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A record review was used to examine case management services provided to 36 workers who sustained a catastrophic or medically complex injury, and who were referred to a case management program. The aims of this phase of the evaluation were to identify and describe: • Workers' demographics and personal attributes, • The structures and processes that affected the course of these cases, and • The role of the nurse case manager (NCM). A data collection instrument was developed to collect quantitative and qualitative information. Structural factors that emerged as most consequential included the quality and quantity of the injured worker's social support and the employment situation, including the availability of a job post-injury, employer support, and worker motivation. Process variables identified included the interactions of service providers including communication, and collaboration. The NCM was described as a monitor, coordinator, supporter, and advocate for the worker. Additionally, the NCM served as a consultant to other service providers and played a key role in the implementation of cost containment strategies.

The perceptions of service providers involved in case management services are described here. The service providers included claims managers, occupational nurse consultants, attending physicians, and nurse case managers. The purposes of this phase of the study were to describe these providers' perceptions about the case management program; to organize findings according to the quality assessment model that guided this study (including structure, function, and outcomes); and to identify barriers and facilitators to satisfaction with case management services. Structural factors that affected services included the workers' compensation system, construction of the service team, roles within the program, and individual attributes of service providers. Process factors were conflicts among parties, role of communication, and interaction with workers. Outcomes were described in terms of program efficiency and effectiveness. Data are used to illustrate and explain each of these themes.

1. Occupational health nurses can advocate for fair and equitable policies for both workers and employers. Assisting workers to understand and negotiate through the workers compensation system can minimize suspicion among workers and service providers, and can increase the effectiveness and efficiency of service provision. 2. Occupational health nurses can work with the team of service providers and the injured worker to develop appropriate and realistic goals for service provision. Make sure there is clarity related to the roles and responsibilities of all persons on the team (including the injured worker) is essential. Consistency and continuity of services throughout the life of the case is crucial. 3. The injury and its sequelae have personal meaning to the worker that may profoundly affect the outcome of their case. The OHN/CM must be sensitive and responsive to the worker's issues and concerns, and respectful of their views. Workers must be assisted to identify and tap into their social support systems. 4. Occupational health nurse/case managers should take an active role in developing and advocating for strategies that will assure effective and meaningful communication among all parties involved in a case.

A major goal of case management programs is the worker's timely return to work. Few studies have examined return to work from the perspective of the injured worker. This article describes the findings from the case management evaluation that describe the return to work experience of workers who sustained catastrophic injuries, or who had secondary conditions or complications following the injury occurrence. Among the factors determined to affect the return to work experience were structural factors (i.e., psychosocial variables including job satisfaction and relationship with employer and coworkers, financial pressures, and system issues such as securing benefits) and process factors (i.e., interaction with service providers and with the workers' compensation system). Outcomes are described in terms of satisfaction with services and return to work.

An increasing number of employers and third party administrators are choosing case management as a strategy to coordinate services for workers who sustain an occupational injury or illness. The successful delivery of case management services requires the service provider possess special skills and knowledge. Occupational health nurses are uniquely qualified to provide case management services to injured and ill workers. The effectiveness of case management services is generally described in terms of costs and quality of services; thus, determining the effectiveness of a case management program requires an evaluation of costs and service quality. Language: en