Opioid-Related Disorders, Opioid Use
Conditions
Keywords
Workers' Compensation, Occupational Injuries, Drug Utilization Review, Humans, Adult, Cohort Studies, Qualitative Research
Brief summary
This study examines the comparative effectiveness of opioid review programs in reducing unsafe opioid prescribing in two states: prospective prior authorization (PA) with hard stops in Washington and retrospective review (RR) with prescriber notification in Ohio.
Detailed description
Use and misuse of opioids is now recognized as a major U.S. public health problem, leading to significant morbidity and mortality. Prescribing of both opioids and concurrent sedative-hypnotics for acute and chronic musculoskeletal pain increased dramatically from 2001 to 2010. The clearest path to preventing transition to chronic opioid use and associated morbidity or addiction is to reduce unnecessary prescribing during the acute (0-6 weeks) and subacute (6-12 weeks) phases of pain. Both prior authorization (PA) and other insurer-based drug utilization programs are increasingly being used in an attempt to stem the tide of the opioid epidemic and to reduce unsafe opioid prescribing. Review programs have proven effective in decreasing use and overall costs of more expensive medications. Washington (WA) and Ohio (OH) offer a unique opportunity to study opioid prescribing interventions because both states have regulatory authority over health care delivery to all injured workers, and are the two largest states with a population-based exclusive State Fund. Further, both states have initiated distinct prescribing guideline-concordant opioid review programs (ORPs), allowing for a unique natural experiment to compare the effectiveness of two substantially different approaches to reducing unsafe opioid prescribing. This is an observational cohort study, with prospective and retrospective components. Aims 1 and 2 rely primarily on administrative data for a prospective cohort, with longitudinal surveys conducted among a subset of the cohort. Aim 1 also includes a retrospective time series analysis. Aim 3 relies on qualitative research, including individual in-depth interviews and key informant interviews. Specific aim 1. Examine the comparative effectiveness of prospective prior authorization (PA) with hard stops in WA versus retrospective review (RR) with prescriber notification in OH in reducing unsafe opioid prescribing. Specific aim 2. Examine the comparative effectiveness of WA's PA program versus OH's RR program with regard to patient reported outcomes (pain, function, quality of life, return to work), harms (presence of opioid use disorder, opioid poisoning events) and work disability outcomes at 6 weeks, 6 months, and 12 months from date of injury. Specific aim 2a. For injured workers in WA, examine unsafe opioid prescribing and patient-reported outcomes and work disability at 6 and 12 months for patients receiving an established, coordinated, stepped care management program during the first 12 weeks following injury plus prospective PA versus patients receiving usual care subject to PA only. Specific aim 3. Using qualitative methods, identify key environmental, programmatic and policy factors that influenced the design, implementation and impact of the PA program in WA and the RR program in OH. This information will lead to the development of an Opioid Review Tool educational module for dissemination to both public and private payers.
Interventions
OTHERProspective prior authorization (PA) with hard stops in Washington
Under Washington regulatory procedures, payment for any opioid prescription billed beyond six weeks after the injury is denied unless the prescriber has submitted a checklist attesting to completion of all best practices from the regulations/guidelines.Thus, the Washington intervention is prospective and includes a hard stop subject to an insurer's decision based on regulatory authority.
OTHERRetrospective review (RR) with prescriber notification in Ohio
In Ohio an automated report identifies new opioid prescriptions beyond the acute phase. Ohio Workers' Compensation pharmacy and clinical staff review the medical record at 12 weeks to determine whether best practices were met. If not, the prescriber is notified via letter, and cases are reviewed again at 16 weeks. If best practices have still not been met, the prescriber and worker are notified via letter that opioid coverage will end in 4 weeks. The Ohio program relies on retrospective chart review and communication of best practices to prescribers.
Sponsors
Patient-Centered Outcomes Research Institute
University of Washington
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
Aims 1 and 2: * File a new accepted State Fund claim * Fill at least one opioid prescription, paid for by workers' compensation, during the first 6 weeks after date of injury Aim 3 key informants * Policy makers and stakeholders who were involved in the creation and implementation of the Washington or Ohio opioid review program. Aim 3 individual in-depth interviews * Providers that had at least one patient whose opioid prescriptions paid for through workers' compensation had been reviewed in accordance with the state's opioid review program. * Patients that had an opioid prescription for at least 6 weeks paid for by workers' compensation or whose prescription payments have been reviewed in accordance with the state's opioid review program.
