Appendix A
ODG Treatment in Workers'
Comp
Methodology Description
using the AGREE Instrument[1]
AGREE stands for "Appraisal of Guidelines Research and Evaluation". It originates from an international collaboration of researchers and policy makers who work together to improve the quality and effectiveness of clinical practice guidelines by establishing a shared framework for their development, reporting and assessment. www.agreecollaboration.org
In mid-2004 the RAND Corporation used the AGREE Instrument to compete the study, "Evaluating Medical Treatment Guideline Sets for Injured Workers in California." This study was prepared for the Commission on Health and Safety and Workers’ Compensation and the Division of Workers’ Compensation, California Department of Industrial Relations, and first published in November 2004. After identifying 73 relevant guidelines, Rand narrowed the list to five guideline sets meeting all the screening criteria, and they performed a detailed technical evaluation using AGREE. The results of this evaluation are reported on page 32 of the study as Table 5.2 (as well as page xx of the Executive Summary as Table S.2)[2] as shown here.
|
Rand Study Table S.2 |
|||||
|
Technical Quality Evaluation AGREE Instrument Results (Standardized Domain
Scores) |
|||||
|
Domain |
AAOS |
ACOEM |
Intracorp |
McKesson |
ODG |
|
Scope & purpose |
1.00 |
0.89 |
0.89 |
1.00 |
1.00 |
|
Stakeholder involvement |
0.54 |
0.79 |
0.79 |
0.88 |
0.79 |
|
Rigor of development |
0.81 |
0.88 |
0.83 |
0.88 |
0.81 |
|
Clarity & presentation |
0.96 |
0.88 |
1.00 |
1.00 |
0.96 |
|
Applicability |
0.17 |
0.33 |
0.33 |
0.61 |
0.72 |
|
Editorial independence |
1.00 |
1.00 |
0.75 |
1.00 |
0.92 |
|
|
|
|
|
|
|
|
Average Rating |
0.75 |
0.80 |
0.77 |
0.90 |
0.87 |
Taking the average rating for each guideline, McKesson was first, ODG was second, ACOEM was third, Intracorp was fourth, and AAOS was fifth. Since this evaluation was based on the first edition of ODG Treatment in Workers’ Comp, the purpose of this document is to provide updated information on ODG according to the AGREE Instrument, using the 2007 edition of ODG Treatment, the fifth edition.
Scope and purpose (items 1-3): The scope and purpose of ODG Treatment in Workers’ Comp (ODG-TWC) is to improve outcomes for any claim that might be seen in a jurisdictional workers’ compensation system. Therefore, critically important to achieving this scope is comprehensiveness. If conditions are missing from a treatment guideline, or treatments are not covered for any condition, there will be uncertainty, and the guideline cannot accomplish its purpose. Delays in treating injured workers or under treatment can result, because providers will not have confidence about reimbursement, and payers may deny necessary care if a treatment is not covered in the guideline. The scope of ODG-TWC is fully comprehensive -- it covers virtually any condition seen in workers’ compensation, as well as any possible treatment for those conditions. Being comprehensive also means covering new technologies as they are introduced, requiring frequent updating. While the overall scope of patients to whom the guideline is meant to apply covers all workers’ comp patients, the focus of the guideline recommendations is on patient selection, i.e., not just whether or not a specific treatment should be approved, but, if it works, what types of patients can it be recommended for.
Stakeholder involvement (items 4-7): The guideline development group includes individuals from all the relevant professional groups (primary care physicians, occupational health specialists, orthopedic surgeons, neurologists, neurosurgeons, physical medicine specialists, physical therapists, chiropractors, radiologists, and others). ODG is independent of any medical specialty group and multidisciplinary in scope, and represents all medical specialties. ODG also strives for patient involvement in the process, and ODG added a Patient Information Resource section in 2006, designed to provide patient education and self care techniques to improve outcomes. Because of the ongoing update process used by ODG, along with ODG’s encouragement of stakeholder suggestions, combined with the widespread use of ODG, ODG receives many editorial suggestions from patient advocacy groups, and these suggestions may prompt additional research into the scientific evidence, and in some cases, updates to the guidelines. This open process is one reason that stakeholders have described ODG as “fair and balanced.” With more editions and more users than any other WC medical treatment guideline, ODG has been well tested. ODG has also been adopted, and is being used successfully, by more states than any other guidelines.
