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Martin B.I.,Dartmouth College | Franklin G.M.,Washington State Department of Labor and Industries | Deyo R.A.,Oregon Health And Science University | Wickizer T.M.,Ohio State University | And 2 more authors.
Spine Journal | Year: 2014

Background context In response to increasing use of lumbar fusion for improving back pain, despite unclear efficacy, particularly among injured workers, some insurers have developed limited coverage policies. Washington State's workers' compensation (WC) program requires imaging confirmation of instability and limits initial fusions to a single level. In contrast, California requires coverage if a second opinion supports surgery, allows initial multilevel fusion, and provides additional reimbursement for surgical implants. There are no studies that compare population-level effects of these policy differences on utilization, costs, and safety of lumbar fusion. Purpose The purpose of this study was to compare population-level data on the use of complex fusion techniques, adverse outcomes within 3 months, and costs for two states with contrasting coverage policies. Study design and setting The study design was an analysis of WC patients in California and Washington using the Agency for Healthcare Research and Quality's State Inpatient Databases, 2008-2009. Patient sample All patients undergoing an inpatient lumbar fusion for degenerative disease (n=4,628) were included the patient sample. Outcome measure(s) Outcome measures included repeat lumbar spine surgery, all-cause readmission, life-threatening complications, wound problems, device complications, and costs. Methods Log-binomial regressions compared 3-month complications and costs between states, adjusting for patient characteristics. Results Overall rate of lumbar fusion operations through WC programs was 47% higher in California than in Washington. California WC patients were more likely than those in Washington to undergo fusion for controversial indications, such as nonspecific back pain (28% versus 21%) and disc herniation (37% versus 21%), as opposed to spinal stenosis (6% versus 15%), and spondylolisthesis (25% versus 41%). A higher percentage of patients in California received circumferential procedures (26% versus 5%), fusion of three or more levels (10% versus 5%), and bone morphogenetic protein (50% versus 31%). California had higher adjusted risk for reoperation (relative risk [RR] 2.28; 95% confidence interval [CI], 2.27-2.29), wound problems (RR 2.64; 95% CI, 2.62-2.65), device complications (RR 2.49; 95% CI, 2.38-2.61), and life-threatening complications (RR 1.31; 95% CI, 1.31-1.31). Hospital costs for the index procedure were greater in California ($49,430) than in Washington ($40,114). Conclusions Broader lumbar fusion coverage policy was associated with greater use of lumbar fusion, use of more invasive operations, more reoperations, higher rates of complications, and greater inpatient costs. © 2014 Elsevier Inc. All rights reserved. Source


Bao S.,Washington State Department of Labor and Industries
Handbook of Clinical Neurology | Year: 2015

This chapter discusses mechanical stressors that are believed to be associated with work-related musculoskeletal disorders. It starts with an introduction to work-related musculoskeletal disorders (particularly those with high incidences in workplaces, such as disorders of low back, neck/shoulder, hand/wrist, elbow, and knee) in high-risk industries, and those mechanical stressors (such as high forces, awkward postures, high repetitions, excessive contact stress, and harmful human vibrations) in workplaces that are responsible for these disorders. Quantification methods of these mechanical stressors are then discussed. Although various quantification methods such as self-report, observational technique, and direct measurement are discussed, details are focused on many of those well-published observational techniques used by practitioners to assess risk levels of these mechanical stressors in jobs. These methods can quantify job mechanical stressors and provide risk level indications that can be used by practitioners to facilitate their decision making. These methods can also be used to evaluate the improvements of ergonomics interventions by comparing the risk levels quantitatively before and after the interventions. © 2015 Elsevier B.V. Source


Miller M.E.,Washington State Department of Labor and Industries
Journal of Agromedicine | Year: 2012

The purpose of this paper is to review the background of key legislative and regulatory milestones of the initial laws and federal child labor provisions limiting hazardous work by children in agriculture up to the more recent developments contributing to the proposed updates to the agricultural hazardous occupations orders. A summary of the key changes are described and the significant differences between agricultural and nonagricultural regulations are highlighted. Recommendations for future policy are provided. © 2012 Copyright Taylor and Francis Group, LLC. Source


Graves J.M.,University of Washington | Fulton-Kehoe D.,University of Washington | Jarvik J.G.,Cost and Outcomes Research Center | Jarvik J.G.,University of Washington | And 2 more authors.
Spine | Year: 2012

STUDY DESIGN.: A population-based, prospective cohort study. OBJECTIVE.: To evaluate the association of early imaging and health and disability status 1 year following acute low back injury, among a population-based sample of Washington State workers' compensation claimants. SUMMARY OF BACKGROUND DATA.: Use of early diagnostic magnetic resonance imaging (MRI) for low back pain (LBP) contributes to increasing health care costs but may not lead to better outcomes than delayed imaging. In the worker's compensation system, LBP is common and costly. This research examines the association between early MRI among workers with LBP and health outcomes (pain intensity, Roland disability score, and 36-Item Short Form Health Survey scores) and disability status 1 year after injury. METHODS.: This nonrandomized prospective cohort study of Washington State workers' compensation claimants with nonspecific LBP used administrative claims and interview data. Multivariable regression methods were used to estimate change in health outcome scores, the relative risk of disability at 1 year, and the rate of recovery 1 year after injury. RESULTS.: Of 1226 participants, 18.6% received early MRI. Most (77.9%) had mild/major sprains and 22.1% had radiculopathy. Participants with early MRI differed significantly at baseline in pain, function, and psychosocial variables. After adjusting for covariates, early imaging was not associated with substantial differences in 1-year health outcomes for sprains or radiculopathy. For workers with mild/major sprain, early imaging was associated with a 2-fold increase in the likelihood of work disability benefits at 1 year (adjusted relative risk: 2.03, 95% confidence interval: 1.33-3.11). Early imaging was not associated with an increased risk of long-term disability for workers with radiculopathy (adjusted relative risk: 1.31, 95% confidence interval: 0.84-2.05). For both groups, early MRI was associated with longer disability duration (P < 0.001). CONCLUSION.: Among workers with LBP, early MRI is not associated with better health outcomes and is associated with increased likelihood of disability and its duration. These associations warrant further testing in a randomized controlled trial. Our findings suggest that adherence to evidence-based guidelines is an important factor in ensuring that workers receive the highest quality care for occupational injuries. Copyright © 2012 Lippincott Williams & Wilkins. Source


Graves J.M.,Washington State University | Miller M.E.,Washington State Department of Labor and Industries
American Journal of Industrial Medicine | Year: 2015

Background: The relationship between sleep and occupational injury risk has not been adequately explored for working adolescents. Methods: Data were analyzed from the 2010 Washington State Healthy Youth Survey of 8th, 10th, and 12th grade public school students. Teens reported average school and weekend night sleep hours and history of work-related injury that received medical treatment. Multivariable logistic regression evaluated the association between sleep duration and occupational injury. Results: Of 4,144 working teens, 6.4% reported ever having an occupational injury. Teens who sleep ≤5hr/school night had greater odds of a history of occupational injury than those sleeping 8hr (OR:2.91, 95% CI:1.85-4.57). No significant association was observed for weekend night sleep duration. Conclusions: Reduced school night sleep was associated with increased odds of work-related injury in adolescents. Long hours and late night schedules may contribute to decreased sleep time and potentially have other health and developmental impacts for youth. Am. J. Ind. Med. 58:464-471, 2015. © 2015 Wiley Periodicals, Inc. Source

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