Ben Amick, Ph.D. Worker Injury National Survey University of Texas

The Worker Injury National Survey (WINS) California Project WINS Project Collaborative California Research Colloquium On Workers’ Compensation Medical Benefit, Delivery and Return to Work Ben Amick, PhD May 1 - 2, 2003, Los Angeles, CA This Project is Supported By a Grant (#038157) from the Workers’ Compensation Health Initiative, a national program of the Robert Wood Johnson Foundation. Original data collection supported by the States of Florida and Minnesota. The California WINS Project is supported by the California Workers’ Compensation Commission.

Take Home Messages Evidence-based policy dialog requires credible information WINS provides claimant/patient reported information on the quality of workers’ compensation medical care WINS allows for system inequities to be identified and tracked WINS leverages existing data systems

Background Summing up the vision of the RWJ Foundation “We have learned that the best results can be obtained when all the key stakeholders – workers, employers, health care providers, insurers, regulators – can have access to credible information and data about workers’ compensation and quality-of-care strategies.” Jay Himmelstein, M.D. Director RWJ Workers’ Compensation Health Initiative

WINS Guiding Principles  State participation  Information must be scientifically credible  Survey instrument will have core & modules  Public access to data  Secure and confidential data  Significant outreach to all stakeholders

A Survey Solves Key Problems  Injured workers ‘voice’ represented  Provides critical data to State WC decision-makers and researchers  Captures otherwise unavailable process and outcome data  Can monitor quality improvement over time  Comparable WCMC data across states

WINS Pilot in Florida & Minnesota It can be done! survey implementation data entry merging with administrative data weighting to generate true population parameters States showed interesting differences States showed interesting similarities Within states, system inequities existed

An Interesting Difference Employer Choice of Physician Percent of State Workers’ Compensation Claimant Population

Comparisons With Normative Data SF-12 PCS/MCS Scale Score

Quality of Patient-Provider Interaction and Satisfaction with Provider Quality of Patient-Provider Interaction (1=Poor quality, 4=High Quality) Satisfaction with Provider (1=Dissatisfied, 5=Satisfied)

Job Accommodation & Work Days Missed Job Accommodation (Percent of state WCC population) Number of Work Days Missed (Includes weekend days)

Inequities in Florida Work Role Functioning (1=Poor Functioning, 4=High Functioning) Number of Work Days Missed (Includes weekend days)

Workers’ Compensation Quality of Care Key Indicators Process Provider (e.g., Interaction Quality) Insurer (e.g., Refuse Treatment Plan) Employer (e.g., Job Accommodations) Outcome Health Satisfaction with Care Economic Employment Structure Provider Type (e.g., Chiropractor) Access Pre-Injury Employment Conditions System of Care

What Will Californians Learn? How Workers’ Compensation Medical Care Compares to General Medical Care? –Built in comparisons with Consumer Assessment of Health Plans (CAHPS) for Access to care Quality of doctor-patient interaction Satisfaction with care –CAHPS is a national benchmarking database for public and private employers, health plans and Medicaid organizations

What Will Californians Learn? Are there Inequities in Workers’ Compensation Medical Care Quality? –Structural, Process and Outcome How does California’s Workers’ Compensation Medical Care Quality compare with other States? –Currently Florida and Minnesota –Near future 13 States

What Will Californians Learn? Does quality vary by provider type or system of care? –Employer choice, Chiropractor, MCO What are the productivity consequences to employers? –Work role functioning

WINS Data Leverages Other Information Systems  Medical procedures and payments  Provider types  Worker, job, and employer, characteristics, pre- and post-injury  Medical and income benefit payments  Injury characteristics

New Accountability! A survey builds accountability into the system from the injured workers perspective “At age 29 now 42 years of age. feel abandoned from all that at one time I was lead to belief out there to help the worker that had the only thing going for them there full use of body. Now some years ago had my life turned upside down by act. of injury on the job. [….] Now 100% disable as I was at time of injury would like to see support "no progress in way of help of opportunity of true concern" for all inline for this hell yet unexp. as I wish this on none but at same time feel they that outline others life to this act of cruelty walk if only one day in the shoes of us that live here in this pain, rejection, and offers of hope without hope of offer.”

Thank You