Rigor of development (items 8-14): ODG Treatment in Workers Comp is the most thoroughly developed guideline used in workers’ comp. ODG is unique in taking evidence-based guidelines to their logical end point; the conclusions are linked directly to the evidence in the studies and references. ODG Treatment is based on a comprehensive and ongoing medical literature review with preference given to high-quality systematic reviews, meta-analyses and clinical trials. Each recommendation is linked to a summary of the supporting medical evidence, provided in abstract form, which has been ranked, highlighted and indexed. Full text copies of these studies are used by physician editors in formulating recommendations and are available on request. ODG is continuously updated reflecting the findings of new studies as they are conducted and released; subscribers are always up to date. ODG undergoes a comprehensive annual update process based on scientific medical literature review, survey data analysis and expert panel validation. In addition, as new studies are released, the Web version is updated throughout the year to reflect these new studies. WLDI is in the guideline business, focused on researching and publishing evidence based medical guidelines. As new technologies are introduced, evidence reviews are initiated and new summaries are added to the Procedure Summaries. This also happens when users contact the help desk because they cannot find something, and ODG editors discover that the topic has not been sufficiently covered. In the five years of previous editions of ODG Treatment, there have been a total over 42,000 paid users, far more than any other medical treatment guideline used in workers’ comp, so these users represent a powerful force for suggesting updates.
Clarity and presentation (items 15-18): Ease-of-use and clarity are the hallmark of ODG, and they reduce uncertainty and facilitate early access to treatment for the injured worker. While hard copy books are published each year with each annual edition, ODG is primarily accessed in a user-friendly Web-based version, which users can access from any location with an Internet connection. ODG Treatment is designed to be used for utilization review (UR) as well as clinical practice, so ODG seeks clarity and lack of ambiguity in recommendations, and ODG allows the ability to copy & paste, saving time and effort in documenting approvals or denials of treatment. Entries in the Procedure Summaries always start with the words, “Recommended,” “Not recommended,” or “Under study.” ODG can be integrated into claims management systems. The ODG ICD9-CPT© Crosswalk UR Advisor file contains every possible combination of ICD9 diagnosis code and CPT procedure code seen in workers’ comp. For each ICD9-CPT combination, it provides information on frequency as well as number of visits, plus recommendations from ODG. The file also provides a "Bill Review Payment Flag" which is Green, Yellow, Red, or Black, for use in automating claims management decision-making. The ODG guidelines have integrated both medical treatment guidelines and return-to-work guidelines (also known as lost time guidelines or disability duration guidelines). Treatment and duration guidelines must work together to be effective (timeframes for duration correspond precisely to treatment pathways). There are many specific tools available to help use the guidelines.
