to back conditions that were not part of the study.

As noted in the study, “to focus on the treatment of uncomplicated LBP claims, claims were removed if they had an inpatient admission during the claim or a “red flag” diagnosis that may indicate treatment outside of guideline recommendations, such as fracture, cancer, infection, aortic aneurysm, and paralysis (S1 Table). Claims were excluded with stenosis diagnoses if they also had an accompanying surgical procedure (i.e., decompression, fusion, or adhesiolysis). Claims were also excluded if there had been a prior LBP claim to remove complicated clinical presentations due to LBP recurrences.” Gaspar FW, Thiese MS, Wizner K, Hegmann K. Guideline adherence and lost workdays for acute low back pain in the California workers’ compensation system. PLoS One. 2021 Jun 17;16(6):e0253268. doi: 10.1371/journal.pone.0253268. PMID: 34138937; PMCID: PMC8211224. [emphasis added]

Thus, the study should not be considered one that should be viewed in an expansive nature.   It was limited as many back problems were not addressed.  It only address uncomplicated back pain complaints.

What Did the Study Look at?

The workers were placed into categories concerning whether or not they received guideline treatment.   Likewise, there were categories in which they received no guideline treatment or no treatment at all. Gaspar FW, Thiese MS, Wizner K, Hegmann K. Guideline adherence and lost workdays for acute low back pain in the California workers’ compensation system. PLoS One. 2021 Jun 17;16(6):e0253268. doi: 10.1371/journal.pone.0253268. PMID: 34138937; PMCID: PMC8211224.

What Were the Study’s Results?

The results of the study were that “[w]hen workers received guideline-recommended interventions, they typically returned to work in fewer days. The majority of workers received at least one non-recommended intervention, demonstrating the need for adherence to guideline recommendations. Fewer lost workdays and improved quality care are outcomes that strongly benefit injured workers.”

The other result of interest was that “workers who received either no intervention or other medical interventions experienced more favorable outcomes than those who received non-recommended interventions”  This result suggests that alternative treatment or no treatment is better than non-recommended interventions.

What If I Need Advice?

If you would like a free consultation regarding workers’ compensation, please contact the Law Offices of Edward J. Singer, a Professional Law Corporation. We have been helping people in Central and Southern California deal with their workers’ compensation cases for 27 years. Contact us today for more information.

ACOEM COVID-19 GUIDELINES AND WORKERS’ COMPENSATION: INJURED WORKERS WITH COVID-19 AND THEIR TREATMENT: WHAT YOU NEED TO KNOW

Medical Treatment Guidelines are important for Injured Workers.   Medical Treatment Guidelines provide instructions to Physicians as to how and what to request as far as treatments and testing.

ACOEM has issued COVID-19 Guidelines. Recently, there were updated COVID Guidelines on 8/19/20.

This article will discuss the ACOEM COVID-19 Guidelines with respect to workers’ compensation.

What Is ACOEM?

ACOEM is the abbreviation for the American College of Occupational and Environmental Medicine.  ACOEM a physician-led organization that focuses on the health of workers, safety of workplaces, and quality of environments.

Why Are ACOEM Guidelines Important?

Per a News Release of 5/27/20 from the California Department of Industrial Relations, notes that “the Division of Workers’ Compensation (DWC) supports this guidance and plans to adopt and incorporate the ACOEM Coronavirus (COVID-19) Guideline into the Medical Treatment Utilization Schedule (MTUS).”

 As An Injured Worker, Why are These Guidelines Important?

The Guidelines are important because they will give you insight as what testing and treatment will be approved on an industrial basis.  Items not recommended by the Guidelines may not be approved by Insurance Company Utilization Review Programs.

What Are the ACOEM Recommended Testing for COVID?

Testing recommended in the ACOEM Guides are PCR testing, Antigen Testing, and Antibody Testing of Blood Serum.   The first two will be recommended.  The third will be subject to possible UR denial. It is to be used for certain purposes.  ACOEM Covid-19 Guidelines, 8/19/20.

What are the ACOEM Recommended Diagnostic Imaging for COVID?

X-Rays are recommended. Note: abnormalities show 10-12 days out from infection.

CT Scans are recommended.  ACOEM Covid-19 Guidelines, 8/19/20.

What Medications that are Recommended or Not Recommended for Use for COVID-19?

Hydroxychloroquine is not recommended for the treatment of patients with COVID-19 after the first three days of symptoms. There is no recommendation for or against use of Hydroxychloroquine in the first three days of symptoms ACOEM Covid-19 Guidelines, 8/19/20.

Chloroquine is not recommended for the treatment of patients with COVID-19 after the first three days of symptoms. There is no recommendation for or against use of Chloroquine in the first three days of symptoms. ACOEM Covid-19 Guidelines, 8/19/20.

Hydroxychloroquine or Chloroquine for Widespread Prophylaxis are not recommended. ACOEM Covid-19 Guidelines, 8/19/20.

Azithromycin is not recommended for the adjunctive treatment of selective patients with more severe COVID-19.  There is no recommendation for or against it use within the first three days. ACOEM Covid-19 Guidelines, 8/19/20.

Favipiravir has: no recommendation for or against the use for COVID-19. ACOEM Covid-19 Guidelines, 8/19/20.

Lopinavir / Ritonavir is recommended in combination therapy but is not recommended as a solitary treatment. ACOEM Covid-19 Guidelines, 8/19/20.

Remdesivir is recommended for the supervised treatment of selected patients with COVID-19. ACOEM Covid-19 Guidelines, 8/19/20.

Interleukin 6- Inhibitors are recommended for the treatment of selected patients with COVID-19. ACOEM Covid-19 Guidelines, 8/19/20.
Convalescent COVID -19 Antibodies have no recommendation for or against the use. ACOEM Covid-19 Guidelines, 8/19/20.

Glucocorticosteroids are provisionally recommended for the treatment of COVID 19, There are other indications of use that may occur in the context of treatment of COVID-19 for example asthma or COPD. ACOEM Covid-19 Guidelines, 8/19/20.

Interferon Beta-1b: recommended adjunctive use is recommended for treatment of selected patients with COVID-19. ACOEM Covid-19 Guidelines, 8/19/20.

Ribavirin is recommended for adjunctive use of ribavirin for treatment of selected patients with COVID-19 ACOEM Covid-19 Guidelines, 8/19/20.

Zinc is recommended for potential prevention of more severe disease well as treatment of patients for COVID-19. ACOEM Covid-19 Guidelines, 8/19/20.

Vitamin D is recommended for potential prevention of more severe disease as well as treatment for patients with COVID-19. ACOEM Covid-19 Guidelines, 8/19/20.

What if I Need Advice?

If you would like a free consultation regarding workers’ compensation, please contact the Law Offices of Edward J. Singer, a Professional Law Corporation. We have been helping people in Central and Southern California deal with their workers’ compensation cases for 27 years. Contact us today for more information.

 

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