Comcare has success with innovative early intervention program
Dr Mary WyattPhone triage is an effective gateway to early intervention, securing cost and recovery benefits via a broad-spectrum approach, with support services accessible to workers regardless of work causation.
An early intervention program at Comcare targeting workers at high risk of delayed recovery and return to work has led to improved recovery and RTW outcomes, lower costs and high participant satisfaction.
Key elements included:
- The program was open to any worker with an injury or illness that impacted ability to work. In other words, access was not dependent on work causation or workers’ compensation claim status.
- The initial step was phone triage by nurse, who then referred the injured worker on to appropriate treatment providers.
- Treatment was provided promptly, via a network of medical and allied professionals with experience in work injury and RTW.
Limitations to the design of a study analysing the success of the early intervention program make it difficult to precisely quantify the benefits secured. However, it’s clear that this program benefited workers and employers alike, and was well-received by both.
Why the research matters
Phone triage is a good approach to early intervention following work injury as it is more personal than submitting an online or hardcopy claim form.
The worker speaks with a professional who has experience in managing work injury. This allows a quick transition to treatment, and—when the professional understands the health benefits of work—RTW is usually in the mix from the start. Phone triage independent of the compensation system also opens the process up to people who will not go on to submit a workers’ compensation claim which may benefit health and the bottom line in the longer term.
Recently, Comcare piloted a program that used phone triage as a gateway to early intervention. The pilot went for six months, and was then assessed in an independent evaluation report created by Deloitte.
What was Comcare's approach to early intervention?
The program was open to anyone who was injured at work, or who developed symptoms that impacted the ability to work, regardless of the cause. In other words, the injury, illness or condition did not have to be work-related, nor did there have to be a workers’ compensation claim—there just had to be an impact on work ability.
Workers contacted a nurse triage service by phone and received a clinical assessment and treatment advice, including advice about self-management of the condition. If appropriate, they were referred on to a treating practitioner who was part of a network of medical and allied health professionals managed by InjuryNet, generally a GP, physiotherapist or psychologist. If the worker preferred, they were able to see their own GP.
Soon after initial contact, the employer was notified that there had been an incident, and later received aggregated data on the progress of the program.
Was the program a success?
Over the course of the pilot, the triage service received 347 calls. Half of these (51%) had to do with work-related injuries, 37% were non-work-related, and the remaining 12% were unknown.
Appointment types generated by the service were as follows:
- 53% of callers saw a physiotherapist
- 21% saw a doctor
- 17% saw a psychologist
- 5% were advised to self-manage their condition
- 3% of callers had already made an appointment to see a treating practitioner
- Only 2% opted out of the service, as they wanted to see their own GP.
The program was effective in securing prompt access to appropriate treatment. Of those with physical injuries, 80% accessed treatment within three days. Of those with psychological injuries, 80% accessed treatment within eight days.
The significance of this outcome was underscored by one participant, who said, “Without the pilot I would have ignored my injury until it became unbearable. Having an actual early intervention which was easy to refer into and free, actually prompted me to take my injury seriously.”
The vast majority of injured workers with physical injuries who used the triage service (93-97%) managed their condition using resources provided within the pilot. Of those with psychological injuries, 85% managed their condition using services provided within the pilot.
Worker satisfaction with the pilot was high. The triage process was easy, and almost all workers involved had a good (15%) or very good (79%) experience with the nurse assessor and the recommended treating practitioner.
Workers who participated in the program valued the connectedness of the service, made possible because of the network of treating practitioners.
“The phone triage service was a wonderful entry point,” one said. “The information sharing amongst care professionals made the whole process a lot less stressful for me.”
Others praised the smooth and integrated nature of the service.
“Experience was easy from start, from speaking to the nurse to be assessed to receiving the email with my booking. Appointment available on same day as I spoke to nurse. Practitioner was good and very experienced. Would highly recommend.”
There were broader benefits too. Workers became more trusting of their employer’s ability to support their injury as a result of participating in the pilot program, and the level of corporate engagement also rose.
Deliotte (who completed an independent assessment of the program), compared recovery and RTW outcomes for workers who participated in the pilot with a control group of Comcare workers who had lodged compensation claims between 2014 and 18.
It must be noted that this is not the perfect comparison to make. All the workers in the control group had lodged a claim for compensation, while the phone triage group included workers who had not lodged a claim. The National RTW Survey tells us 20-25% of people have significant concern about lodging a claim. However, the researchers used various approaches to minimise the differences between these two groups.
Firstly, they selected workers for the control group who had similar injury characteristics to the pilot group to enable a like-with-like comparison. The injury characteristics captured (for both the pilot and control groups) included type of injury, mechanism of injury and body location.
Secondly, the pilot and control groups were aligned for age, gender and location.
The researchers found that the pilot group did better on a number of important measures.
They had twice the recovery rate of the control group. They also had less time away from work. Almost all (93%) of the participants in the pilot group who were triaged to a GP were certified fit for work.
There was also less transition from acute to chronic injury. Workers with physical injuries were 50% less likely to develop a chronic condition. Workers with psychological injuries were 10-30% less likely to develop a chronic condition. There was also less chance of developing a secondary injury or illness.
Overall, the intervention was well received and seems to have led to improvements in recovery and RTW outcomes. We have long recommended reporting of injuries by phone—it is personable, makes reporting easy for the worker and supports people getting help early. Notwithstanding the challenges with the control group comparison, we consider this a great initiative from Comcare. Supporting staff pays off.