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.DirectorRWJ 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

0.0%10.0%20.0%30.0%40.0%50.0%60.0%70.0%80.0%90.0%

100.0%

Florida Minnesota

Percent of State

Workers’ Compensation

Claimant Population

Comparisons With Normative Data

0

10

20

30

40

50

60

70

80

90

100

Physical Health Mental Health

FloridaMinnesota

SF

-12

PC

S/M

CS

Sca

l e S

core

Quality of Patient-Provider Interaction and Satisfaction with Provider

1

1.5

2

2.5

3

3.5

4

Florida Minnesota

1

1.5

2

2.5

3

3.5

4

4.5

5

Florida Minnesota

Quality of Patient-Provider Interaction(1=Poor quality, 4=High Quality)

Satisfaction with Provider(1=Dissatisfied, 5=Satisfied)

Job Accommodation & Work Days Missed

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

100.0%

Florida Minnesota

0

20

40

60

80

100

120

Florida Minnesota

Job Accommodation(Percent of state WCC population)

Number of Work Days Missed(Includes weekend days)

Inequities in Florida

1

1.5

2

2.5

3

3.5

4

Whites Nonwhites

50

55

60

65

70

Whites Nonwhites

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

www.winsonline.net