Model Clinic Program (1990 to Present)
Margareta Nordin (PI), Marco Campello, Sherri Weiser
The Model Back Clinic, established by the OIOC with 10 consecutive years of federal funding established an algorithm for patient care that has a 92% rate of return to any work and 84% return to regular duty, calculated for workers with a mean duration of time out of work of 9.4 months prior to their treatment at the Model Clinic. This algorithm is:

  1. Workers with acute low back pain are seen in a primary occupational healthcare facility by a healthcare practitioner who has received instruction in the management of acute low back pain.

  2. Injured workers who are still unable to return to work after four or more weeks are invited to enroll in a goal-oriented program at a secondary, independent healthcare facility/clinic.

  3. At this facility, a multidisciplinary team provides individualized, aggressive care and follow-up.

Research from this program has provided the following information.

  1. Clinical and workplace-related factors associated with delayed recovery (more than 28 days) have been identified. The following predictors have been identified within the first week after injury for workers with nonspecific low back pain: perceived disability, abnormal gait, comorbidity, age, and exposure to whole body vibration. These clinical and work-related signs and factors can be used to target individuals for early intervention and/or workplace changes.

  2. Overall effectiveness is evaluated by analyzing the rate of lost workdays and delayed return to work due to back pain. We are currently evaluating the long-term benefits (5-10 years) and efficacy of implemented programs.

  3. The effectiveness of the educational program at the primary care facility is measured by the implementation of case management and evaluation protocols and procedures. Compliance with standardized evaluation by company physicians is currently 98% in the targeted companies.

  4. Treatment efficacy of the 4-week Return To Work program is measured using functional testing, pain measurements, functional perceived disability, and quality of life. An outcome study has been performed on 82 consecutive RTW participants. The study indicates a 92% rate of return to any work and 84% return to regular duty, calculated for workers with a mean duration of time out of work of 9.4 months prior to their treatment at the OIOC Model Clinic.

The Model Back Clinic was first established in 1990 when the OIOC received a 5-year grant from the National Institute for Occupational Safety and Health, Centers for Disease Control (NIOSH/CDC). The aim of the grant was to establish a Model Clinic for the treatment of occupational low back pain and the prevention of chronic disability. This project fostered the development of a state-of-the-art facility uniquely suited to meet the needs of the working community. In 1996, the OIOC received continuous funding from the National Institute of Arthritis and Musculoskeletal and Skin Disorders, National Institutes of Health (NIAMS/NIH) to take the Model Clinic into the next millennium.

In the design, development, implementation and testing of the Model Clinic, the OIOC founded a Model Clinic Program that requires the following three phases:

  1. Education at the primary care facility:
    The OIOC developed the curriculum for medical personnel at the primary care facility in collaboration with an advisory group that included management, union, medical, safety, and human resource staff, the research group, and others as appropriate. This collaborative effort, called LMAC (Labor, Management, and Academic Collaboration), is crucial to the success of the Model Clinic, as the LMAC works to overcome obstacles to providing state-of-the-art care to injured employees.

  2. Clinical Practice - Patient evaluation and treatment at primary and secondary care facilities: The Model Clinic is unique in its concept of providing coordinated, structured care from primary to secondary care facilities that provides aggressive, individualized, and work-oriented treatment for workers with acute, sub-acute, or chronic low back pain.

    Primary Care Facility: The OIOC evaluated job requirements at primary care facilities based on the workers' descriptions of their work tasks and existing job descriptions. In this process, the importance of establishing standardized nomenclature and procedures vital to the provision of optimal care for the injured worker with the focus on returning the employee to full-time duty was established for labor, management, and union representatives.

    The OIOC also created and implemented a standard protocol was followed when an employee visited the primary healthcare facility to report an injury. This protocol includes questionnaires and a 15-minute clinical evaluation.

    Secondary Care Facility: Through its Model Clinic Program research, the OIOC discovered that it is optimal to offer an employee who is unable to return to work after 4 weeks or more the opportunity to visit a secondary care facility that has been trained in the procedures and protocols of the OIOC Model Clinic for evaluation and treatment. Once the employee contacts the secondary care facility, the employee should be seen within one to five days after referral and insurance approval. The secondary care facility will conduct standardized evaluations and interviews with the employee. The results of all these assessments are discussed by the clinical team to determine whether the worker is appropriate for enrollment in an aggressive multi-disciplinary Return To Work (RTW) program , or if s/he is better suited for another type of treatment. The course of treatment is also influenced by input from the worker, and contingent upon approval of the insurance carrier. A key component to the success of this program is to have all stakeholders agree to the goals and the process to achieving the goals.

  3. Research and Evaluation: The results of the OIOC-NIOSH Model Clinic and similar Model Clinic Programs established by the OIOC are continuously evaluated. Since 1990, the OIOC has found that the Model Clinic Program has substantial benefits for companies, patients, and insurance companies, and believes that this phase.

A critical component to the research and evaluation phase is the computerization of clinical practices. When the OIOC Model Clinic was established, there was a need to automate its clinical practices and use clinical information for research purposes. This need led to the design, development, and implementation of a clinical management system that utilizes the most recent developments in relational database management system and fourth generation information management technologies. This system consists of menu-driven screens, data-entry screens, and zoom windows.

This clinical management system also consists of computerized forms, protocols, and questionnaires such as:

  1. medical history
  2. medical evaluation
  3. physical therapy protocol
  4. psychosocial questionnaires
  5. alcohol and drug screening
  6. medical evaluation
  7. ergonomic workplace evaluation

    back to Clinical Research