Exclusion criteria
(Aims 1 and 2): * Under 18 years of age * Current cancer diagnosis * Surveys only: do not speak English or Spanish, physically or mentally incapable of completing the survey, incarcerated, deceased
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Chronic Phase - High Dose (Average of ≥50 Morphine Equivalent Daily Dose [MEDD] Among All Days With Opioids) | 3-6, 6-9, and 9-12 months after injury | Mean MEDD of 50 or more during the days a worker received opioids (based on days' supply) within the time period |
| Subacute Phase - More Than 7 Days of Opioids | 6-12 weeks after injury | More than 7 unique days of opioids within the time period |
| Chronic Phase - Composite (Meeting ≥1 of the 3 Chronic Phase Metrics) | 3-6, 6-9, and 9-12 months after injury | At least 1 instance of either chronic opioid prescribing, concurrent opioid and sedative prescribing, or high dose opioid prescribing attributed to a worker within the time period |
| Chronic Phase - Chronic Opioids (≥60 Days' Supply) | 3-6, 6-9, and 9-12 months after injury | 60 or more unique days of opioids within the time period |
| Chronic Phase - Concurrent (Concurrent Sedatives/Hypnotics and Opioids on ≥1 Day) | 3-6, 6-9, and 9-12 months | At least 1 overlapping day of both a sedative and an opioid within the time period |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Disability - Activity Limitation | 12 months after injury | Modified activity limitation items from the National Health Interview Survey (NHIS) 2011 Adult Functioning Supplement. Participants were asked to rate on a 3-point scale (limited a lot, limited a little, not limited at all) whether their health was limited in four domains: participating in leisure or social activities, getting out with friends or family, doing household chores such as cooking and cleaning, and using transportation to get to places you want to go. 1 = limited a lot ; 0 = otherwise. |
| Not Working for Pay | 12 months after injury | Participants asked whether they worked for pay in the past week. 1 = did not work for pay in the week prior to assessment; 0 = otherwise. |
| On Time Loss (Not Working) | 12 months after injury | 1 = on time loss (workers' compensation warrant data); 0 = otherwise. |
| Earning Less Than Before Injury | 12 months after injury | Participants asked to rate on a 5-point Likert scale the extent to which earnings differed from earnings at time of injury (1 = a lot more than before the injury, 5 = a lot less than before the injury). 1 = somewhat less than before, a lot less than before the injury, or not working; 0 = otherwise. |
| Quality of Life (EuroQol EQ-5D) | 12 months after injury | 5-item scale in which participants were asked to rate the extent to which they experienced problems with mobility, self-care, usual activities, pain/discomfort, and anxiety/depression on a 5-point scale (1 = no problems, 5 = extreme problems). Individual item responses were used to create score profiles (range 11111 to 55555), which were then converted to an index value using a US-based value set. -0.573 (worst health state) to 1 (best health state) |
| Satisfaction With Overall Treatment | 12 months after injury | Single-item 5-point Likert scale rating of how satisfied participants were with all injury-related treatment (-2 = very dissatisfied, 2 = very satisfied). |
| Satisfaction With Pain-related Treatment | 12 months after injury | Single-item 5-point Likert scale rating of how satisfied participants were with treatment received for injury-related pain (-2 = very dissatisfied, 2 = very satisfied). |
| Opioid Overdose/Adverse Effects | 12 months after injury | Qualifying International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) diagnosis codes: first 3 digits = T40 and 5th digit = (0,1,2,3,4,6) and 7th digit not = 6 (excludes underdosing). 1 = presence of qualifying ICD-10-CM diagnosis code; 0 = otherwise. |
| ≥30% Decrease in Pain Intensity/Interference (PEG-3) | 12 months after injury | Clinically important improvement in pain intensity/interference defined as obtaining a ≥30% reduction in pain intensity and interference from baseline. This was assessed with the PEG-3, which is comprised of 3 items assessing pain intensity and pain interference with enjoyment of life/general activity on a 0 to 10 numerical rating scale (0 = no pain/does not interfere, 10 = pain as bad as you can imagine/completely interferes). 1 = ≥30% reduction in mean PEG-3 summary score from baseline; 0 = otherwise. |
