| Preface |
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iii | |
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ix | |
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xi | |
| Summary |
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xiii | |
| Acknowledgments |
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xxxiii | |
| Glossary |
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xxxvii | |
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1 | (4) |
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5 | (14) |
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Policies Governing Medical Care in the California Workers' Compensation System |
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5 | (4) |
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The Role of the Primary Treating Physician |
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6 | (1) |
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The Role of Medical Treatment Guidelines |
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6 | (2) |
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Implications for Utilization Management in California Workers' Compensation |
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8 | (1) |
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Implications for Disputes over Medical Treatment |
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8 | (1) |
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Background on Evidence-Based Medicine, Medical Treatment Guidelines, and Utilization Management |
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9 | (10) |
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10 | (3) |
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Medical Treatment Guidelines |
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13 | (1) |
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14 | (5) |
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Identifying Guidelines for Work-Related Injury |
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19 | (2) |
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19 | (1) |
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20 | (1) |
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Selecting Guidelines for Further Evaluation |
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21 | (8) |
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21 | (5) |
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Defining Selection Criteria Based on the Legislation |
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21 | (1) |
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Developing Selection Criteria with CHSWC and DWC |
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22 | (3) |
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Applying the Selection Criteria |
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25 | (1) |
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26 | (3) |
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Evaluating the Technical Quality of the Selected Guidelines |
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29 | (6) |
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29 | (3) |
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32 | (1) |
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32 | (1) |
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32 | (1) |
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32 | (1) |
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32 | (1) |
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32 | (1) |
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33 | (1) |
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33 | (2) |
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Evaluating the Clinical Content of the Selected Guidelines |
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35 | (18) |
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35 | (9) |
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Adapting an Evaluation Method from the RAND/UCLA Appropriateness Method |
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35 | (2) |
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Developing Evaluation Criteria That Address Utilization Decisions |
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37 | (2) |
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Defining and Identifying the Guideline Content to Be Evaluated |
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39 | (2) |
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Selecting Clinical Panelists |
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41 | (1) |
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42 | (2) |
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44 | (6) |
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44 | (4) |
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48 | (1) |
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Conclusions from the Guideline Evaluations |
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49 | (1) |
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50 | (3) |
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Stakeholder Issues and Concerns |
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53 | (8) |
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Stakeholder Experiences with Interim Use of the ACOEM Guidelines |
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53 | (4) |
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54 | (1) |
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Common Themes in the Interviews |
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55 | (2) |
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Summary of Stakeholder Meeting on Guideline Implementation Issues |
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57 | (4) |
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Application of the Guidelines to Determine Whether Care Is Reasonably Required |
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61 | (18) |
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How the Utilization Schedule Is Applied as the Presumptively Correct Standard |
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61 | (11) |
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What Policies Should Apply to Topical Gaps? |
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61 | (7) |
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What Policies Should Apply to Unusual Cases? |
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68 | (1) |
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How Should the Guidelines Be Updated? |
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69 | (1) |
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What Is the Relationship Between Guidelines and Utilization Review Criteria? |
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70 | (1) |
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Consideration of Nonclinical Factors in Providing Care |
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71 | (1) |
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Processes and Procedures Used in Utilization Management |
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72 | (7) |
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Disseminating Guidelines to Providers |
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72 | (1) |
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Training and Educating Providers to Improve Compliance with Treatment Guidelines |
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73 | (2) |
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Utilization Management Processes |
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75 | (1) |
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Easing Provider Administrative Burden |
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76 | (1) |
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Toward a Best-Practice System |
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77 | (2) |
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79 | (48) |
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Overview of Methods and Findings |
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80 | (2) |
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Analysis and Recommendations |
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82 | (3) |
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82 | (2) |
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Stakeholder Experiences and Opinions |
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84 | (1) |
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85 | (4) |
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Short Term (After December 1, 2004) |
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85 | (1) |
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86 | (1) |
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87 | (2) |
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A. Identified Guidelines That Address Work-Related Injuries |
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89 | (8) |
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B. Publicly Posted Screening Criteria |
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97 | (2) |
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C. Selecting Clinical Panelists |
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99 | (2) |
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D. Sample Rating Forms, Round One |
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101 | (6) |
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E. Clinical Panel Ratings, Round Two |
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107 | (10) |
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F. Clinical Panelists' Comments |
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117 | (4) |
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G. Participants in the Stakeholder Meeting |
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121 | (4) |
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H. Stakeholder Discussion Questions on Guidelines Implementation Issues |
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125 | (2) |
| Bibliography |
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127 | |
