Evaluating Clinical Practice Guidelines Based on Their Association with Return to Work in Administrative Claims Data

Objective

To examine the association between non‐adherence to clinical practice guidelines (s) and time to return to work () for patients with workplace injuries.

Data Sources/Study Setting

Secondary analysis of medical billing and disability data for 148,199 for shoulder and back injuries from a workers' compensation insurer.

Study Design

Cox proportional hazard regression is used to estimate the association between time to and receipt of guideline‐discordant care. We test the robustness of our findings to an omitted confounding variable.

Data Collection

Collected by the insurer from the time an injury was reported, through recovery or last follow‐up.

Principal Findings

Receiving guideline‐discordant care was associated with slower for only some guidelines. Early receipt of care, and getting less than the recommended amount of care, were correlated with faster . Excessive physical therapy, bracing, and injections were associated with slower .

Conclusions

There is not a consistent relationship between performance on s and . The association between performance on and is difficult to measure in observational data, because analysts cannot control for omitted variables that affect a patient's treatment and outcomes. s supported by observational studies or randomized trials may have a more certain relationship to health outcomes.