Attitudes towards evaluation of psychiatric disability claims: a survey of Swiss stakeholders

Schandelmaier, Stefan; Leibold, Andrea; Fischer, Katrin; Mager, Ralph; Hoffmann-Richter, Ulrike; Ms, Bachmann; Kedzia, Sarah; Busse, Jason W.; Gh, Guyatt; Jeger, J; Marelli, Renato; We, De Boer; Kunz, Regina

doi:10.4414/smw.2015.14160

Cited by 4 publications

(16 citation statements)

References 9 publications

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“…While such findings seem plausible, it would be important to confirm these findings in a second independent sample, e.g., the interviews performed in the RELY 2-study ( 17 ). Furthermore, despite substantial improvement in agreement, the observed level is still far below the expectations of more than 700 Swiss stakeholders who considered a level of 9.0% WC as the maximum acceptable value of SEM ( 11 ). Additional efforts in other quality assurance activities will be required to meet these expectations.…”

Section: Discussionmentioning

confidence: 59%

“…Furthermore, despite substantial improvement in agreement, the observed level is still far below the expectations of more than 700 Swiss stakeholders who considered a level of 9.0% WC as the maximum acceptable value of SEM (11). Additional efforts in other quality assurance activities will be required to meet these expectations.…”

Section: Implications For Policy Practice and Researchmentioning

confidence: 78%

“…Switzerland, one of the countries that promotes such a shift ( 1 , 7 – 11 ) is suggesting the ICF as a reference framework to establish and communicate functional and work (in-) capacity in the context of disability assessments ( 8 , 9 , 12 , 13 ). However, its implementation into practice is still at the beginning ( 4 , 7 , 14 ).…”

Section: Introductionmentioning

confidence: 99%

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Functional Interviewing Was Associated With Improved Agreement Among Expert Psychiatrists in Estimating Claimant Work Capacity: A Secondary Data Analysis of Real-Life Work Disability Evaluations

et al. 2020

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Objective: Functional evaluations establish functional and work (in-)capacities in the context of disability assessments and are increasingly recommended as a modern technique for work disability assessments. The RELY (Reliable disability EvaLuation in psychiatrY)-studies introduced semi-structured functional interviews in real-life assessments of claimants with mental disorders for evaluating their self-perceived health-related limitations and for investigating the reproducibility of work capacity (WC) estimates. Functional interviews elicit claimants' self-perceptions about their work-related limitations and capacities in the labour market. This secondary data analysis explored the coverage of work-related key topics in these interviews and investigated whether interviews with high coverage (versus low coverage) of work-related topics resulted in better reproducibility of WC estimates among experts. Methods: Thirty video-taped RELY-assessments underwent a content analysis along a predefined framework for functional interviewing, including the claimant's self-perceived work limitations and work-related health complaints as centrepieces of functional interviewing. Following transcription, interviews were segmented into coding units. Coding units were allocated to the five steps with 19 key topics of the framework. Enquiry into key topics was ascertained by summing the functional coding units per key topic. Median split grouped the interviews into high and low coverage of functional topics and compared them for inter-rater reliability (intraclass correlation coefficient, ICC) and inter-rater agreement (standard error of measurement, SEM). Results: Interviews were broken down in 40,010 coding units, 31% of which addressed functional topics. Enquiries in self-perceived work limitations and work-related health

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Section: Discussionmentioning

confidence: 59%

Section: Implications For Policy Practice and Researchmentioning

confidence: 78%

Section: Introductionmentioning

confidence: 99%

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Functional Interviewing Was Associated With Improved Agreement Among Expert Psychiatrists in Estimating Claimant Work Capacity: A Secondary Data Analysis of Real-Life Work Disability Evaluations

et al. 2020

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“…We used descriptive statistics for continuous and categorical data, plotting experts’ ratings of overall WC per patient (‘last job’, ‘alternative work’) and counting patients with maximum divergent WC ratings (i.e., ranging between 100 and 0%) [6]. Variance components (psychiatrists, patients, residuals) underlying the ICC were determined using a linear mixed-effects model.…”

Section: Methodsmentioning

confidence: 99%

“…Our research on the reproducibility of WC evaluations evolved from widespread dissatisfaction with medical evaluations in Switzerland, where two nationwide surveys highlighted serious concerns regarding psychiatric evaluations of WC [3, 6]. Respondents ranked the missing link between expert findings and their final judgement on work incapacity as their top concern.…”

