TEXAS ORTHOPAEDIC ASSOCIATION AUSTIN TEXAS MAY 11 TH 2007

James Walter Simmons, Jr., M.D. International Spine & Orthopaedic Institute San Antonio, Texas Clinical Professor of Orthopaedics and Rehabilitation Clinical Professor of Neurosurgery Galveston, Texas al

Orthopaedic Care of Workers Compensation Spinal Injuries within the Parameters of ODG and EBM

ODG (Official Disability Guidelines) EBM (Evidence Based Medicine)

DWC TITLE 28. INSURANCE Part 2. Texas Department of Insurance, Division of Workers Compensation Chapter 137. Disability Management

ODG (TWC) Low Back Integrated Treatment / Disability Duration Guidelines Low Back, Lumbar, Thoracic (Acute Chronic) Integrated Treatment / Disability Duration Guidelines Low Back, Lumbar, Thoracic (Acute Chronic) pp (2,102 pages)

Evidence-Based Practice: A Primer AAOS Evidence-Based Practice Committee Anthology, Evidence-Based Practice clinical expertise and patient values “The integration of best research evidence with clinical expertise and patient values.” Sackett DL, Straus SE, Richardson WS, et al. Evidence-based medicine. How to practice and teach EBM, 2 nd ed. London: Churchill Livingstone, 2000.

THE RAND INSTITUTE ODG, and other four guidelines studied, scored high in the rigor of development domain by clearly describing the methods used to search for evidence and formulate recommendations (RAND, Evaluating Medical Treatment Guideline Sets for Injured Workers in California, P. 32) THE ODG ARE SCIENTIFICALLY VALID META-ANALYSIS-The Only Scientific Analysis of the Literature THE ODG GUIDELINES ARE EVIDENCE-BASED

A Fair and Balanced View of Spine Fusion Surgery Errico TJ, Gatchel RJ, Schofferman J, Benzel EC, Faciszewski T, Eskay- Auerbach M, Wang JC. A Fair and Balanced View of Spine Fusion Surgery. Spine J Sep-Oct;4 (5 Suppl):S “EBM is not nor is it meant to be an effective cost containment tool, as it is directed toward maximizing a patient’s quality of life, which may increase or decrease the cost of care.”

Practice Guidelines “Practice guidelines bring order out of chaos. They allow the practitioner to develop treatment for a specific patient based not only on his/her experience and personal knowledge, but also on the most up-to-date scientific evidence, recently reviewed and evaluated as to the strength of this evidence. Through the process of guideline development, experts evaluate and distill the universe of information on a clinical problem down to a usable set of parameters to which the physician can apply his/her own experience and knowledge in managing a patient. Guidelines are not a substitute for continued study, but rather represent a focus for the practitioner to provide the best care for his/her patients. Practice guidelines also serve as an excellent reference source for the physician and can function as an educational tool for the patient.” AAOS Evidence-Based Practice Committee Anthology, AAOS Evidence-Based Practice Committee Anthology,

The ODG Duration guidelines are designed for prospective case/claims management as well as retrospective benchmarking. Some of the reasons people use ODG are as follows: effective management of return-to-workTo obtain the information necessary for effective management of return-to-work following illness/injury guidelinesTo reduce delayed recovery rates with evidence-based disability duration guidelines To provide upfront, clear targets for forecasting and reserving WC/STD/LTD/Auto claims clear indications for job modificationTo identify early return-to-work opportunities with clear indications for job modification To benchmark lost work time and cost data to measure return-to- work performance, track outliers and demonstrate the value of case management and occupational health programs To open the lines of communication among all parties in the return- to-work process by providing a common framework based on existing and emerging medical evidence To help injured workers get back on back to work safely, in a reasonable amount of time supported by the evidence

Evidence-Based Guidelines allows Implementation of Evidence- Based Practice AAOS Evidence-Based Practice Committee Anthology, AAOS Evidence-Based Practice Committee Anthology,

AAOS Evidence-Based Practice Committee Anthology, Practice Guidelines Evidence-Based Guidelines Evidence-Based Practice Guidelines Evidence-Based Practice

Thank You and God Bless America