| Anxious Symptoms (PHQ-4) | 12 months after injury | 2-item PHQ-4 subscale assessed how often participant was bothered by anxious symptoms on 4-point scale (0 = not at all, 3 = nearly every day). 1 = summed subscale score ≥3; 0 = otherwise. |
| Depressive Symptoms (PHQ-4) | 12 months after injury | 2-item PHQ-4 subscale assessing how often participant was bothered by depressive symptoms on 4-point scale (0 = not at all, 3 = nearly every day). 1 = summed subscale score ≥3; 0 = otherwise. |
| Global Improvement (GIC) | 12 months after injury | Global Impression of Change on 7-point Likert scale. Participants asked to rate how they compared now to immediately after their injury (1 = very much improved, 7 = very much worse) 1 = much improved or very much improved; 0 = otherwise. |
Other
| Measure | Time frame | Description |
|---|---|---|
| Problematic Opioid Use (TAPS) | 12 months after injury | 3-item TAPS tool Part 2 assessing any problematic opioid use in the past 3 months. Participants asked if they used a prescription opioid not as prescribed, if they failed in cutting down on opioid use, and if anyone has expressed concern about their opioid use (0 = no, 1 = yes). The items were summed to create a summary score in which scores ≥1 represented problematic or high-risk opioid use. 1 = summed subscale score ≥1; 0 = otherwise. |
Countries
United States
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Washington Injured workers in the Washington Department of Labor and Industries (L&I) state fund insurance system - required to obtain prior authorization for opioids prescribed after 6 weeks from an injury. | 4,632 |
| Ohio Injured workers in the Ohio Bureau of Workers' Compensation (BWC) state fund insurance system - subject to a retrospective review of claim if receiving opioid prescription after 6 weeks from injury. Prescriber notified if best practices are not being documented. | 779 |
| Total | 5,411 |
Baseline characteristics
| Characteristic | Washington | Ohio | Total |
|---|---|---|---|
| Age, Customized 18-24 | 440 Participants | 51 Participants | 491 Participants |
| Age, Customized 25-34 | 1100 Participants | 167 Participants | 1267 Participants |
| Age, Customized 35-44 | 1121 Participants | 154 Participants | 1275 Participants |
| Age, Customized 45-54 | 1033 Participants | 175 Participants | 1208 Participants |
| Age, Customized 55-64 | 791 Participants | 187 Participants | 978 Participants |
| Age, Customized ≥65 | 147 Participants | 45 Participants | 192 Participants |
| Race and Ethnicity Not Collected | — | — | 0 Participants |
| Sex: Female, Male Female | 1153 Participants | 193 Participants | 1346 Participants |
| Sex: Female, Male Male | 3479 Participants | 569 Participants | 4048 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | 0 / 0 | 0 / 0 |
| other Total, other adverse events | 0 / 0 | 0 / 0 |
| serious Total, serious adverse events | 0 / 0 | 0 / 0 |
Outcome results
Primary
Chronic Phase - Chronic Opioids (≥60 Days' Supply)
60 or more unique days of opioids within the time period
Time frame: 3-6, 6-9, and 9-12 months after injury
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Washington | Chronic Phase - Chronic Opioids (≥60 Days' Supply) | 3-6 months | 0.0 % of participants |
| Washington | Chronic Phase - Chronic Opioids (≥60 Days' Supply) | 6-9 months | 0.0 % of participants |
| Washington | Chronic Phase - Chronic Opioids (≥60 Days' Supply) | 9-12 months | 0.0 % of participants |
| Ohio | Chronic Phase - Chronic Opioids (≥60 Days' Supply) | 9-12 months | 1.9 % of participants |
| Ohio | Chronic Phase - Chronic Opioids (≥60 Days' Supply) | 3-6 months | 1.7 % of participants |
| Ohio | Chronic Phase - Chronic Opioids (≥60 Days' Supply) | 6-9 months | 2.3 % of participants |
Primary
Chronic Phase - Composite (Meeting ≥1 of the 3 Chronic Phase Metrics)
At least 1 instance of either chronic opioid prescribing, concurrent opioid and sedative prescribing, or high dose opioid prescribing attributed to a worker within the time period
Time frame: 3-6, 6-9, and 9-12 months after injury
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Washington | Chronic Phase - Composite (Meeting ≥1 of the 3 Chronic Phase Metrics) | 3-6 months | 1.2 % of participants |
| Washington | Chronic Phase - Composite (Meeting ≥1 of the 3 Chronic Phase Metrics) | 6-9 months | 0.9 % of participants |
| Washington | Chronic Phase - Composite (Meeting ≥1 of the 3 Chronic Phase Metrics) | 9-12 months | 0.8 % of participants |
