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

ABSTRACT: To examine the association between non-adherence to clinical practice guidelines (CPGs) and time to return to work (RTW) for patients with workplace injuries.Secondary analysis of medical billing and disability data for 148,199 for shoulder and back injuries from a workers' compensation insurer.Cox proportional hazard regression is used to estimate the association between time to RTW and receipt of guideline-discordant care. We test the robustness of our findings to an omitted confounding variable.Collected by the insurer from the time an injury was reported, through recovery or last follow-up.Receiving guideline-discordant care was associated with slower RTW for only some guidelines. Early receipt of care, and getting less than the recommended amount of care, were correlated with faster RTW. Excessive physical therapy, bracing, and injections were associated with slower RTW.There is not a consistent relationship between performance on CPGs and RTW. The association between performance on CPG and RTW is difficult to measure in observational data, because analysts cannot control for omitted variables that affect a patient's treatment and outcomes. CPGs supported by observational studies or randomized trials may have a more certain relationship to health outcomes.

SUBMITTER: Roberts ET

PROVIDER: S-EPMC4874815 | biostudies-other | 2016 Jun

REPOSITORIES: biostudies-other

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

Roberts Eric T ET DuGoff Eva H EH Heins Sara E SE Swedler David I DI Castillo Renan C RC Feldman Dorianne R DR Wegener Stephen T ST Canudas-Romo Vladimir V Anderson Gerard F GF

Health services research 20150914 3

<h4>Objective</h4>To examine the association between non-adherence to clinical practice guidelines (CPGs) and time to return to work (RTW) for patients with workplace injuries.<h4>Data sources/study setting</h4>Secondary analysis of medical billing and disability data for 148,199 for shoulder and back injuries from a workers' compensation insurer.<h4>Study design</h4>Cox proportional hazard regression is used to estimate the association between time to RTW and receipt of guideline-discordant car ...[more]

PMID: 26368813

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Project description:Importance:It is well documented that financial conflicts of interest influence medical research and clinical practice. Prior to the Open Payments provisions of the Affordable Care Act, financial ties became apparent only through self-disclosure. The nature of financial interests has not been studied among physicians who develop dermatology clinical practice guidelines. Objective:To evaluate payments received by physicians who author dermatology clinical practice guidelines, compare disclosure statements for accuracy, determine whether pharmaceutical companies from which the authors received payments manufactured products related to the guidelines, and examine the extent to which the American Academy of Dermatology enforced their Administrative Regulations for guideline development. Design, Setting, and Participants:Three American Academy of Dermatology guidelines published from 2013 to 2016 were retrieved. Double data extraction was used to record financial payments received by 49 guideline authors using the Open Payments database. Payments received by the authors from the date of the initial literature search to the date of publication were used to evaluate disclosure statement accuracy, detail the companies providing payments, and evaluate Administrative Regulations enforcement. This study is applicable to clinical practice guideline panels drafting recommendations, physicians using clinical practice guidelines to inform patient care, and those establishing policies for guideline development. Main Outcomes and Measures:Our main outcomes are the monetary values and types of payments received by physicians who author dermatology guidelines and the accuracy of disclosure statements. Data were collected from the Open Payments database and analyzed descriptively. Results:Of the 49 authors evaluated, 40 received at least 1 reported industry payment, 31 accepted more than $1000, 25 accepted more than $10?000, and 18 accepted more than $50?000. Financial payments amounted to a mean of $157?177 per author. The total reimbursement among the 49 authors from 2013 to 2015 was $7?701?681. Of the 40 authors receiving payments, 22 did not accurately disclose industry relationships. Authors received payments from companies with products directly related to the guideline topic. Violations to the Administrative Regulations were found. Conclusions and Relevance:Dermatology clinical practice guideline authors received sizable industry payments and did not completely disclose these payments. The American Academy of Dermatology policies may benefit from stricter enforcement or the adoption of new standards.

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

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

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