The influence of applying insurance medicine guidelines for depression on disability assessments

Abstract

BackgroundIn the current study we report on the effects of an implementation strategy in the form of a training programme on the assessed work limitations of a client with depression by insurance physicians (IPs) participating in a RCT. These assessed work limitations of a client were in the form of scores on the List of Functional Abilities (LFA).MethodWe conducted a randomised controlled trial (RCT) for IPs in which we compared the intervention of a specially developed training programme with the usual methods of implementation and training currently used. The outcome was the mean sum score and the inter-rater reliability (Intraclass Correlation Coefficient, ICC) of the LFA scores. These LFA scores were scored by the IPs participating in the RCT for the work limitations of the cases presented in different videos, two videos before the training and two after the training of the intervention group.ResultsAt baseline, the intervention group (IG) consisted of 21 IPs and the control group (CG) of 19. For one participant of the IG and for one of the CG the LFAs of the two case reports after training were not available. Before training the sum scores for the first case report did not differ significantly between the groups, while the mean sum score was higher in the IG than in the CG for the second case report. For both case reports after training a higher score was found in the IG than in the CG. The inter-rater reliability measured for the two case reports before training was about the same in the IG and the CG: 0.64 and 0.65, respectively. For the two case reports after training, the ICC was higher in the IG than in the CG: 0.69 and 0.54, respectively. This difference was not significant however.ConclusionIt would appear that the implementation of a specially designed training programme on guidelines for depression may lead to greater inter-rater reliability in the assessments by insurance physicians of the work limitations of clients with depression. It is, however, important to note that insurance physicians who receive training may find more work limitations than those who do not.Trial registrationNetherlands’ Trial Register NTR1863

Inter-rater agreement in evaluation of disability: systematic review of reproducibility studies

“…Of 4562 potentially relevant citations identified, 101 reports proved potentially eligible after we had screened titles and abstracts. On full text screening, 23 studies, 9 11 22 23 24 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 including four non-English studies, 9 39 40 41 proved eligible for analysis (fig 1 ). All studies were published from 1992 onwards and enrolled disability claimants from 12 countries in Europe, North America, Australia, the Middle East, and northeast Asia.…”

“…In the insurance setting, 13 studies including 463 patients and 367 raters explored agreement between medical experts (two or more experts assessing the same patient) (table 1 ; appendix 4). 9 11 22 23 24 32 34 37 39 43 44 45 46 Three studies including 3729 patients (with 3562 patients from a single centre 33 ) and eight raters (information was lacking from one study 33 ) explored agreement between medical experts and claimant’s treating physicians 33 or independent rehabilitation or occupational health teams with a mandate to care. 38 42 The median number of patients per study was 13.5 (range 1-3562), and the median number of raters per study was 12 (2-103, excluding one study that did not report the number of raters 33 ).…”

A training programme facilitating guideline use of occupational health professionals: a feasibility study

“…The provision of recent and relevant evidence can support OHPs in their guidance or assessment tasks. Several guidelines have been developed, incorporating recent evidence, with the aim of improving the quality of guidance or assessment given by OHPs [ 4 , 5 ]. One of these guidelines is the ‘Work participation of people with a chronic disease’ guideline [ 6 ], which aims to support the work participation of people with a chronic disease.…”

“…Although the use of knowledge and skills provided by a guideline [ 6 ] can lead to a higher quality of occupational care [ 4 , 5 ], guideline adherence by OHPs is generally low [ 7 – 9 ]. Previous studies have shown that guideline use is influenced by various factors that may act as barriers, which are related to the professional, the individual with a chronic disease, or to the knowledge included in the guideline [ 10 , 11 ].…”

Use of a structured functional evaluation process for independent medical evaluations of claimants presenting with disabling mental illness: rationale and design for a multi-center reliability study

“…The intra-class correlation coefficient (ICC) should be at least 0.6 to be useful [ 42 ], which seems achievable in the insurance medicine context. [ 43 , 44 ] With a sample size of 30 claimants, each evaluated by four raters, we expect to estimate an assumed ICC of at least 0.6 with a precision expressed as the width of a two sided 95 % confidence interval (CI) of ± 0.15 [ 45 ].…”