| Ohio | Chronic Phase - Composite (Meeting ≥1 of the 3 Chronic Phase Metrics) | 3-6 months | 2.4 % of participants |
| Ohio | Chronic Phase - Composite (Meeting ≥1 of the 3 Chronic Phase Metrics) | 6-9 months | 2.4 % of participants |
| Ohio | Chronic Phase - Composite (Meeting ≥1 of the 3 Chronic Phase Metrics) | 9-12 months | 2.1 % of participants |
Comparison: * Primary predictor is binary (1 for Washington, 0 for Ohio)~* Outcome modeled longitudinally over the 3 time periods (3-6, 6-9, and 9-12 months)~* Time periods clustered at the individual worker level~* Exchangeable working correlation structure~* Robust variance estimatesp-value: 0.4395% CI: [0.53, 1.31]Generalized estimating equation
Primary
Chronic Phase - Concurrent (Concurrent Sedatives/Hypnotics and Opioids on ≥1 Day)
At least 1 overlapping day of both a sedative and an opioid within the time period
Time frame: 3-6, 6-9, and 9-12 months
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Washington | Chronic Phase - Concurrent (Concurrent Sedatives/Hypnotics and Opioids on ≥1 Day) | 3-6 months | 0.0 % of participants |
| Washington | Chronic Phase - Concurrent (Concurrent Sedatives/Hypnotics and Opioids on ≥1 Day) | 6-9 months | 0.0 % of participants |
| Washington | Chronic Phase - Concurrent (Concurrent Sedatives/Hypnotics and Opioids on ≥1 Day) | 9-12 months | 0.0 % of participants |
| Ohio | Chronic Phase - Concurrent (Concurrent Sedatives/Hypnotics and Opioids on ≥1 Day) | 3-6 months | 0.4 % of participants |
| Ohio | Chronic Phase - Concurrent (Concurrent Sedatives/Hypnotics and Opioids on ≥1 Day) | 6-9 months | 0.1 % of participants |
| Ohio | Chronic Phase - Concurrent (Concurrent Sedatives/Hypnotics and Opioids on ≥1 Day) | 9-12 months | 0.1 % of participants |
Primary
Chronic Phase - High Dose (Average of ≥50 Morphine Equivalent Daily Dose [MEDD] Among All Days With Opioids)
Mean MEDD of 50 or more during the days a worker received opioids (based on days' supply) within the time period
Time frame: 3-6, 6-9, and 9-12 months after injury
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Washington | Chronic Phase - High Dose (Average of ≥50 Morphine Equivalent Daily Dose [MEDD] Among All Days With Opioids) | 3-6 months | 1.2 % of participants |
| Washington | Chronic Phase - High Dose (Average of ≥50 Morphine Equivalent Daily Dose [MEDD] Among All Days With Opioids) | 6-9 months | 0.9 % of participants |
| Washington | Chronic Phase - High Dose (Average of ≥50 Morphine Equivalent Daily Dose [MEDD] Among All Days With Opioids) | 9-12 months | 0.8 % of participants |
| Ohio | Chronic Phase - High Dose (Average of ≥50 Morphine Equivalent Daily Dose [MEDD] Among All Days With Opioids) | 3-6 months | 1.0 % of participants |
| Ohio | Chronic Phase - High Dose (Average of ≥50 Morphine Equivalent Daily Dose [MEDD] Among All Days With Opioids) | 6-9 months | 0.5 % of participants |
| Ohio | Chronic Phase - High Dose (Average of ≥50 Morphine Equivalent Daily Dose [MEDD] Among All Days With Opioids) | 9-12 months | 0.4 % of participants |
Comparison: * Primary predictor is binary (1 for Washington, 0 for Ohio)~* Outcome modeled longitudinally over the 3 time periods (3-6, 6-9, and 9-12 months)~* Time periods clustered at the individual worker level~* Exchangeable working correlation structure~* Robust variance estimatesp-value: 0.00295% CI: [1.5, 6.14]Generalized estimating equation
Primary
Subacute Phase - More Than 7 Days of Opioids
More than 7 unique days of opioids within the time period
Time frame: 6-12 weeks after injury
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Washington | Subacute Phase - More Than 7 Days of Opioids | 1.9 % of participants |
| Ohio | Subacute Phase - More Than 7 Days of Opioids | 12.2 % of participants |
Comparison: * Primary predictor is binary (1 for Washington, 0 for Ohio)~* Robust variance estimatesp-value: <0.00195% CI: [0.16, 0.38]Regression, Logistic
Secondary
≥30% Decrease in Pain Intensity/Interference (PEG-3)
Clinically important improvement in pain intensity/interference defined as obtaining a ≥30% reduction in pain intensity and interference from baseline. This was assessed with the PEG-3, which is comprised of 3 items assessing pain intensity and pain interference with enjoyment of life/general activity on a 0 to 10 numerical rating scale (0 = no pain/does not interfere, 10 = pain as bad as you can imagine/completely interferes). 1 = ≥30% reduction in mean PEG-3 summary score from baseline; 0 = otherwise.
