Development of prediction models of stress and long-term disability among claimants to injury compensation systems: a cohort study

Mathew Spittal, Genevieve Grant, Meaghan O'Donnell, Alexander McFarlane, David M Studdert

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Objectives: We sought to develop prognostic risk scores for compensation-related stress and long-term disability using markers collected within 3 months of a serious injury.

Design: Cohort study. Predictors were collected at baseline and at 3 months postinjury. Outcome data were collected at 72 months postinjury.

Setting: Hospitalised patients with serious injuries recruited from four major trauma hospitals in Australia.

Participants: 332 participants who made claims for compensation for their injuries to a transport accident scheme or a workers’ compensation scheme.

Primary outcome measures: 12-item WHO Disability Assessment Schedule and 6 items from the Claims Experience Survey.

Results: Our model for long-term disability had four predictors (unemployed at the time of injury, history of a psychiatric disorder at time of injury, post-traumatic stress disorder symptom severity at 3 months and disability at 3 months). This model had good discrimination (R2=0.37) and calibration. The disability risk score had a score range of 0–180, and at a threshold of 80 had sensitivity of 56% and specificity of 86%. Our model for compensation-related stress had five predictors (intensive care unit admission, discharged to home, number of traumatic events prior to injury, depression at 3 months and not working at 3 months). This model also had good discrimination (area under the curve=0.83) and calibration. The compensation-related stress risk score had score range of 0–220 and at a threshold of 100 had sensitivity of 74% and specificity of 75%. By combining these two scoring systems, we were able to identify the subgroup of claimants at highest risk of experiencing both outcomes.

Conclusions: The ability to identify at an early stage claimants at high risk of compensation-related stress and poor recovery is potentially valuable for claimants and the compensation agencies that serve them. The scoring systems we developed could be incorporated into the claims-handling processes to guide prevention-oriented interventions.
Original languageEnglish
Article numbere020803
Number of pages10
JournalBMJ Open
Volume8
Issue number4
DOIs
Publication statusPublished - 2018

Keywords

  • Injury compensation systems
  • Claims processes
  • Health outcomes
  • Injury outcomes

Cite this

Spittal, Mathew ; Grant, Genevieve ; O'Donnell, Meaghan ; McFarlane, Alexander ; Studdert, David M. / Development of prediction models of stress and long-term disability among claimants to injury compensation systems : a cohort study. In: BMJ Open. 2018 ; Vol. 8, No. 4.
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abstract = "Objectives: We sought to develop prognostic risk scores for compensation-related stress and long-term disability using markers collected within 3 months of a serious injury.Design: Cohort study. Predictors were collected at baseline and at 3 months postinjury. Outcome data were collected at 72 months postinjury.Setting: Hospitalised patients with serious injuries recruited from four major trauma hospitals in Australia.Participants: 332 participants who made claims for compensation for their injuries to a transport accident scheme or a workers’ compensation scheme.Primary outcome measures: 12-item WHO Disability Assessment Schedule and 6 items from the Claims Experience Survey.Results: Our model for long-term disability had four predictors (unemployed at the time of injury, history of a psychiatric disorder at time of injury, post-traumatic stress disorder symptom severity at 3 months and disability at 3 months). This model had good discrimination (R2=0.37) and calibration. The disability risk score had a score range of 0–180, and at a threshold of 80 had sensitivity of 56{\%} and specificity of 86{\%}. Our model for compensation-related stress had five predictors (intensive care unit admission, discharged to home, number of traumatic events prior to injury, depression at 3 months and not working at 3 months). This model also had good discrimination (area under the curve=0.83) and calibration. The compensation-related stress risk score had score range of 0–220 and at a threshold of 100 had sensitivity of 74{\%} and specificity of 75{\%}. By combining these two scoring systems, we were able to identify the subgroup of claimants at highest risk of experiencing both outcomes.Conclusions: The ability to identify at an early stage claimants at high risk of compensation-related stress and poor recovery is potentially valuable for claimants and the compensation agencies that serve them. The scoring systems we developed could be incorporated into the claims-handling processes to guide prevention-oriented interventions.",
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Development of prediction models of stress and long-term disability among claimants to injury compensation systems : a cohort study. / Spittal, Mathew; Grant, Genevieve; O'Donnell, Meaghan; McFarlane, Alexander; Studdert, David M.