Applicability (items 19-21): There is extensive training available so that the guidelines can be applied successfully, and there are tools to monitor and review outcomes compared to the guidelines. There are many training options for ODG customers, including complimentary online demos of ODG Treatment before or after purchase of the product, the ODG Helpdesk for general questions and guidance about the product, several versions of self-paced training online training presentations, and in depth courses offering CME or CE credit. Tools to monitor outcomes include the ODG Crosswalk UR Advisor and the ODG Benchmarking Absence tool. ODG is cost effective for all types of users, and in states that have adopted ODG, users within those states can purchase the guidelines at a 50% discount, bringing the cost down to $162.50. There are also substantial discounts available to organizations with quantity users. In addition, because ODG has been accepted by AHRQ for inclusion in the National Guidelines Clearinghouse, summaries of the guidelines are available at no charge on www.guidelines.gov, and these summaries may be all some users need, including providers doing a limited amount of workers’ comp, as well as small employers and even some injured workers. The goal is for the guidelines to be a communication tool so that all parties are on the same page when it comes to expectations for treatment and return to work. For guidelines to be successful, they need to facilitate early access to appropriate care for the injured worker, when all providers know up-front that they will get paid if they follow the guidelines. ODG has been proven. The 2007 edition of Official Disability Guidelines is the 12th annual edition of these leading return-to-work guidelines, and the 2007 edition of ODG Treatment is the 5th annual edition of those leading treatment guidelines. And studies have shown that outcomes are significantly improved through use of ODG. In fact, one study showed that after adoption of ODG, medical costs were reduced by 64% and lost work days were reduced by 69%, while at the same time injured workers got earlier access to appropriate care and doctors praised the program.
Editorial independence
(items 22-23): ODG is independent of any medical specialty group and
multidisciplinary in scope, and represents all medical specialties, and not
just occupational medicine doctors, orthopaedic surgeons, chiropractors,
physical therapists, etc. ODG has
realized considerable provider acceptance (including adoption by 16 states and
provinces – more than any other guideline) because ODG is evidence based, and
recommendations are linked directly to the most up to date studies; the results
of that research are reflected in the constant updating of the guidelines.
These studies are focused on one outcome: What is best for the injured
worker. WLDI is in the guideline
business, focused on researching and publishing evidence based medical
guidelines. The funding body for ODG Treatment in Workers Comp is the
subscribers who purchase the guideline. With 42,000 paid ODG users from all
types of stakeholders in workers’ comp, this is a diverse group with many
different interests. The employees of WLDI who guide the editorial process are
independent of this funding body, and their overriding objective is to publish
the highest quality guideline, one that is evidence based and defensible before
all of these different interests, as these customers make decisions about which
guideline to purchase or adopt. Ultimately, the recommendations in ODG may not
please each of these subscribers, but they do agree that ODG is fair and
balanced, and accurately summarizes the scientific evidence. ODG has been more
successful in this than any other workers’ compensation medical treatment
guideline, which attests to the editorial independence of ODG. It has proven to
be the only guideline that employers, insurers, providers, and labor can all
get behind and support. The only measure of success for the ODG editors is that
they have created a high quality product that succeeds in the marketplace. This
is in contrast to guidelines produced by special interest groups, such as
insurance companies or medical specialty societies, whose interests go beyond
just sales of the guideline, and whose agenda may be to advance the success of
their own members.
##########################################
Scope and purpose (items 1-3)
1. The overall objective is specifically described.
2. The clinical questions covered by the guidelines are specifically described.
3. The patients
to whom the guideline is meant to apply are specifically described.
Stakeholder involvement (items 4-7)
4. The guideline development group includes individuals from all the relevant professional groups.
5. The patients’ views and preferences have been sought.
6. The target users of the guidelines are clearly defined.
7. The guideline
has been piloted among target users.
Rigor
of development (items 8-14)
8. Systematic methods were used to search for evidence.
9. The criteria for selecting the evidence are clearly described.
10. The methods used for formulating the recommendations are clearly described.
11. The health benefits, side effects, and risks have been considered in formulating the recommendations.
12. There is an explicit link between the recommendations and the supporting evidence.
13. The guideline has been externally reviewed by experts prior to its publication.
14. A
procedure for updating the guideline is provided.