Time frame: 12 months after injury
Population: * Analysis performed within a distinct survey sample of workers~* Estimates for Washington (WA) have been survey-weighted; sampling weights for Ohio (OH) were always 1.
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Washington | ≥30% Decrease in Pain Intensity/Interference (PEG-3) | 1001 Participants |
| Ohio | ≥30% Decrease in Pain Intensity/Interference (PEG-3) | 151 Participants |
Comparison: * Primary predictor is binary (1 for Washington, 0 for Ohio)~* Models survey weighted~* Robust variance estimatesp-value: 0.8495% CI: [0.71, 1.32]Regression, Logistic
Secondary
Anxious Symptoms (PHQ-4)
2-item PHQ-4 subscale assessed how often participant was bothered by anxious symptoms on 4-point scale (0 = not at all, 3 = nearly every day). 1 = summed subscale score ≥3; 0 = otherwise.
Time frame: 12 months after injury
Population: * Analysis performed within a distinct survey sample of workers~* Estimates for WA have been survey-weighted; sampling weights for OH were always 1.
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Washington | Anxious Symptoms (PHQ-4) | 487 Participants |
| Ohio | Anxious Symptoms (PHQ-4) | 79 Participants |
Comparison: * Primary predictor is binary (1 for Washington, 0 for Ohio)~* Models survey weighted~* Robust variance estimatesp-value: 0.8895% CI: [0.71, 1.49]Regression, Logistic
Secondary
Depressive Symptoms (PHQ-4)
2-item PHQ-4 subscale assessing how often participant was bothered by depressive symptoms on 4-point scale (0 = not at all, 3 = nearly every day). 1 = summed subscale score ≥3; 0 = otherwise.
Time frame: 12 months after injury
Population: * Analysis performed within a distinct survey sample of workers~* Estimates for WA have been survey-weighted; sampling weights for OH were always 1.
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Washington | Depressive Symptoms (PHQ-4) | 322 Participants |
| Ohio | Depressive Symptoms (PHQ-4) | 64 Participants |
Comparison: * Primary predictor is binary (1 for Washington, 0 for Ohio)~* Models survey weighted~* Robust variance estimatesp-value: 0.1595% CI: [0.49, 1.11]Regression, Logistic
Secondary
Disability - Activity Limitation
Modified activity limitation items from the National Health Interview Survey (NHIS) 2011 Adult Functioning Supplement. Participants were asked to rate on a 3-point scale (limited a lot, limited a little, not limited at all) whether their health was limited in four domains: participating in leisure or social activities, getting out with friends or family, doing household chores such as cooking and cleaning, and using transportation to get to places you want to go. 1 = limited a lot ; 0 = otherwise.
