In August 2010, a quality improvement assessment conducted by the occupational medicine marketing team of a large multi-state healthcare system revealed dissatisfaction with current occupational medicine service in a rural northern plains multi-specialty lack of timeliness of mandatory reports and inconsistency with work restrictions. Similar problems are recognized within all aspects of the United States healthcare delivery system. The Institute of Medicine documented lack of are coordination and fragmentation of care as systemic problems that increased costs and decreased quality of care. In September 2010, based on this assessment an occupational medicine project team was formed to investigate the needs for an occupational medicine service line. In October 2010, the team recommended the implementation of an Occupational Medicine Program based on the sports medicine care delivery model. Changes were made to improve the satisfaction of local and area employers, maintain quality care for injured workers and decrease the risk of competitors moving to the local area. The program was developed based on two theoretical frameworks. Bartanlanffy’s Open System Theory and Lewin’s Change Theory provided guidance for the practice change developmet and assessment. These frameworks and application of Larrabee’s Evidence-based Care Model supported use of the best evidence to develop and implement the program. The objective of the practice change was to deliver quality cost effective occupational medicine services that satisfied the injured worker, employer and insurance carriers. The pilot phase was launched on January 1, 2011, allowing the project team to test and refine processes developed for the service line. The Occupational Medicine Program was fully implemented on April 1, 2011. The purpose of this capstone project was to conduct short term evaluation of the practice change. Evaluation focused on employer satisfaction and satisfaction of the project team with internal processes. These evaluations were conducted with clinic generated survey instrument. A pair of retrospective chart audits detailed medical record evidence on fragmentation of care, inconsistency of work restrictions and lack of timely report completion from both prior to and after service line implementation. The chart audit data supported the problems identified in the prior assessment. The 2011 chart audit showed increased compliance with service line metrics. The employer satisfaction surveys showed increased satisfaction of ninety-four percent at the nine month data point, while the project team survey showed no dissatisfaction with internal processes. There were problems indentified through the surveys which required rapid improvement events to facilitate process refinement to meet the needs of both the internal and external stakeholders. Satisfaction with internal processes and increased employer satisfaction provide a sound foundation for the occupational medicine service line. Long term sustainability will require further assessments of clinical finanicals, employer lost work day data, Press-Ganey scores for patient satisfaction and insurance carrier metrics for cost of care. These assessments are not within the timeframe of this capstone project. These assessments could be added to this project to give a complete short and long term evaluation.
