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Scientific Articles   |    
Effects of Workers’ Compensation on the Diagnosis and Surgical Treatment of Patients with Hand and Wrist Disorders
Charles S. Day, MD, MBA1; Marcus Alexander, MPhil1; Shalini Lal, MD1; Henry Horton, MD1; Christine S. Ahn, BA1; Thierry Pauyo, BS1; Tamara D. Rozental, MD1
1 Department of Orthopedic Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Avenue, Stoneman 10, Boston, MA 02215. E-mail address for C.S. Day: cday1@bidmc.harvard.edu
View Disclosures and Other Information
Disclosure: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity.

Investigation performed at the Department of Orthopedic Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts

Copyright © 2010 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2010 Oct 06;92(13):2294-2299. doi: 10.2106/JBJS.I.00158
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Abstract

Background: 

Workers’ Compensation differs from standard insurance, and it is unclear how or if Workers’ Compensation insurance influences the diagnosis and treatment of hand and wrist disorders. The aim of this study was to compare the diagnosis and course of treatment of hand disorders between patients with Workers’ Compensation insurance and patients with standard insurance.

Methods: 

The complete medical records of patients who visited an academic orthopaedic hand clinic between January 2005 and January 2007 were reviewed, and information on patient history, utilization of diagnostic tests, diagnosis, surgery, and wait-time to surgery was collected. Patients with Workers’ Compensation insurance and those with other, third-party coverage were analyzed and compared. Patients without insurance were excluded from this study.

Results: 

1413 patients (representing 2121 diagnoses) were included in the study. One hundred and sixteen patients (8%) had Workers’ Compensation insurance and 1297 patients (92%) had standard insurance. Patients with Workers’ Compensation insurance were younger than patients with standard insurance (mean age, forty-three years compared with fifty years, respectively; p < 0.05) and were also more likely to be male (50% compared with 40%, respectively; p = 0.04). Generally, Workers’ Compensation patients more often had neurological conditions (p < 0.01), but there was no significant difference in the most common diagnoses between the two groups. Patients with Workers’ Compensation underwent surgery slightly more often than did patients with standard insurance (44% compared with 35%, respectively; p = 0.07) and had a higher average number of visits before undergoing surgery (2.3 visits compared with 1.2 visits, respectively; p < 0.05). Twenty-three (45%) of the fifty-one patients with Workers’ Compensation insurance who received a diagnosis indicating the need for surgery underwent surgery after the first visit, compared with 316 (69%) of 458 patients with standard insurance (p < 0.05). Patients with Workers’ Compensation insurance were more likely than patients with standard insurance to undergo electrodiagnostic testing (26% compared with 15%, respectively; p < 0.01) or magnetic resonance imaging (16% compared with 9%, respectively; p = 0.02).

Conclusions: 

Compared with patients receiving standard insurance, patients receiving Workers’ Compensation insurance have a greater number of clinic visits before undergoing surgery and receive more diagnostic testing. More research is needed to explore these differences and their potential clinical and economic consequences.

Level of Evidence: 

Prognostic Level II. See Instructions to Authors for a complete description of levels of evidence.

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    References

    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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