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What Users Want – A Perspective from a Project Business Owner. Kevin Morris Director of Clinical Services ACC. What do I need research evidence for?. Purchasing decisions Health economics modelling Statistical analysis of claim duration, cost, trends Survey of stakeholder opinion
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What Users Want – A Perspective from a Project Business Owner Kevin Morris Director of Clinical Services ACC
What do I need research evidence for? • Purchasing decisions • Health economics modelling • Statistical analysis of claim duration, cost, trends • Survey of stakeholder opinion • Programme evaluation
Evaluation Challenges • Behaviour is complex – changing it is difficult • Systems are complex – there are multiple players • Data may not be reliable • Management want simple answers
The Issue in 2010/11 • Capacity for work certification does not fit expected norms • 20,000 clients certified as Fully Unfit for 1 month or more • 15,000 had exceeded MDA optimum • 10,000 had exceeded MDA maximum
Chance of Returning to Work after workplace injury: • 70% if off for 20 days • 50% if off for 45 days • 35% if off for 70 days Johnson D, Fry T. Factors Affecting Return to Work after Injury: A study for the Victorian WorkCover Authority Melbourne. Melbourne Institute of Applied Economic and Social Research; 2002
Better @ Work Evidence based Paradigm Shift Behaviour change through Outcome Based Payments Collaboration
Collaboration Employers Employees/Unions Practitioners International Input
Better @ Work Process GP consultation Referral & Certification eACC18 Local Coordinator Handover from coordinator to case manager at negotiated time if incapacity ongoing Local agreements with Emergency and A&M clinics Outcome & Fee for Service payments
Outcomes Wanted Fewer Employees certificated as “fully unfit” by practitioners Accommodation at workplace All parties are satisfied with the process
Methodology - Difference in Difference The impact of a policy on an outcome can be estimated by computing a double difference, one over time (before-after) and one across sites (between B@W and not B@W) If average sample data is available for B@W and not B@W for at least two time periods, the DID method produces estimates of impacts that are in principle more plausible than those based on a single difference (either over time or between groups).
Statistically Significant Results • Certification of FFSW vs FUF increased by 4.5% overall • WC cost for claims that lasted 90 – 180 days decreased by 21%
Behaviour Change Findings • Financial Incentives were not the primary motivator • Role of RTWC key for both GPs and Employers • eACC18 essential mechanism • All parties satisfied