In: BMJ Open, Vol. 8, No. 4, e020803, 2018.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Development of prediction models of stress and long-term disability among claimants to injury compensation systems

T2 - a cohort study

AU - Spittal, Mathew

AU - Grant, Genevieve

AU - O'Donnell, Meaghan

AU - McFarlane, Alexander

AU - Studdert, David M

PY - 2018

Y1 - 2018

N2 - Objectives: We sought to develop prognostic risk scores for compensation-related stress and long-term disability using markers collected within 3 months of a serious injury.Design: Cohort study. Predictors were collected at baseline and at 3 months postinjury. Outcome data were collected at 72 months postinjury.Setting: Hospitalised patients with serious injuries recruited from four major trauma hospitals in Australia.Participants: 332 participants who made claims for compensation for their injuries to a transport accident scheme or a workers’ compensation scheme.Primary outcome measures: 12-item WHO Disability Assessment Schedule and 6 items from the Claims Experience Survey.Results: Our model for long-term disability had four predictors (unemployed at the time of injury, history of a psychiatric disorder at time of injury, post-traumatic stress disorder symptom severity at 3 months and disability at 3 months). This model had good discrimination (R2=0.37) and calibration. The disability risk score had a score range of 0–180, and at a threshold of 80 had sensitivity of 56% and specificity of 86%. Our model for compensation-related stress had five predictors (intensive care unit admission, discharged to home, number of traumatic events prior to injury, depression at 3 months and not working at 3 months). This model also had good discrimination (area under the curve=0.83) and calibration. The compensation-related stress risk score had score range of 0–220 and at a threshold of 100 had sensitivity of 74% and specificity of 75%. By combining these two scoring systems, we were able to identify the subgroup of claimants at highest risk of experiencing both outcomes.Conclusions: The ability to identify at an early stage claimants at high risk of compensation-related stress and poor recovery is potentially valuable for claimants and the compensation agencies that serve them. The scoring systems we developed could be incorporated into the claims-handling processes to guide prevention-oriented interventions.

AB - Objectives: We sought to develop prognostic risk scores for compensation-related stress and long-term disability using markers collected within 3 months of a serious injury.Design: Cohort study. Predictors were collected at baseline and at 3 months postinjury. Outcome data were collected at 72 months postinjury.Setting: Hospitalised patients with serious injuries recruited from four major trauma hospitals in Australia.Participants: 332 participants who made claims for compensation for their injuries to a transport accident scheme or a workers’ compensation scheme.Primary outcome measures: 12-item WHO Disability Assessment Schedule and 6 items from the Claims Experience Survey.Results: Our model for long-term disability had four predictors (unemployed at the time of injury, history of a psychiatric disorder at time of injury, post-traumatic stress disorder symptom severity at 3 months and disability at 3 months). This model had good discrimination (R2=0.37) and calibration. The disability risk score had a score range of 0–180, and at a threshold of 80 had sensitivity of 56% and specificity of 86%. Our model for compensation-related stress had five predictors (intensive care unit admission, discharged to home, number of traumatic events prior to injury, depression at 3 months and not working at 3 months). This model also had good discrimination (area under the curve=0.83) and calibration. The compensation-related stress risk score had score range of 0–220 and at a threshold of 100 had sensitivity of 74% and specificity of 75%. By combining these two scoring systems, we were able to identify the subgroup of claimants at highest risk of experiencing both outcomes.Conclusions: The ability to identify at an early stage claimants at high risk of compensation-related stress and poor recovery is potentially valuable for claimants and the compensation agencies that serve them. The scoring systems we developed could be incorporated into the claims-handling processes to guide prevention-oriented interventions.

KW - Injury compensation systems

KW - Claims processes

KW - Health outcomes

KW - Injury outcomes

U2 - 10.1136/bmjopen-2017-020803

DO - 10.1136/bmjopen-2017-020803

M3 - Article

VL - 8

JO - BMJ Open

JF - BMJ Open

SN - 2044-6055

IS - 4

M1 - e020803

ER -