Department of Quality of Life, TNO, Hoofddorp, the Netherlands.
BMC Public Health. 2009 Sep 18;9:349. doi: 10.1186/1471-2458-9-349.
In social insurance, the evaluation of work disability is becoming stricter as priority is given to the resumption of work, which calls for a guarantee of quality for these evaluations. Evidence-based guidelines have become a major instrument in the quality control of health care, and the quality of these guidelines' development can be assessed using the AGREE instrument. In social insurance medicine, such guidelines are relatively new. We were interested to know what guidelines have been developed to support the medical evaluation of work disability and the quality of these guidelines.
Five European countries that were reported to use guidelines were approached, using a recent inventory of evaluations of work disability in Europe. We focused on guidelines that are disease-oriented and formally prescribed in social insurance medicine. Using the AGREE instrument, these guidelines were appraised by two researchers. We asked two experts involved in guideline development to indicate if they agreed with our results and to provide explanations for insufficient scores.
We found six German and sixteen Dutch sets of disease-oriented guidelines in official use. The AGREE instrument was applicable, requiring minor adaptations. The appraisers reached consensus on all items. Each guideline scored well on 'scope and purpose' and 'clarity and presentation'. The guidelines scored moderately on 'stakeholder involvement' in the Netherlands, but insufficiently in Germany, due mainly to the limited involvement of patients' representatives in this country. All guidelines had low scores on 'rigour of development', which was due partly to a lack of documentation and of existing evidence. 'Editorial independence' and 'applicability' had low scores in both countries as a result of how the production was organised.
Disease-oriented guidelines in social insurance medicine for the evaluation of work disability are a recent phenomenon, so far restricted to Germany and the Netherlands. The AGREE instrument is suitably applicable to assess the quality of guideline development in social insurance medicine, but some of the scoring rules need to be adapted to the context of social insurance. Existing guidelines do not meet the AGREE criteria to a sufficient level. The way patients' representatives can be involved needs further discussion. The guidelines would profit from more specific recommendations and, for providing evidence, more research is needed on the functional capacity of people with disabilities.
在社会保险中，由于优先考虑恢复工作，对工作能力丧失的评估变得更加严格，这就要求对这些评估进行质量保证。循证指南已成为医疗保健质量控制的主要手段，AGREE 工具可用于评估这些指南的开发质量。在社会保险医学中，此类指南相对较新。我们想知道已经制定了哪些指南来支持工作能力丧失的医学评估，以及这些指南的质量如何。
我们联系了五个据报道在欧洲使用指南的国家，使用的是最近的欧洲工作能力丧失评估清单。我们专注于在社会保险医学中具有针对性且正式规定的疾病导向指南。我们使用 AGREE 工具由两名研究人员对这些指南进行评估。我们询问了两位参与指南制定的专家，他们是否同意我们的结果，并对得分不足的原因进行了解释。
我们发现了六种在德国和十六种在荷兰正式使用的具有针对性的疾病指南。AGREE 工具是适用的，需要进行一些小的调整。评估者在所有项目上都达成了共识。每项指南在“范围和目的”以及“清晰性和呈现”方面都取得了很好的分数。在荷兰，指南在“利益相关者参与”方面得分中等，但在德国得分不足，主要是因为该国患者代表的参与有限。由于缺乏文件记录和现有证据，所有指南在“制定严谨性”方面的得分都较低。由于生产组织方式的原因，在两国指南的“编辑独立性”和“适用性”方面得分都较低。
社会保险医学中针对工作能力丧失评估的疾病导向指南是一个新兴现象，迄今为止仅限于德国和荷兰。AGREE 工具适用于评估社会保险医学中指南制定的质量，但一些评分规则需要适应社会保险的背景。现有的指南没有达到 AGREE 标准的足够水平。需要进一步讨论如何让患者代表参与进来。这些指南将受益于更具体的建议，并且需要进行更多的研究，以提供残疾人士功能能力方面的证据。