Time frame: 12 months after injury
Population: * Analysis performed within a distinct survey sample of workers~* Estimates for WA have been survey-weighted; sampling weights for OH were always 1.
| Arm | Measure | Group | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|---|
| Washington | Disability - Activity Limitation | Leisure or social activities | 281 Participants |
| Washington | Disability - Activity Limitation | Getting out with friends or family | 220 Participants |
| Washington | Disability - Activity Limitation | Doing household chores | 246 Participants |
| Washington | Disability - Activity Limitation | Using transportation | 137 Participants |
| Ohio | Disability - Activity Limitation | Using transportation | 22 Participants |
| Ohio | Disability - Activity Limitation | Leisure or social activities | 49 Participants |
| Ohio | Disability - Activity Limitation | Doing household chores | 56 Participants |
| Ohio | Disability - Activity Limitation | Getting out with friends or family | 37 Participants |
Comparison: * Leisure or social activities outcome~* Primary predictor is binary (1 for Washington, 0 for Ohio)~* Models survey weighted~* Robust variance estimatesp-value: 0.1295% CI: [0.91, 2.28]Regression, Logistic
Comparison: * Getting out with friends or family outcome~* Primary predictor is binary (1 for Washington, 0 for Ohio)~* Models survey weighted~* Robust variance estimatesp-value: 0.4295% CI: [0.74, 2.07]Regression, Logistic
Comparison: * Doing household chores outcome~* Primary predictor is binary (1 for Washington, 0 for Ohio)~* Models survey weighted~* Robust variance estimatesp-value: 0.9195% CI: [0.63, 1.51]Regression, Logistic
Comparison: * Using transportation outcome~* Primary predictor is binary (1 for Washington, 0 for Ohio)~* Models survey weighted~* Robust variance estimatesp-value: 0.5995% CI: [0.64, 2.21]Regression, Logistic
Secondary
Earning Less Than Before Injury
Participants asked to rate on a 5-point Likert scale the extent to which earnings differed from earnings at time of injury (1 = a lot more than before the injury, 5 = a lot less than before the injury). 1 = somewhat less than before, a lot less than before the injury, or not working; 0 = otherwise.
Time frame: 12 months after injury
Population: * Analysis performed within a distinct survey sample of workers~* Estimates for WA have been survey-weighted; sampling weights for OH were always 1.
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Washington | Earning Less Than Before Injury | 819 Participants |
| Ohio | Earning Less Than Before Injury | 129 Participants |
Comparison: * Primary predictor is binary (1 for Washington, 0 for Ohio)~* Models survey weighted~* Robust variance estimatesp-value: 0.195% CI: [0.95, 1.83]Regression, Logistic
Secondary
Global Improvement (GIC)
Global Impression of Change on 7-point Likert scale. Participants asked to rate how they compared now to immediately after their injury (1 = very much improved, 7 = very much worse) 1 = much improved or very much improved; 0 = otherwise.
Time frame: 12 months after injury
Population: * Analysis performed within a distinct survey sample of workers~* Estimates for WA have been survey-weighted; sampling weights for OH were always 1.
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Washington | Global Improvement (GIC) | 1413 Participants |
| Ohio | Global Improvement (GIC) | 222 Participants |
Comparison: * Primary predictor is binary (1 for Washington, 0 for Ohio)~* Models survey weighted~* Robust variance estimatesp-value: 0.3895% CI: [0.6, 1.21]Regression, Logistic
Secondary
Not Working for Pay
Participants asked whether they worked for pay in the past week. 1 = did not work for pay in the week prior to assessment; 0 = otherwise.
Time frame: 12 months after injury
Population: * Analysis performed within a distinct survey sample of workers~* Estimates for WA have been survey-weighted; sampling weights for OH were always 1.
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Washington | Not Working for Pay | 599 Participants |
| Ohio | Not Working for Pay | 107 Participants |
Comparison: * Primary predictor is binary (1 for Washington, 0 for Ohio)~* Models survey weighted~* Robust variance estimatesp-value: 0.2295% CI: [0.88, 1.75]Regression, Logistic
Secondary
On Time Loss (Not Working)
1 = on time loss (workers' compensation warrant data); 0 = otherwise.
Time frame: 12 months after injury
Population: * Analysis performed within a distinct survey sample of workers~* Estimates for WA have been survey-weighted; sampling weights for OH were always 1.
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Washington | On Time Loss (Not Working) | 209 Participants |
| Ohio | On Time Loss (Not Working) | 43 Participants |
Comparison: * Primary predictor is binary (1 for Washington, 0 for Ohio)~* Models survey weighted~* Robust variance estimatesp-value: 0.0295% CI: [1.12, 3.47]Regression, Logistic
Secondary
Opioid Overdose/Adverse Effects
Qualifying International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) diagnosis codes: first 3 digits = T40 and 5th digit = (0,1,2,3,4,6) and 7th digit not = 6 (excludes underdosing). 1 = presence of qualifying ICD-10-CM diagnosis code; 0 = otherwise.
