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Musculoskeletal Injuries in the Workplace: Defining Quality Care

Department of Orthopaedic Surgery, Georgetown University Medical Center, Washington, DC.

Quality health care for a specific medical condition may be defined as adherence to an algorithm in which decision points are based on established medical practice as supported in the literature. The decision points can be considered either a "stan-dard of care" if there is definitive scientific evidence for their validity or a "guide-line for care" if there is only a consensus of medical opinion available. Algorithms for musculoskeletal injuries can be and have been successfully applied to patients in the workers' compensation setting. They can function as a concurrent surveil-lance system and are well accepted by physicians, patients, and industry if imple-mented by unbiased medical experts. A high level of quality care is attained by following such algorithms. Other goals achieved are early functional restoration as measured by return to work, a more efficient use of diagnostic studies, and avoidance of unnecessary therapeutic interventions, with the result that treatment is more cost-effective. Such a program that strives for high-quality care and emphasizes appropriate utilization will realize cost savings that may be far greater and longer lasting than the financial saving seen with arbitrary spending caps and fee controls.