Our department is about ... Occupational Medicine

The Occupational & Environmental Medicine Clinic at Harborview Medical Center is the only major regional referral center for occupational medicine cases. Clinic physicians are part of the Center of Occupational Health and Education (COHE) network.

Preventing Disability

For nearly a decade, department researchers have been developing a system to improve the quality of care for injured workers in Washington state. Investigators from the Department of Environmental and Occupational Health Sciences are involved in research and educational activities to identify and raise awareness about workplace hazards, safety solutions, and occupational health best practices. Studies show that early intervention can shorten the length of time an injured employee is disabled and away from work, saving money for employers and taxpayers.

In 2011, evidence from these studies culminated in a new Washington state law, directing the Department of Labor & Industries (L&I) to create a statewide network for providers who treat injured workers. The legislation also calls for expanding access to the state’s Centers of Occupational Health and Education (COHE). By 2015, all of the state’s injured workers will have access to the COHE system, which started in 2002 in Renton and Spokane. This legislation is expected to save the state $218 million over the next four years by returning more workers to good health and helping them get back on the job more quickly after an injury.

COHEs teach occupational health best practices to healthcare providers who treat injured workers. The providers are encouraged to intervene soon after an injury and work with the injured worker and employer to develop a return-to-work plan. Providers affiliated with the four COHEs (Renton, Spokane, Everett, and Seattle) treat about one-third of workers who file compensation claims in the state. More than 1,000 providers are currently participating in the COHE system.

In a study of more than 100,000 injured workers, researchers found that patients whose healthcare providers adopted COHE’s best practices had, on average, 57 percent fewer disability days, and their medical costs were about $500 lower than those who saw independent physicians. The savings were greater for cases involving back sprain, which can lead to permanent disability.

The study, which was funded by L&I, is published in the December 2011 issue of Medical Care. Many of the authors of the study are involved with the Occupational Epidemiology and Health Outcomes Program in our department. The program uses workers’ compensation data and its own research to improve medical care, update treatment guidelines, and provide information on treatment outcomes to injured workers and physicians. Investigators include Research Professor Gary Franklin, who is also the medical director of L&I, Research Scientists Deborah Fulton-Kehoe and Jeremy Gluck; Occupational Health Nurse Terri Smith-Weller; and Research Coordinator Kathleen Egan. Professor Thomas Wickizer, formerly a professor in the UW School of Public Health and now at The Ohio State University, was the study’s lead investigator.

COHEs save money partly by reducing paperwork and employing health services coordinators to help facilitate case management. Often in workers’ compensation cases, Franklin said, long delays result from communication problems among the healthcare provider, the employer, the injured worker, and the insurer. The longer a worker is off work and on disability, the lower his or her chance of returning to work.

“Work-related disability is a major public health problem that’s largely overlooked in the US,” Franklin said. “This study shows that using occupational health best practices when treating injured workers can have an important effect on their recovery.”