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In recent years, the California workers’ compensation system has been encumbered by rising costs and high utilization of medical care. To address these concerns, the California legislature passed a series of initiatives that call for the use of evidence-based medical-treatment guidelines concerning, at a minimum, the frequency, duration, intensity, and appropriateness of all treatment procedures and modalities commonly performed in workers’ compensation cases. The American College of Occupational and Environmental Medicine (ACOEM) guidelines were adopted as presumptively correct until alternative plans could be evaluated and a decision made about which guidelines to adopt for the long term. This report presents an evaluation of the medical guidelines that might be used to determine the appropriateness of care provided California’s injured workers. The study identified 72 guidelines for work-related injuries, which were then screened using multiple criteria. Five comprehensive guideline sets were found to satisfy the requirements of the legislation and the preferences of the state. A comparative evaluation was made of both the technical quality and clinical content of the selected guidelines. Based on the results of the evaluation, recommendations are presented for actions the state might take in the short term, the intermediate term, and the longer term.
Table of Contents
Chapter One
Introduction
Chapter Two
Context
Chapter Three
Identifying Guidelines for Work-Related Injury
Chapter Four
Selecting Guidelines for Further Evaluation
Chapter Five
Evaluating the Technical Quality of the Selected Guidelines
Chapter Six
Evaluating the Clinical Content of the Selected Guidelines
Chapter Seven
Stakeholder Issues and Concerns
Chapter Eight
Application of the Guidelines to Determine Whether Care Is Reasonably Required
Chapter Nine
Conclusion
Appendix A
Identified Guidelines That Address Work-Related Injuries
Appendix B
Publicly Posted Screening Criteria
Appendix C
Selecting Clinical Panelists
Appendix D
Sample Rating Forms, Round One
Appendix E
Clinical Panel Ratings, Round Two
Appendix F
Clinical Panelists’ Comments
Appendix G
Participants in the Stakeholder Meeting
Appendix H
Stakeholder Discussion Questions on Guidelines Implementation Issues
The research described in this report was conducted by the RAND Institute for Civil Justice and RAND Health, units of the RAND Corporation. This research was sponsored by the Commission on Health and Safety and Workers’ Compensation and the Division of Workers’ Compensation, California Department of Industrial Relations.
This report is part of the RAND Corporation Monograph series. RAND monographs present major research findings that address the challenges facing the public and private sectors. All RAND monographs undergo rigorous peer review to ensure high standards for research quality and objectivity.
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