Clarity and presentation (items 15-18)
15. The recommendations are specific and unambiguous.
16. The different options for management of conditions are clearly presented.
17. Key recommendations are easily identifiable.
18. The guideline is supported with tools for application.
Applicability (items 19-21)
19. The potential organizational barriers to applying the recommendations have been discussed.
20. The potential cost implications of applying the recommendations have been considered.
21. Key review criteria are included for monitoring and review purposes.
Editorial independence (items 22-23)
22. The guideline is editorially independent from the funding body.
23. Conflicts of interest of guideline development members have been recorded.
Exhibit A - Background on AGREE
Exhibit B - Thirteen unique and major advantages of ODG
Exhibit C - Procedure Summary/Sample Search Terms Used
Exhibit D - Editorial Advisory Board, ODG/ODG Treatment
Exhibit E - ODG Methodology Outline
Exhibit F - Explanation of Medical
Literature Ratings
##########################################
Summary. The scope and purpose of ODG Treatment in Workers’ Comp (ODG-TWC) is to improve outcomes for any claim that might be seen in a jurisdictional workers’ compensation system. Therefore, critically important to achieving this scope is comprehensiveness. If conditions are missing from a treatment guideline, or treatments are not covered for a condition, there will be uncertainty, and the guideline cannot accomplish its purpose. Delays in treating injured workers or under treatment can result, because providers will not have confidence about reimbursement, and payers may deny necessary care if a treatment is not covered in the guideline. The scope of ODG-TWC is fully comprehensive -- it covers virtually any condition seen in workers’ compensation, as well as any possible treatment for those conditions. See Exhibit B, ODG is comprehensive. Being comprehensive also means covering new technologies as they are introduced, requiring frequent updating. The comprehensiveness of ODG has also been validated by ODG’s national workers’ compensation claims database, representing over 2 million claims, covering almost 50 million paid invoices on medical encounters for those claims. The focus of the guideline recommendations is on patient selection, i.e., not just whether or not a specific treatment should be approved, but, if it works, what types of patients can it be recommended for.
1. The
overall objective is specifically described.
ODG Treatment in Workers’ Comp (ODG-TWC) is designed to help improve outcomes for any claim that might be seen in a jurisdictional workers’ compensation system, and to be comprehensive in doing this so that no diagnoses or treatments are missing. Being comprehensive also means covering new technologies as they are introduced, requiring frequent updating. Specific objectives of ODG Treatment in Workers Comp include the following:
2. The clinical questions covered by the guidelines are specifically described.
ODG Treatment in Workers’ Comp contains 14 core
chapters, broken into three sections each.
In general, the first section,
the Treatment Planning, answers the following major question:
Based on the
characteristics of each case, what is the ideal treatment plan towards
restoration of function that should be followed after injury of… the lower back
(for example)?
Within the
guideline, hundreds of other questions are answered, depending on the nature of
injuries in each chapter. Cases branch
out based on symptoms/signs/tests/demographics.
Below are only a few
examples answered in various stages of the Low Back Treatment Planning:
a. For the first visit, what percentages of cases are likely to see a primary care physician MD/DO, an orthopedist or a chiropractor?
b. For cases with lower back pain, what are the signs of radiculopathy?
c. For cases with radiculopathy, under what circumstances is an epidural steroid injection (ESI) considered? What are the risks or side effects, if any, of ESI’s? Would a 2nd ESI ever be considered? What would be the maximum allowable ESI’s? What is the benchmark cost of an ESI?
d. Under what circumstances is surgery appropriate? What procedure(s) are recommended for candidates for surgery? What are the inherent risks?
e. What is the expected length of disability following each procedure? What activity modifications are appropriate in the early stages of recovery?
f. What are the recommended frequency and duration of chiropractic care?
The second section
in each chapter, Codes for Auto-Approval, maps CPT codes to ICD9 codes based on
the Treatment Plan, with a field for “Maximum Occurrences”, for auto-approval
of universally supported treatment methods, to answer questions for utilization
management: What CPT procedure codes are recommended/allowed for each
diagnosis, and how many occurrences?
The third section in
each chapter, the Procedure Summary, lists all the potential therapies for each
condition and provides summaries of their effectiveness based on existing
medical evidence. The recommendations
are linked to summaries of the supporting studies in abstract form.
