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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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