Section: Introductionmentioning

confidence: 99%

The reproducibility of psychiatric evaluations of work disability: two reliability and agreement studies

Kunz

Allmen

Marelli³

et al. 2019

BMC Psychiatry

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Background Expert psychiatrists conducting work disability evaluations often disagree on work capacity (WC) when assessing the same patient. More structured and standardised evaluations focusing on function could improve agreement. The RELY studies aimed to establish the inter-rater reproducibility (reliability and agreement) of ‘functional evaluations’ in patients with mental disorders applying for disability benefits and to compare the effect of limited versus intensive expert training on reproducibility. Methods We performed two multi-centre reproducibility studies on standardised functional WC evaluation (RELY 1 and 2). Trained psychiatrists interviewed 30 and 40 patients respectively and determined WC using the Instrument for Functional Assessment in Psychiatry (IFAP). Three psychiatrists per patient estimated WC from videotaped evaluations. We analysed reliability (intraclass correlation coefficients [ICC]) and agreement (‘standard error of measurement’ [SEM] and proportions of comparisons within prespecified limits) between expert evaluations of WC. Our primary outcome was WC in alternative work (WC alternative.work ), 100–0%. Secondary outcomes were WC in last job (WC last.job ), 100–0%; patients’ perceived fairness of the evaluation, 10–0, higher is better; usefulness to psychiatrists. Results Inter-rater reliability for WC alternative.work was fair in RELY 1 (ICC 0.43; 95%CI 0.22–0.60) and RELY 2 (ICC 0.44; 0.25–0.59). Agreement was low in both studies, the ‘standard error of measurement’ for WC alternative.work was 24.6 percentage points (20.9–28.4) and 19.4 (16.9–22.0) respectively. Using a ‘maximum acceptable difference’ of 25 percentage points WC alternative.work between two experts, 61.6% of comparisons in RELY 1, and 73.6% of comparisons in RELY 2 fell within these limits. Post-hoc secondary analysis for RELY 2 versus RELY 1 showed a significant change in SEM alternative.work (− 5.2 percentage points WC alternative.work [95%CI − 9.7 to − 0.6]), and in the proportions on the differences ≤ 25 percentage points WC alternative.work between two experts ( p = 0.008). Patients perceived the functional evaluation as fair (RELY 1: mean 8.0; RELY 2: 9.4), psychiatrists as useful. Conclusions Evidence from non-randomised studies suggests that intensive training in functional evaluation may increase agreement on WC between experts, but fell short to reach stakeholders’ expectations. It did not alter reliability. Isolated efforts in training psychiatrists may not suffice to reach the expected level of agreement. A societal discussion about achievable goals and readiness to consider procedural changes in WC evaluations may deserve considerations. Electron...

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Expert assessments of war casualties

Lalić

2017

Med Sci Law

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By describing three different war casualty cases, this paper highlights the harshness of current legal regulations in Croatia, and the possible consequences of their strict implementation. In two of the three cases the second instance expert witness has ultimately found that, due to legal procedures being followed too strictly, the expert witness initially assessing the cases had exceeded the legal framework and actually assessed patients, that is, individuals claiming disability benefits, inadequately. However, in the third case the expert witnesses employed by the Disability Pension Insurance Institute were right in deciding that the claimant was not entitled to a higher category of disability. Assessment of ability to work thus continues to be a subject of disagreement between experts of various profiles in legal and medical circles. Similar assessment issues appear not to be uncommon in other countries also. Therefore, the time has perhaps come for the existing rules and regulations to be re-evaluated. In fact, this may apply not only to those countries that share the same values and interests, such as EU member states, but also further abroad, particularly within a wider context of international recognition of basic human rights.

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Attitudes towards evaluation of psychiatric disability claims: a survey of Swiss stakeholders

Cited by 4 publications

References 9 publications

Functional Interviewing Was Associated With Improved Agreement Among Expert Psychiatrists in Estimating Claimant Work Capacity: A Secondary Data Analysis of Real-Life Work Disability Evaluations

Functional Interviewing Was Associated With Improved Agreement Among Expert Psychiatrists in Estimating Claimant Work Capacity: A Secondary Data Analysis of Real-Life Work Disability Evaluations

The reproducibility of psychiatric evaluations of work disability: two reliability and agreement studies

Expert assessments of war casualties

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