The Procedure Summaries were developed to answer the questions: What proven efficacy, if any, does each treatment method have for each condition, and what potential risks or side effects exist? Are there patient selection criteria that should be met? There may be hundreds listed in the Procedure Summary of each chapter. For a sample from the Low Back chapter, see Exhibit C.
3. The
patients to whom the guideline is meant to apply are specifically described.
As implied by its name, ODG Treatment in Workers Comp is designed to apply to patients ill or injured while on the job. Essentially, these are working-age adults (18-65) of both genders stricken with conditions commonly associated with occupation, including musculoskeletal and other disorders. Core chapters currently include Ankle/Foot, Burns, Carpal Tunnel Syndrome, Elbow, Eye, Fitness for Duty, Forearm/Wrist/Hand, Head, Hernia, Hip, Knee, Low Back, Neck, Pain, Shoulder and Stress/Mental. Impairment Guides are also provided in ODG Treatment in Workers Comp from the International Association of Industrial Accident Boards and Commissions (IAIABC). Within the Procedure Summaries, there are often specific Patient Selection Criteria that may be highlighted in blue, where the scientific evidence shows that a treatment may work on some patients and not others. For example, for knee meniscus tears, ODG says, “Patient selection criteria: Patients younger than 35 with clear evidence of a meniscus tear may benefit from arthroscopic partial meniscectomy or arthroscopic meniscal repair. For older patients with degenerative tears, possibly indicating osteoarthritis, surgery may not be as beneficial.” http://www.odg-twc.com/odgtwc/knee.htm#Codes Here is another example, for Low Back Physical Therapy, “Patient Selection Criteria: Multiple studies have shown that patients with a high level of fear-avoidance do much better in a supervised physical therapy exercise program, and patients with low fear-avoidance do better following a self-directed exercise program. When using the Fear-Avoidance Beliefs Questionnaire (FABQ), scores greater than 34 predicted success with PT supervised care.” http://www.odg-twc.com/odgtwc/low_back.htm#Physicaltherapy
Stakeholder involvement (items 4-7)
Summary. The guideline development group includes individuals from all the relevant professional groups (primary care physicians, occupational health specialists, orthopedic surgeons, neurologists, neurosurgeons, physical medicine specialists, physical therapists, chiropractors, radiologists, and others). ODG is independent of any medical specialty group and multidisciplinary in scope, and represents all medical specialties, and not just occupational medicine doctors, orthopaedic surgeons, chiropractors, physical therapists, etc. ODG has realized considerable provider acceptance (including adoption by 16 states and provinces – more than any other guideline) because ODG is evidence based, and recommendations are linked directly to the most up to date studies; the results of that research are reflected in the constant updating of the guidelines. These studies are focused on one outcome: What is best for the injured worker. Unlike medical specialty society guidelines, ODG does not represent the interests of any one provider-group over other providers. ODG is serious about patient involvement in the process. ODG now has a Patient Information Resource appendix, designed to provide patient education and self care techniques to improve outcomes. Because of the ongoing update process used by ODG, along with ODG’s encouragement of stakeholder suggestions, combined with the widespread use of ODG, ODG receives many editorial suggestions from patient advocacy groups. These suggestions may prompt additional research into the scientific evidence, and in some cases, updates to the guidelines. This open process is one reason that stakeholders have described ODG as “fair and balanced.” With more editions and more users than any other WC medical treatment guideline, ODG has been well tested. ODG has also been adopted, and is being used successfully, by more states than any other guidelines.
4. The
guideline development group includes individuals from all the relevant professional
groups.
The guideline development group includes individuals from all the relevant professional groups (primary care physicians, occupational health specialists, orthopedic surgeons, neurologists, neurosurgeons, physical medicine specialists, physical therapists, chiropractors, radiologists, and others). ODG is independent of any medical specialty group and multidisciplinary in scope, and represents all medical specialties, and not just occupational medicine doctors, orthopaedic surgeons, chiropractors, physical therapists, etc. Unlike medical specialty society guidelines, ODG does not represent the interests of any one provider-group over other providers. See Exhibit D, the ODG Treatment in Workers Comp Editorial Advisory Board.
