ODG Announces Comorbidity Calculator

April 1, 2010 – Encinitas, CA – Subscribers to Official Disability Guidelines on the Web now have access to a new online inquiry tool that helps forecast disability duration based on any combination of diagnoses, plus age, using the largest database of actual disability experience data available.

Called the Comorbidity Calculator™, this new tool will accept entries of any combination of two valid ICD9 diagnosis codes as well as the employee age to calculate the expected median return-to-work time resulting from that combination of diagnoses. In total, there are over 100 million different combinations of valid ICD9 diagnosis codes. If this list were supplied in printed form, it would require over a million pages.

Comorbid Conditions and Age Drive Disability Duration

Among those attributes that are readily available in a claim, the ones that are most predictive of time out of work are comorbid diagnoses and age. Some combinations have a much greater impact than others, especially combinations of certain musculoskeletal problems with psychiatric comorbidities. For example, the expected median disability duration for a lumbar sprain (ICD9 847.2) is 10 days, and the expected median disability duration for lingering depression with anxiety (ICD9 300.4) is 26 days, but when the two are combined the expected median disability duration is 153 days. Age can also have a major effect. For example, the expected median disability duration for a herniated disc (ICD9 722.1) is 55 days, but for a 24-year-old worker it is 36 days, as opposed to 90 days for a 65-year-old worker.

DOL Job Class is Not Predictive of Disability Duration

DOL job categories, based on lifting requirements, are frequently used to predict disability duration, but there is little evidence to support this. Various high quality published studies have shown that the DOL job class, at the time of injury or illness (i.e., "sedentary", "light", "medium", "heavy", and “very heavy”), are not predictive of return-to-work time.[1] When DOL Class was tested as part of the ODG Comorbidity Calculator, they did not result in statistically significant differences, so they are not included in the calculator.

According to Michael Erdil, MD, FACOEM, Medical Director for Occupational Disability Solutions, Occupational and Environmental Health Network: "There are several problems with the DOL categories and return to work. Workers often have jobs that would seem to be in one category but in reality fall into other categories in terms of physical demands. Jobs are commonly misclassified. There are over and under estimates for job demands. The DOL categories better reflect low back lifting demands but may not appreciate dynamic factors including frequency of materials handling, distance from the spinal axis to the load, twisting, height lifted, etc."

There are other important predictors of return to work, with job organizational factors including unfavorable supervisor ratings, job satisfaction, co-worker support, coping abilities and fear avoidance being major factors. However, these predictors are typically not quantified in the claim or readily available to help manage the case.

The expected disability durations from the ODG Comorbidity Calculator are used to help manage absence when an employee misses work, whether for short-term disability, long-term disability, incidental absence, family medical leave absence, or workers’ compensation. Having an accurate expectation by considering comorbidities and age can be extremely helpful in getting buy-in regarding recovery time from both the employee and the treating medical provider. These disability durations are also used to benchmark absences retrospectively, and to determine normal recovery time when estimating Maximum Medical Improvement or expected healing time in the case of auto medical liability. The ODG Comorbidity Calculator can be located from the main ODG Contents page, or directly from this link: http://www.odg-twc.com/calculator/index.html

The 2010 release in the ODG product line (including the 15th edition of Official Disability Guidelines and 8th edition of ODG Treatment in Workers Comp) provides the most up to date evidence-based medical treatment and disability duration guidelines to improve as well as benchmark outcomes in workers' compensation and non-occupational disability. ODG 2010 is based on an aggregate of over 10 million cases, including CDC and OSHA, referred to as the "most direct form of evidence that can be offered in court" under the Federal Rules of Evidence, plus over 2 million medical records from actual workers’ compensation and disability claims.

For more information about ODG, go to www.worklossdata.com or contact Work Loss Data Institute, publisher of the ODG product line. WLDI is an independent database development company focused on workplace health and productivity, based in Encinitas, CA.