Effects of Workers’ Compensation of the Diagnosis and Surgical Treatment of Patients with Hand and Wrist Disorders

Author(s): Day CS, Alexander M, Lal S, Horton H, Ahn CS, Pauyo T, Rozental TD

Source: J Bone Joint Surg Am 92:2294-9, 2010.

Summary:

Worker’s Compensation insurance can represent a significant portion of the typical upper extremity practice.  The purpose of this retrospective study was twofold.  First, it asks if the diagnostic workup of a patient with Worker’s Compensation insurance is different from a patient with standard health insurance.  Second, it looks at what differences may exist in the treatment of patients with Worker’s Compensation insurance.

Medical records from all patients presenting to a single Hand center over a two-year period were collected.  Patients with Worker’s Compensation insurance were placed in one group and compared to all other insured patients.  Patients without insurance were excluded. 

While patients with Worker’s Compensation insurance tended to be younger males who were smokers, there was no difference in the most common diagnoses between the two groups.  A statistically significant difference was seen in the use of electrodiagnostic testing and MRI scans in patients with Worker’s Compensation insurance, with this population more likely to receive these tests. 

Additionally, patients receiving Worker’s Compensation insurance had nearly twice the number of preoperative office visits than patients with standard insurance (2.3 versus 1.2 visits (p<0.05)).  While a trend toward higher rates of surgical intervention in Worker’s Compensation patients was observed, this was not statistically significant (p<0.07).

The results of this study are consistent with prior studies that show higher rates of health-care resource utilization in the Worker’s Compensation population.  The reasons for this remain unclear.  While limited by its retrospective nature, this study provides additional support to the characteristics of the Worker’s Compensation population.