Medical Management

Study: Aggressive Beats Conservative Care for Best Outcomes

Early, aggressive care can improve outcomes and reduce costs, studies show.
By: | December 1, 2014

Shorter claim durations, lower indemnity costs, and less litigation may result from early, aggressive care of injured workers. Those are the results of a pilot study on clinical practice guidelines, according to Harbor Health Systems.

While proponents say guidelines allow for a reduction in health care variation and lead to enhanced value and improved patient care, critics say they may impede innovation and promote “cookbook” medicine. The study compared claims that received aggressive care where the date of surgery was prior to the recommendations of clinical practice guidelines with conservative care where the date of surgery was beyond the guideline recommendations.

“The findings show that when knowledgeable and experienced physicians were allowed to perform some common specific surgical procedures prior to the recommendations of the guidelines, the outcomes improved,” according to the newly released white paper. “These results demonstrate the importance of integrating best-in-class physicians with the use of evidence-based guidelines, and validate the importance of outcomes-based networks by supporting the concept of working with experienced, proven providers and accelerating care when there is a trusted diagnosis.”

The study included data from more than 700,000 claims with a date of injury between January 2010 and June 30, 2012, from one of four common procedures: ACL repair, knee menisectomy, shoulder rotator cuff repair, and carpal tunnel injuries. The researchers used the Official Disability Guidelines from the Work Loss Data Institute as a reference point to separate the claims into aggressive or conservative care.

“Within the workers’ compensation industry in the United States, the Official Disability Guidelines are commonly used to assess the appropriateness of requested medical care. These guidelines typically outline a progressive course of treatment based on the diagnosis of the patient,” the paper states. “The purpose of this study is to investigate whether allowing some common specific surgical procedures to be performed prior to the guideline recommendation would impact the outcome of the case.”

To determine the outcome of a case, the authors considered the cost of the claim, number of disability days, and claim duration. According to the authors, the more aggressive approach achieved the following results:

  • Reductions in claim duration from 13-20 percent.
  • Reductions in indemnity costs from 19-61 percent.
  • Reductions in litigation from 7.2-16 percent.

“In all of the procedures studied, there is a statistically significant shorter time in the study group (aggressive care) versus the control group (conservative care) with regard to the interval between the date of injury and date of surgery,” according to the report. “Therefore, the premise of this paper is validated as this parameter confirmed the validity of the cohorts.”

There was also a noticeable different in the litigation rates with a “remarkably lower litigation rate in the study group compared to the control group,” the paper said. “Perhaps a perceived delay of care led to the higher litigation rate in the control group, or by virtue of the litigation and perhaps change of treating physicians, the surgery was delayed in the control group.”


Nancy Grover is the president of NMG Consulting and the Editor of Workers' Compensation Report, a publication of our parent company, LRP Publications. She can be reached at [email protected]

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