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Well-known comp disability guidelines removed from federal database

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The Official Disability Guidelines’ withdrawal from a federal database of approved clinical practice guidelines earlier this month could cause workers compensation professionals to question what evidence-based treatment guidelines should entail for injured workers.

Published by the for-profit Encinitas, California-based Work Loss Data Institute, the Official Disability Guidelines are the foundation of workers comp treatment guidelines and closed drug formularies in states like Texas and Oklahoma.

Prior to this month, the guidelines were included in the National Guideline Clearinghouse at Guideline.gov, a source of clinical practice guidelines that’s sponsored by the Agency for Healthcare Research and Quality within the U.S. Department of Health and Human Services.

The change has caused some debate among industry professionals about what standards medical guidelines should meet to be considered evidence-based and, thus, used in the treatment of injured workers.

“There’s no immediate effect on the treatment guidelines or formulary used in the Texas workers compensation system,” a spokesman for the Texas Department of Insurance said in a statement. “There are a number of good, evidence-based treatment guidelines available, both on and off the clearinghouse. We’ll be looking into the reasons for ODG’s withdrawal from the clearinghouse to determine our next steps.”

Meanwhile, a spokeswoman for the Ohio Bureau of Workers’ Compensation, which uses ODG as a tool for utilization review, said in an email, “we do not expect an impact from the removal of ODG from the Clearinghouse (database) and believe it will continue to meet our needs.”

It was revised inclusion criteria, effective June 1, 2014, that prevented the National Guideline Clearinghouse from including an updated version of the guidelines, said Mary Nix, health scientist administrator for the Agency for Healthcare Research and Quality in Rockville, Maryland. “We have a higher bar now for the evidence underpinning the guidelines,” she added.

According to the new criteria, a guideline must contain “systematically developed statements including recommendations intended to optimize patient care and assist physicians and/or other health care practitioners and patients to make decisions about appropriate health care for specific clinical circumstances,” among other things.

“We were not able to … assure that the systematic evidence review was conducted for each of the topics that they cover in the ODGs,” Ms. Nix said.

However, Work Loss Data Institute President and CEO Phil Denniston said in an email that he sent a “withdrawal letter” to Ms. Nix on June 16, stating that “being published on Guideline.gov is not a good fit for ODG.”

“Commercial guidelines are successful at improving outcomes because they are comprehensive and up to date, and that is our mission,” Mr. Denniston said. “The new (National Guideline Clearinghouse) criteria do not support those requirements.”

Groups may choose not to submit their guidelines to the clearinghouse if they don’t have time to review all the required data records or if they know it won’t meet the criteria, Ms. Nix said.

For the American College of Occupational and Environmental Medicine practice guidelines, the decision made more than two years ago to no longer be included in the clearinghouse was about protecting “intellectual property,” said Joseph Guerriero, Westminster, Colorado-based senior vice president for Reed Group Ltd.’s MDGuidelines, which partners with ACOEM.

There are only two remaining for-profit groups in the database, neither of which is specific to occupational medicine, Ms. Nix said.