IntelliOBM / First Insurance

Case Management: Prevention and Management of Delayed Functional Recovery

Can accidents and or illness be avoided and eliminated from the work environment? Ideally yes, however once the person is ill or the employee suffers an accident, then the employer, the employee, the family, private and government agencies have to deal with the situation. Case management is a process were you as an employer must be able to manage the employee's return to work; unfortunately after the employee suffers the illness or the accident. But through case management, a tool is provided to the employer to evaluate and analyze each situation and have the employee back on a timely manner while reducing cost.

After a job related health incident, most patients will smoothly and promptly recover their ability to function, usually within a matter of days. When the employee does not recover quickly, this result in employers frustration, families and peers concerns, also results in increasing cost and lost workdays. From the employer and the occupational physician perspective the most important role is prevention, although most employers get the prevention through the orientation, training and communication programs, unfortunately we have to treat health work related conditions. Statistically there is indication that workers absent, due to work-related, complaint for more than six months have approximately a 50% probability of return to work, those absent more than one year have less than 25% probability, and those absent for more than two years have no chance of returning to the work force.

Occupational health professionals can be the most effective case managers when they perform a comprehensive evaluation of the worker with a health problem. Integrating potential job-related physical and operational causes, personal health factors and social factors are the best plan of action. A delay in recovery from acute work related conditions might be due to psychosocial or work related factors, it may be also to a medical problem not identified on initial examination or misdiagnosed.

A useful approach to the establishment of a plan is to review the following:

Assessments of functional status: It is recommended a Statistical Funtional Capacity Evaluation, to rule out malignant conditions.

Evidence based guidelines for treatment: Medications, physical therapy among other methods of treatment should be adequate.

Set expectations for recovery: Set goals and timelines

The employee’s expectation for recovery: Identify secondary gains

Internal case-management protocols: This assures consistency and uniformity

The success of a case management program for disability conditions is the coordination of all care through one provider. The use of multiple providers can result in polypharmacy and adverse drug reactions and interactions, loss of information and lack of adequate treatments because care was not well coordinated. Employees which do not recover as expected, usually have several interrelated causes. Cases of delayed functional recovery require close management rather than simple care. The occupational health clinician can act as the manager of the case or can enlist the help of a skilled case manager, who is typically an occupational health nurse. The final goal is, in fact, functional recovery and prompt return to work.

For any questions or comments please contact us at: info@intelliobm.com or call us at 787-756-5880