Editor-in-Chief, Philip L. Denniston, Jr. and Senior Medical Editor, Charles W. Kennedy, MD, together pilot the group of approximately 80 members. Senior Chiropractic Editor is Preston B. Fitzgerald, DC CDE CICE CIFCME (President, National Board of Forensic Chiropractors) and Senior Physical Therapy Editor is Stuart H. Platt, MSPT, PT (Principal, Appropriate Utilization Group). Research analysts and medical editorial assistants are on staff at WLDI.
o
Medical Device Register (MDR) – an annually
updated directory of hospital equipment and supplies first published in 1981
and acquired by Thomson
Corporation in 1985, along with Distributor
Profiles, Product SOS, and Homecare
Product Directory, also created by Phil. While under contract with Thomson, the Directory of Hospital Personnel and the HMO/PPO Directory were developed. Phil later became CEO of Medical Economics Data with
responsibility for the Physicians’
Desk Reference (PDR) and
American Health Consultants, publisher of Occupational Health Management, Case Management Advisor, Disease State
Management, Home Care Case Management, Employee Health & Fitness, and
Hospital Case Management.
o
Physicians’ GenRx –
a complete annual reference on branded and generic prescription drugs used by
physicians and pharmacists to determine when generic substitution is
appropriate and when it is not. With
the GenRx database, Phil later became charter provider to Physicians’ Online. Physicians’
GenRx was acquired by Mosby-YearBook (now part of Harcourt Brace) in
1994.
Due largely to a reputation for evidence-based medicine instilled under the direction of Philip Denniston, Work Loss Data Institute was selected by the American College of Occupational and Environmental Medicine (ACOEM) as the medical library research contractor in the development of the second edition of the ACOEM Occupational Medicine Practice Guidelines. Work Loss Data Institute has also recently been chosen by the Council on Chiropractic Guidelines and Practice Parameters (CCGPP) to lead research and development for an evidence-based guideline for chiropractic professional care, which is scheduled for completion and publication by Work Loss Data Institute in conjunction with CCGPP in 2005.
Charles W. Kennedy, MD, Senior Medical Editor, has been extensively involved in the workers’ compensation process and involved with the development of guidelines by the American Academy of Orthopaedic Surgeons (AAOS) for the spine and lower extremities. He was on the Guidelines Development Committee for the American Academy of Orthopaedic Surgeons and also the Task Force for Disability Testing Phase 1 of the Spine Treatment Guidelines for the American Academy of Orthopaedic Surgery. He is a founding member of the Evidence Analysis Committee for AAOS. He was past Board of Counselor member of the American Academy of Orthopaedic Surgery and is a current member of the Complementary and Alternative medicine Committee of the American Academy of Orthopaedic Surgery.
Dr. Kennedy was the original co-chairman of the Designated Doctor training as taught by the American Academy of Disability Evaluating Physicians and has been a frequent lecturer on disability issues. He is on the Board of Directors of the American Academy of Disability Evaluating physicians.
Dr. Kennedy has been
either chairman or co-chairman of the Texas Orthopaedic Workers’ Compensation
Committee for a ten-year period. He was
the original alternate physician for the Medical Advisory Committee to the
Texas Workers’ Compensation Commission.
He was also on the Task Force for the Spine Treatment Guideline
development for the Texas Workers’ Compensation Commission. He is a former president of the Texas
Orthopaedic Association.
Currently, Dr. Kennedy is a frequent lecturer
to case managers and other physicians on workers’ compensation issues. His orthopedic practice now specializes in
the integrative medicine approach to treatment of industrial problems. He serves as President of the Disability
Evaluating Center of Texas and has been active in disability evaluation over the
last ten years.
5. The
patients’ views and preferences have been sought.
