Department of Social Medicine, Aalborg Hospital, Aarhus University Hospital, Aalborg, Denmark.
Scand J Public Health. 2011 Nov;39(7):766-72. doi: 10.1177/1403494811418282. Epub 2011 Aug 22.
Medical specialists in social medicine play an important role in description of work-related health problems of the individual citizen in the Municipalities, yet knowledge of the consistency in their medical assessment remains poor. However, we expect good agreement between medical specialists' descriptions of health and work ability. The present paper aims to evaluate inter-rater differences between assessments issued by medical specialists in social medicine on health-related work ability in patients with musculoskeletal diseases and some lighter psychiatric diseases.
A total of 11 medical specialists in social medicine from four departments across Denmark each described eight subjects' health and health-related disability upon request from the municipal authorities. The resultant 88 written medical expert assessments were evaluated and scored independently by two medical specialists in social medicine with respect to functional impairment/ health-related work ability as intact, slightly reduced, much reduced, or extremely reduced. Kappa analysis described the inter-rater agreements.
The combined Kappa value for work ability was 0.33 (slight agreement). In the category ''extremely reduced'' work ability the Kappa value was 0.61 (good agreement), but mostly this result was due to one subject. One department had better intra-departmental agreement than the other departments. Agreement on the level of work ability was poorer in subjects with psychiatric diseases.
The assessments from medical specialists in social medicine on work ability and thereby occupational possibilities show much variation. The results of the present study demonstrate that there is much room for improving agreement on these assessments.
在市一级，社会医学专业医生在描述个体公民与工作相关的健康问题方面发挥着重要作用，但他们对医疗评估一致性的了解仍然很差。然而，我们期望医学专家在描述健康和工作能力方面具有良好的一致性。本文旨在评估社会医学专业医生对肌肉骨骼疾病和一些较轻的精神疾病患者健康相关工作能力的评估之间存在的评分者间差异。
丹麦四个部门的 11 名社会医学专业医生应市当局的要求，对 8 名患者的健康和健康相关残疾情况进行了书面医疗专家评估。这总共 88 份书面医疗专家评估由两名社会医学专业医生独立评估和评分，评估标准为功能障碍/健康相关工作能力是否完整、轻度降低、中度降低或严重降低。Kappa 分析描述了评分者间的一致性。
工作能力的综合 Kappa 值为 0.33（轻度一致）。在“严重降低”工作能力的类别中，Kappa 值为 0.61（良好一致），但这主要是由于一个患者。一个部门的内部一致性优于其他部门。在精神疾病患者中，工作能力水平的一致性较差。
社会医学专业医生对工作能力和职业可能性的评估存在很大差异。本研究的结果表明，在这些评估方面还有很大的改进空间。
