MoHaWK Round 4 Preparation
Prepared for:MoHawk participants
Prepared by: Hilary Winch
Date: June 2013
Regus House, 1 Friary, Temple Quay, Bristol, BS1 6EA 0117 344 5105
Syngentis is the trading name of the Health and Work Community Interest Company- a not-for-profit company dedicated to improving the fitness, health and productivity of the UK’s working age population.
Round 4 indicator preparation
Round 4 New Indicator Preparations
- Yellow Flags for back pain
The criterion and target standard for this indicator has been derived from the national back pain audit. In the 2011 back pain audit, it was identified nationally that OH clinicians need to improve the screening of Yellow flags. Only 47% of participant assessments undertook this screening at that time. This indicator will assist your unit in identifying if progress has been made since that audit in this area. The 2000 FOM Guidelines on backpain (Waddell, G and Burton, K. Occupational Health Guidelines for the Management of Low Back Pain: Evidence Review and Recommendations. London: Faculty of Occupational Medicine, 2000) advised that yellow flags (personal psychosocial risk factors for chronicity) should be considered in order to identify workers at particular risk of developing long-term pain and disability. This assessment should be used to instigate active case management at an early stage.
Indicator: All consultations for back pain should document consideration of yellow flags
The initial consultation records of new back pain should demonstrate that yellow flags have been considered.
Documentation can be:
- Case notes mention yellow flags
- Two or more of the following
A belief that back pain is harmful or potentially disabling
Fear / avoidance behaviour and reduced activity levels
Tendency to low mood and withdrawal from social interaction
Expectation of passive treatments rather than a belief that active participation will help.
How to collect data
Collect data on back pain cases from August – October 2013. When the data input stage occurs, input data for 20 cases of back pain (or as many as you have in that time period if less than 20).
- Identify the cases by pulling a report of those cases seen for back pain from your IT system. If you do not use an electronic system to record reasons for assessment then start collecting names of people seen for back (on a spread sheet) from 1st August – 31st October 2013.
- If you use an electronic template questionnaire for back pain consultations, then a report should be able to be pulled on those assessments linked with back pain on the content of questions that may link to Yellow flags.
- If you do not use an electronic template questionnaire, then pull the records of the cases identified (either electronic or paper) and review how many of them have indicated the yellow flag criteria above. (consider marking this on the spread sheet for easy recording)
- You can then input into Mohawk, how many had documentary evidence of yellow flags being considered against the total number of back pain cases in the data period.
- Communication with treating doctors
There is evidence that improved communication between the workplace (occupational health) and patients’ primary and secondary care providers improves vocational rehabilitation for employees on long-term sick leave, leads to earlier return to work, and is cost effective (Waddell et al 2008).Equally a study undertaken in 2012 (Stern &Madan) reveals that GPs want more information about their patients from occupational physicians. GPs would value a report, by post, after every consultation, including clinical and functional information, advice on the timing and adjustments of any return-to-work plan, and any alternative medical diagnosis or management suggested. This would increase occupational health knowledge and awareness within general practice and would assist the GP in completing the patient’s ‘fit note’, ultimately increasing the chances of their patient being rehabilitated back to work — a prime goal of Dame Carol Black’s Review of the health of Britain’s working age population: Working for a Healthier Tomorrow.
Waddell G, Burton AK, Kendall NAS, Vocational Rehabilitation Task Group —Industrial Injuries Advisory Council. Vocational rehabilitation: what works, for whom, and when? London: The Stationery Office, 2008.
Stern, A, Madan, I (2012) Optimal communication from occupational physicians to GPs, British Journal of General Practice 834-839
The Occupational health practitioner and the treating doctor should liaise if workers are on absence attributable for longer than four weeks.
If a worker is seen by OH who has been absent for more than 4 weeks they should document that liaison with treating physician has taken place.
Documentation could be
- Ask for medical report
- Copy of manager report to GP / treating physician.
How to collect data
- Pull off report of the cases absent for > than 4 weeks (this will be for a months duration). In Cohort these are often considered as ‘Long Term sickness’, and this can be captured in the ‘Referral Reason’ drop down list.In Opas / E-opas providing the absence is recorded into an absence event at day one. Any case of absence less than 4 weeks could be reported. Equally if you record the length of absence when you triage / at the assessment a report can be pulled.
- From those cases identify if either a report was requested or that a copy of the management report has been sent to the GP / treating physician.
In cohort this can be captured as part of the process of ‘Reports Requested’ in the Management Referral module. Dates can show – Date Requested and Date Received
In either OPAS or eOPAS Using the ‘contacts’ would allow you to pull a report to indicate if the GP has been sent a copy of the report or GR report requested.
- You can then input into Mohawk, how many had documentary evidence of communication with the individuals treating doctor over the total number of cases that were seen who had been absent for > 4weeks or more.
Syngentis – June 2013