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Inter-doctor variations in the assessment of functional incapacities by insurance physicians

BACKGROUND: The aim of this study was to determine the - largely unexplored - extent of systematic variation in the work disability assessment by Dutch insurance physicians (IPs) of employees on long-term sick leave, and to ascertain whether this variation was associated with the individual characte...

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Autores principales: Schellart, Antonius JM, Mulders, Henny, Steenbeek, Romy, Anema, Johannes R, Kroneman, Herman, Besseling, Jan
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2011
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3276607/
https://www.ncbi.nlm.nih.gov/pubmed/22077926
http://dx.doi.org/10.1186/1471-2458-11-864
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author Schellart, Antonius JM
Mulders, Henny
Steenbeek, Romy
Anema, Johannes R
Kroneman, Herman
Besseling, Jan
author_facet Schellart, Antonius JM
Mulders, Henny
Steenbeek, Romy
Anema, Johannes R
Kroneman, Herman
Besseling, Jan
author_sort Schellart, Antonius JM
collection PubMed
description BACKGROUND: The aim of this study was to determine the - largely unexplored - extent of systematic variation in the work disability assessment by Dutch insurance physicians (IPs) of employees on long-term sick leave, and to ascertain whether this variation was associated with the individual characteristics and opinions of IPs. METHODS: In March 2008 we conducted a survey among IPs on the basis of the 'Attitude - Social norm - self-Efficacy' (ASE) model. We used the ensuing data to form latent variables for the ASE constructs. We then linked the background variables and the measured constructs for IPs (n = 199) working at regional offices (n = 27) to the work disability assessments of clients (n = 83,755) and their characteristics. These assessments were carried out between July 2003 and April 2008. We performed multilevel regression analysis on three important assessment outcomes: No Sustainable Capacity or Restrictions for Working Hours (binominal), Functional Incapacity Score (scale 0-6) and Maximum Work Disability Class (binominal). We calculated Intra Class Correlations (ICCs) at IP level and office level and explained variances (R(2)) for the three outcomes. A higher ICC reflects stronger systematic variation. RESULTS: The ICCs at IP level were approximately 6% for No Sustainable Capacity or Restrictions for Working Hours and Maximum Work Disability Class and 12% for Functional Incapacity Score. Background IP variables and the measured ASE constructs for physicians contributed very little to the variation - at most 1%. The ICCs at office level ranged from 0% to around 1%. The R(2 )was 11% for No Sustainable Capacity or Restrictions for Working Hours, 19% for Functional Incapacity Score and 37% for Maximum Work Disability Class. CONCLUSION: Our study uncovered small to moderate systematic variations in the outcome of disability assessments in the Netherlands. However, the individual characteristics and opinions of insurance physicians have very little impact on these variations. Our findings provided no indications of other reasons for these variations. They may be related to different work routines or to different views on the workload of a 'normal' employee. If so, they could be reduced by well-developed and comprehensively implemented guidelines. Therefore, further research is needed.
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spelling pubmed-32766072012-02-10 Inter-doctor variations in the assessment of functional incapacities by insurance physicians Schellart, Antonius JM Mulders, Henny Steenbeek, Romy Anema, Johannes R Kroneman, Herman Besseling, Jan BMC Public Health Research Article BACKGROUND: The aim of this study was to determine the - largely unexplored - extent of systematic variation in the work disability assessment by Dutch insurance physicians (IPs) of employees on long-term sick leave, and to ascertain whether this variation was associated with the individual characteristics and opinions of IPs. METHODS: In March 2008 we conducted a survey among IPs on the basis of the 'Attitude - Social norm - self-Efficacy' (ASE) model. We used the ensuing data to form latent variables for the ASE constructs. We then linked the background variables and the measured constructs for IPs (n = 199) working at regional offices (n = 27) to the work disability assessments of clients (n = 83,755) and their characteristics. These assessments were carried out between July 2003 and April 2008. We performed multilevel regression analysis on three important assessment outcomes: No Sustainable Capacity or Restrictions for Working Hours (binominal), Functional Incapacity Score (scale 0-6) and Maximum Work Disability Class (binominal). We calculated Intra Class Correlations (ICCs) at IP level and office level and explained variances (R(2)) for the three outcomes. A higher ICC reflects stronger systematic variation. RESULTS: The ICCs at IP level were approximately 6% for No Sustainable Capacity or Restrictions for Working Hours and Maximum Work Disability Class and 12% for Functional Incapacity Score. Background IP variables and the measured ASE constructs for physicians contributed very little to the variation - at most 1%. The ICCs at office level ranged from 0% to around 1%. The R(2 )was 11% for No Sustainable Capacity or Restrictions for Working Hours, 19% for Functional Incapacity Score and 37% for Maximum Work Disability Class. CONCLUSION: Our study uncovered small to moderate systematic variations in the outcome of disability assessments in the Netherlands. However, the individual characteristics and opinions of insurance physicians have very little impact on these variations. Our findings provided no indications of other reasons for these variations. They may be related to different work routines or to different views on the workload of a 'normal' employee. If so, they could be reduced by well-developed and comprehensively implemented guidelines. Therefore, further research is needed. BioMed Central 2011-11-14 /pmc/articles/PMC3276607/ /pubmed/22077926 http://dx.doi.org/10.1186/1471-2458-11-864 Text en Copyright ©2011 Schellart et al; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Research Article
Schellart, Antonius JM
Mulders, Henny
Steenbeek, Romy
Anema, Johannes R
Kroneman, Herman
Besseling, Jan
Inter-doctor variations in the assessment of functional incapacities by insurance physicians
title Inter-doctor variations in the assessment of functional incapacities by insurance physicians
title_full Inter-doctor variations in the assessment of functional incapacities by insurance physicians
title_fullStr Inter-doctor variations in the assessment of functional incapacities by insurance physicians
title_full_unstemmed Inter-doctor variations in the assessment of functional incapacities by insurance physicians
title_short Inter-doctor variations in the assessment of functional incapacities by insurance physicians
title_sort inter-doctor variations in the assessment of functional incapacities by insurance physicians
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3276607/
https://www.ncbi.nlm.nih.gov/pubmed/22077926
http://dx.doi.org/10.1186/1471-2458-11-864
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