Patient satisfaction is one of many outcomes considered. The studies considered in ODG are focused on one primary outcome, whether or not the treatment under consideration helped the patient get better.
In addition, a new “Patient Information Resources” section was added in 2006 to Official Disability Guidelines Treatment in Workers’ Comp. This enhancement to ODG contains prescreened links to credible patient-friendly treatment resources available on the Web. Patient Information is provided for all workers’ comp conditions including those pertaining to Ankle & Foot, Burns, Carpal Tunnel Syndrome, Elbow, Eye, Forearm, Wrist, & Hand, Head, Hernia, Hip & Pelvis, Knee & Leg, Low Back, Neck & Upper Back, Pain, Shoulder and Stress/Mental.
The links are followed by a short description or excerpt from each of the website’s contents so, without having to filter through hundreds of online and hardcopy resources, healthcare providers can quickly provide their patient with a personal aid to recovery by printing the list of selected links or clicking on the links and printing the most relevant pages within the selected websites. ODG’s Patient Information Resources section efficiently connects the patient and provider to pertinent information such as a basic understanding of the injury, self-help methods for speeding recovery and suggested therapies for regaining functionality and productivity.
The Patient Information Resource appendix is designed to provide patient education and self care techniques to improve outcomes. ODG Senior Medical Editor, Dr. Charles W. Kennedy, initiated the idea behind this section. According to Dr. Kennedy, “Blending the principals of holistic medicine which recognize and encourage an individual’s responsibility for his own well-being with the latest evidence-based treatment protocols creates an ideal environment for maximum healing and preventive care.”
The Patient Information Resources appendix also includes ODG’s disability duration guidelines for common conditions. It is part of WLDI’s philosophy that the educated patient, who is made aware of the best practices for treatment and disability duration through effective communication with his or her provider, will be more likely to return to work sooner and in better health.
This section enables the treating physician to conveniently empower their patients with relevant and targeted recovery information from some of the finest resources available. Patient education links referenced include the National Library of Medicine, the American Association of Family Physicians, the Mayo Clinic and the American Association of Orthopaedic Surgeons, and others.
The new appendix, entitled “Appendix B, Patient Information Resources,” is available to online subscribers of ODG Treatment in Workers’ Comp and was also included in the hard-copy book beginning with the 2007 edition.
ODG is serious about patient involvement in the process. Because of the ongoing update process used by ODG, along with ODG’s encouragement of stakeholder suggestions, combined with the widespread use of ODG, ODG receives many editorial suggestions from patient advocacy groups. These suggestions may prompt additional research into the scientific evidence, and in some cases, updates to the guidelines. This open process is one reason that stakeholders have described ODG as “fair and balanced.”
6. The target users of the guidelines are clearly defined.
As indicated in the first chapter, Background and Description,
ODG Treatment in Workers Comp is designed
for use by independent treating physicians, allied healthcare providers,
insurance claims professionals, nurse case managers, state and federal workers’
comp authorities, and employer representatives. Without any specific affiliation, Work Loss Data Institute is
unique in its ability to bridge the interests of the many professional groups
involved in diagnosing and treating the various conditions associated with
workers’ compensation.
7. The
guideline has been piloted among target users.
Draft editions of ODG Treatment in Workers Comp have been released to clients of Work Loss Data Institute from each of the above groups for testing and response prior to publication.
The 2008 edition of ODG Treatment in Workers Comp will be the 6th annual edition, and draft copies of this edition have already been circulated to members of the ODG Editorial Advisory Board. See Exhibit D.
In addition, in the five years of previous editions of ODG Treatment, there have been a total over 42,000 paid users, far more than any other medical treatment guideline used in workers’ comp, so ODG Treatment in Workers Comp has clearly stood the test of time. With more editions and more users than any other WC medical treatment guideline, ODG has been well tested. ODG has also been adopted, and is being used successfully, by more states than any other guidelines.
Rigor of development (items 8-14)
Summary: ODG Treatment in W