Predicting work-related disability and medical cost outcomes: A comparison of injury severity scoring methods
| Autor: | Laura Blanar, Stephen M. Bowman, Jeanne M. Sears |
|---|---|
| Rok vydání: | 2014 |
| Předmět: |
Washington
medicine.medical_specialty Occupational injury Workers' compensation Context (language use) Work related Occupational safety and health Disability Evaluation Injury Severity Score Cost of Illness International Classification of Diseases Predictive Value of Tests medicine Humans Disabled Persons Registries Occupational Health General Environmental Science Abbreviated Injury Scale business.industry Prognosis medicine.disease Explained variation Occupational Injuries Quality Improvement United States Physical therapy Workers' Compensation Wounds and Injuries General Earth and Planetary Sciences business |
| Zdroj: | Injury. 45:16-22 |
| ISSN: | 0020-1383 |
| DOI: | 10.1016/j.injury.2012.12.024 |
| Popis: | Introduction Acute work-related trauma is a leading cause of death and disability among U.S. workers. Occupational health services researchers have described the pressing need to identify valid injury severity measures for purposes such as case-mix adjustment and the construction of appropriate comparison groups in programme evaluation, intervention, quality improvement, and outcome studies. The objective of this study was to compare the performance of several injury severity scores and scoring methods in the context of predicting work-related disability and medical cost outcomes. Methods Washington State Trauma Registry (WTR) records for injuries treated from 1998 to 2008 were linked with workers’ compensation claims. Several Abbreviated Injury Scale (AIS)-based injury severity measures (ISS, New ISS, maximum AIS) were estimated directly from ICD-9-CM codes using two software packages: (1) ICDMAP-90, and (2) Stata's user-written ICDPIC programme (ICDPIC). ICDMAP-90 and ICDPIC scores were compared with existing WTR scores using the Akaike Information Criterion, amount of variance explained, and estimated effects on outcomes. Competing risks survival analysis was used to evaluate work disability outcomes. Adjusted total medical costs were modelled using linear regression. Results The linked sample contained 6052 work-related injury events. There was substantial agreement between WTR scores and those estimated by ICDMAP-90 (kappa = 0.73), and between WTR scores and those estimated by ICDPIC (kappa = 0.68). Work disability and medical costs increased monotonically with injury severity, and injury severity was a significant predictor of work disability and medical cost outcomes in all models. WTR and ICDMAP-90 scores performed better with regard to predicting outcomes than did ICDPIC scores, but effect estimates were similar. Of the three severity measures, maxAIS was usually weakest, except when predicting total permanent disability. Conclusions Injury severity was significantly associated with work disability and medical cost outcomes for work-related injuries. Injury severity can be estimated using either ICDMAP-90 or ICDPIC when ICD-9-CM codes are available. We observed little practical difference between severity measures or scoring methods. This study demonstrated that using existing software to estimate injury severity may be useful to enhance occupational injury surveillance and research. |
| Databáze: | OpenAIRE |
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