Szczotkowski D, Neik C, Polak U, Wittwer M, Kohlmann T
Institut für Community Medicine, Universitätsmedizin Greifswald, Walther-Rathenau-Str. 48, 17475, Greifswald, Deutschland.
Deutsche Gesetzliche Unfallversicherung e. V., Glinkastraße 40, Berlin, 10117, Deutschland.
Unfallchirurg. 2021 Jan;124(1):48-58. doi: 10.1007/s00113-020-00824-4.
Accident insurance consultants (D-physicians) are qualified specialists with particular expertise in occupational medicine. Within the medical treatment procedure of the German Statutory Accident Insurance (DGUV), D‑physicians must make a report on the medical care after occupational accidents. This nationwide evaluation aimed to systematically measure the quality of documentation of these medical reports. Peer review is a common method to ensure process quality.
For each included D‑physician 30 reports of more severe cases from 2017 were randomly selected. The reports were anonymized and randomly assigned to a peer reviewer. Peer reviewers used a web-based checklist with nine rating categories and dichotomous response format (deficiency/no deficiency). To evaluate overall quality each report was rated with an overall grade from 1 (very good) to 6 (insufficient).
A total of 30,384 reports were evaluated by 82 peer reviewers. One third of the reports contained no deficiencies. Most deficiencies were found in the category on information about the accident. The mean overall grade for each D‑physician was 2.6 and ranged from 1.5 (best) to 4.1 (worst). All evaluated D‑physicians were given an individual quality report which described the main findings.
The first nationwide peer review of the DGUV proved to be a practical and valid quality assurance procedure to evaluate the medical reports of D‑physicians. The quality of the reports was in general good. The DGUV plans to repeat the peer review process taking further groups of D‑physicians into consideration.
事故保险顾问（专科医生）是在职业医学方面具有特殊专业知识的合格专家。在德国法定事故保险（DGUV）的医疗程序中，专科医生必须就职业事故后的医疗护理情况撰写报告。这项全国性评估旨在系统地衡量这些医疗报告的文件记录质量。同行评审是确保过程质量的常用方法。
对于每位纳入研究的专科医生，随机选取其2017年30份病情较重病例的报告。报告被匿名处理，并随机分配给一位同行评审员。同行评审员使用基于网络的清单，该清单有九个评级类别和二分法回答格式（有缺陷/无缺陷）。为评估整体质量，每份报告被评定一个从1（非常好）到6（不足）的整体等级。
82位同行评审员共评估了30384份报告。三分之一的报告没有缺陷。大多数缺陷出现在事故信息类别中。每位专科医生的平均整体等级为2.6，范围从1.5（最佳）到4.1（最差）。所有接受评估的专科医生都收到了一份描述主要结果的个人质量报告。
DGUV首次全国性同行评审被证明是评估专科医生医疗报告的一种实用且有效的质量保证程序。报告质量总体良好。DGUV计划考虑更多组专科医生重复同行评审过程。
