1. Functional Recovery Pilot(s): What have we learned? Advisory Committee on HealthCare Innovation and Evaluation October 23, 2014

2. What are FRQ and FRI? Functional Recovery Questionnaire (FRQ):  Identify workers at risk for long term disability using a six question questionnaire. Functional Recovery Interventions (FRI):  Help providers identify and implement interventions to reduce likelihood of disability.

3. FRQ Development  $1.5 million, 5 year grant  Predictors of disability in workers with back sprains and CTS  Early baseline interviews  Multivariate statistical models

4. Baseline Interviews Timing  Conducted within 6 weeks after claim filing  Median 18 days Domains  Sociodemographic  Clinical  Pain and Function  Psychosocial  Health Behaviors  Employment

5. Prediction of Work Disability 1 Year After Back Sprain N=1885 14% on TL 1 at 1 year Pain interference with ability to work 2 N=743 <2% on TL at 1 year N=1142 22% on TL at 1 year Current work status 3 N=684 30% on TL at 1 year N=458 10% on TL at 1 year Radiating pain 4 N=523 36% on TL at 1 year N=161 10% on TL at 1 year <5≥5 not workingworking yesno 1 On TL=on time loss (receiving wage replacement benefits) 2 0=no interference to 10=unable to carry on any activities 3 Approximately 3 weeks after injury 4 Pain, numbness, or tingling that travels down your leg Fulton-Kehoe et al. J Occup Environ Med 2008; 50:1042-1052

6. Functional Recovery Pilots Approximate DatesPilot Participants Find Candidates Administer and Score Questionnaire Notification of Positives Received By Conduct Appropriate Intervention June 2010-June 2011 The Everett Clinic COHE and L&I L&I Teams L&I Early Claims Solutions COHE Health Services Coordinator None tested Oct 2011-Sep 2012 Six Provider Clinics Provider’s Office (with support from UW/L&I) Provider’s OfficeProvider Mar 2013- Mar 201433 Volunteer Providers and University of Washington UW (with support from L&I) UWProvider

7. Functional Recovery Pilots Successes to date:  Several models of FRQ administration have been tested.  Initial tests of FRI have been completed. Challenges include:  It is difficult to identify workers for FRQ administration.  Current models for FRQ not replicable outside of pilot.  Providers haven’t agreed that FRI are needed for all FRQ+ patients.  Providers report FRI more appropriate for less experienced peers.  FRI documentation and tracking was difficult.

8. What worked best? Find Candidates Administer and Score Questionnaire Notification of Positives Received By Conduct Appropriate Intervention Centralized: L&I and UW Provider: needed improvement What’s next? Centralized: COHE HSC Provider: COHE HSC and/or Provider

9. Next Steps FRQ  COHE Community of Eastern Washington is conducting a quality-improvement project with FRQ  In first year, the COHE will: –Figure out how to integrate the FRQ into Health Services Coordinators (HSCs) standard work processes –Identify providers to receive FRQ+ notifications –Collaborate closely with L&I team to monitor progress and address implementation issues –Track lessons learned to inform future potential expansion of FRQ use

10. Next Steps FRI  Analyze provider and HSC feedback from earlier pilots  Develop and enhance FRI protocol(s)  Develop toolkit(s) and training materials  Identify providers to incorporate FRI into practice (with FRQ team)  Collect input from participants and incorporate improvements  Make improved FRI broadly available