TEXAS ORTHOPAEDIC ASSOCIATION

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TEXAS ORTHOPAEDIC ASSOCIATION

• AUSTIN TEXAS
• MAY 11TH 2007

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James Walter Simmons, Jr., M.D. International
Spine Orthopaedic Institute San Antonio,
TexasClinical Professor of Orthopaedics and
RehabilitationClinical Professor of
NeurosurgeryUTMB _at_ Galveston, Texas
al
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Orthopaedic Care of Workers Compensation Spinal
Injuries within the Parameters of ODG and EBM
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ODG (Official Disability Guidelines) EBM
(Evidence Based Medicine)
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DWC-06-0057TITLE 28. INSURANCEPart 2. Texas
Department of Insurance,Division of Workers
CompensationChapter 137. Disability Management
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ODG (TWC) Low Back

• Integrated Treatment / Disability Duration
  Guidelines Low Back, Lumbar, Thoracic (Acute
  Chronic)
• pp. 995-1535 (2,102 pages)

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Evidence-Based PracticeA Primer AAOS
Evidence-Based Practice Committee Anthology,
2003-2005. Evidence-Based Practice

• 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, 2nd ed. London Churchill
Livingstone, 2000.
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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

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A Fair and Balanced View of Spine Fusion Surgery

• EBM is not nor is it meant to be an effective
  cost containment tool, as it is directed toward
  maximizing a patients quality of life, which may
  increase or decrease the cost of care.

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. 2004 Sep-Oct4 (5 Suppl)S129-38.
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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, 2003-2005.
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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

• To obtain the information necessary for effective
  management of return-to-work following
  illness/injury
• To reduce delayed recovery rates with
  evidence-based disability duration guidelines
• To provide upfront, clear targets for forecasting
  and reserving WC/STD/LTD/Auto claims
• To 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

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Evidence-Based Guidelines allows Implementation
of Evidence-Based Practice
AAOS Evidence-Based
Practice Committee Anthology, 2003-2005.
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• Practice Guidelines
• Evidence-Based Guidelines
• Evidence-Based Practice Guidelines
• Evidence-Based Practice

AAOS Evidence-Based Practice Committee Anthology,
2003-2005.
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Thank You
and
God Bless America