Re: Measuring the success of our rehab programs

In his October column (BCMJ 2005;47[8]:419), Dr Graham provides some impressive “durable return-to-work” statistics for the various WorkSafeBC-sponsored programs. I was particularly interested to read that chronic pain programs have a 61% durable return-to-work rate.

However, reading further, I saw that “durable return-to-work” is defined as the number of workers no longer receiving wage loss 3 months after discharge.

In my experience, workers have their WorkSafeBC wage-loss benefits terminated after such programs as they are no longer considered “temporarily disabled.” Within this group are a component of workers who are considered “permanently partially disabled” and, as their condition has plateaued, will be considered for a permanent partial disability pension (usually with a 12- to 18-month wait time). They have not returned to work.

There are also a number of workers who, once their WorkSafeBC benefits are terminated, find their claim is no longer considered “compensable” and apply for long-term disability coverage through their disability insurance carriers.

I ask Dr Graham and WorkSafeBC to clarify the criteria used to define “durable return-to-work.” If the assumption is being made that because benefits have been cut off, the worker must have returned to durable work, then this is erroneous and misleading.

—John Sehmer, MD

Dr Graham responds

Dr Sehmer has rightly questioned the relationship between claim closure and viable return-to-work (RTW) stats from the Chronic Pain Providers for the Rehabilitation Network. The simple truth is that this measure is the easiest to track and measure, but it does relate to other tracking methods as well.

Those deemed as durable RTW outcomes include workers who are off wage-loss but are receiving vocational rehabilitation benefits as well as workers who are off wage-loss but may not necessarily be back at work. We recognize that there are a variety of reasons why a worker’s entitlement to wage-loss benefits may change, however this is currently the best measure for evaluating program performance based on RTW that is available to us.

Historically, durable return-to-work outcomes were established based on a survey of a representative number of program participants by an outside agency evaluating the worker’s actual return-to-work status. This was a costly and time-consuming method of gathering the information that did not prove to be much different from using the wage-loss status as a parameter.

In the future, we will have an electronic in-house tracking system that will give us superior outcome stats, but for now, this is the most reliable system available.

—Don Graham, MD
Director, Clinical and Health Care Services

John Sehmer, MD, Don Graham, MD, CCFP. Re: Measuring the success of our rehab programs. BCMJ, Vol. 47, No. 10, December, 2005, Page(s) 530 - Letters.

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