Time frame: 12 months after injury
Population: * Analysis performed within a distinct survey sample of workers~* Estimates for WA have been survey-weighted; sampling weights for OH were always 1.
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Washington | Opioid Overdose/Adverse Effects | 2 Participants |
| Ohio | Opioid Overdose/Adverse Effects | 0 Participants |
Secondary
Quality of Life (EuroQol EQ-5D)
5-item scale in which participants were asked to rate the extent to which they experienced problems with mobility, self-care, usual activities, pain/discomfort, and anxiety/depression on a 5-point scale (1 = no problems, 5 = extreme problems). Individual item responses were used to create score profiles (range 11111 to 55555), which were then converted to an index value using a US-based value set. -0.573 (worst health state) to 1 (best health state)
Time frame: 12 months after injury
Population: * Analysis performed within a distinct survey sample of workers~* Estimates for WA have been survey-weighted; sampling weights for OH were always 1.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Washington | Quality of Life (EuroQol EQ-5D) | 0.81 index value | Standard Deviation 0.16 |
| Ohio | Quality of Life (EuroQol EQ-5D) | 0.79 index value | Standard Deviation 0.16 |
Comparison: * Primary predictor is binary (1 for Washington, 0 for Ohio)~* Models survey weighted~* Robust variance estimatesp-value: 0.5395% CI: [-0.03, 0.01]Regression, Logistic
Secondary
Satisfaction With Overall Treatment
Single-item 5-point Likert scale rating of how satisfied participants were with all injury-related treatment (-2 = very dissatisfied, 2 = very satisfied).
Time frame: 12 months after injury
Population: * Analysis performed within a distinct survey sample of workers~* Estimates for WA have been survey-weighted; sampling weights for OH were always 1.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Washington | Satisfaction With Overall Treatment | 0.98 score on 5-point Likert scale | Standard Deviation 1.17 |
| Ohio | Satisfaction With Overall Treatment | 0.81 score on 5-point Likert scale | Standard Deviation 1.32 |
Comparison: * Primary predictor is binary (1 for Washington, 0 for Ohio)~* Models survey weighted~* Robust variance estimatesp-value: 0.05395% CI: [0, 0.32]Regression, Logistic
Secondary
Satisfaction With Pain-related Treatment
Single-item 5-point Likert scale rating of how satisfied participants were with treatment received for injury-related pain (-2 = very dissatisfied, 2 = very satisfied).
Time frame: 12 months after injury
Population: * Analysis performed within a distinct survey sample of workers~* Estimates for WA have been survey-weighted; sampling weights for OH were always 1.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Washington | Satisfaction With Pain-related Treatment | 0.88 score on 5-point Likert scale | Standard Deviation 1.26 |
| Ohio | Satisfaction With Pain-related Treatment | 0.66 score on 5-point Likert scale | Standard Deviation 1.34 |
Comparison: * Primary predictor is binary (1 for Washington, 0 for Ohio)~* Models survey weighted~* Robust variance estimatesp-value: 0.0195% CI: [0.05, 0.38]Regression, Logistic
Other Pre-specified
Problematic Opioid Use (TAPS)
3-item TAPS tool Part 2 assessing any problematic opioid use in the past 3 months. Participants asked if they used a prescription opioid not as prescribed, if they failed in cutting down on opioid use, and if anyone has expressed concern about their opioid use (0 = no, 1 = yes). The items were summed to create a summary score in which scores ≥1 represented problematic or high-risk opioid use. 1 = summed subscale score ≥1; 0 = otherwise.
Time frame: 12 months after injury
Population: * Analysis performed within a distinct survey sample of workers~* Estimates for WA have been survey-weighted; sampling weights for OH were always 1.
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Washington | Problematic Opioid Use (TAPS) | 113 Participants |
| Ohio | Problematic Opioid Use (TAPS) | 22 Participants |
Comparison: * Primary predictor is binary (1 for Washington, 0 for Ohio)~* Models survey weighted~* Robust variance estimatesp-value: 0.3595% CI: [0.42, 1.35]Regression, Logistic