Sylvia P. Snoeck – Krygsman, MD MSc, Jan L. Hoving, PhD, Birgit H. P. M. Donker-Cools, MD PhD, Lyanne P. Jansen, MSc, Frederieke G. Schaafsma, MD PhD, Angela A.G.E.M. de boer, MD PhD.
After working as a psychologist and as a resident in psychiatry, I joined UWV in 2011. I completed my training as an insurance physician in 2016. I still consider insurance medicine, the broadest and most profound medical specialty, the most beautiful profession that exists. It is continuously developing, and I would like to contribute to that. I have been working with great pleasure since October 2018 on this research: developing a methodology for determining the prognosis in insurance medicine.
In insurance medicine, prognosis is defined as the improvement of functional capabilities. Research indicates that insurance physicians find it difficult to assess the prognosis of functional abilities, especially in relation to applicable legal frameworks (Hoving et al 2016a; 2016b). Insurance physicians frequently have questions regarding prognosis. Evidence, it is often hard to find, and translating it into functional abilities is not straightforward. There appears to be a need for support and tools in determining the prognosis.
Therefore, a methodology and training are being developed to assist the insurance physician in assessing the prognosis of functional capabilities. In the preliminary phase, the aspects that insurance physicians consider were investigated (Kox et al 2019): (1) Medical condition: nature and severity; (2) Treatment: type, effect, and quality of the treatment, and alternative options; (3) Course: understanding the progression of the condition and disease-maintaining factors as well as their causes; (4) Information: from the specialist or healthcare provider, or from literature (e.g., guidelines, prediction tools, protocols); (5) Patient-related considerations: patient's own view on recovery, disease insight, illness gain, coping with the illness, and changed role, work perspectives, significance of work, and social issues; (6) Insurance physician-related considerations: e.g., empathy, interpretation and role anticipation.
The goal of the research is the development and evaluation of a working method and training for the disability prognosis evaluation by insurance physicians.
Using information from previous studies, literature, and stakeholders, a methodology is being developed. This methodology will include a step-by-step plan to assess the evidence based prognosis of functional abilities. It includes the possibility of consulting evidence. The methodology will be offered in the form of a supportive (software) tool and training.
The training will consist of education about insurance medicine prognosis assessment, about the methodology, and the use of a supportive digital tool. A key part of this involves learning or refreshing EBM (Evidence-Based Medicine) skills (according to Kok et al 2013), focused on prognosis.
The intervention (comprising a methodology, tool, and training for insurance medicine prognosis assessment) will be tested on a small scale in a feasibility study. It will examine whether insurance physicians find it acceptable and useful, but also whether they think it can work in practice and if it seems to improve prognosis assessment.
Ultimately, insurance physicians will receive support from the step-by-step 'Prognosable’ working method. This makes it easier for professionals to oversee and weigh key aspects of prognosis. It supports the finding and application of information from scientific research literature. It also assists in formulating decisions in a transparent, understandable, and useful way.
With this working method, a high-quality, evidence-based prognosis assessment is facilitated. This can contribute to the quality and uniformity of the insurance medicine (prognosis) assessment. It may also improve the timing and deployment of re-assessments.
The research will continue until August 2025.
In a workshop, using a case study with evidence fragments, it was explored which aspects (see Kox 2019) insurance physicians find more or less important at different times. Further details for a supportive tool to be developed were also gathered. [Snoeck-Krygsman et al, #1]
Using frameworks for intervention development, all elements, desires, requirements, and challenges for the prognosis methodology were collected. These were systematically brought to a first design of the intervention 'Prognosable' [Snoeck-Krygsman et al, #2], which has since been developed into a prototype. The 'Prognosable' intervention consists of a five-step working method, of which the principles of evidence-based medicine (EBM) form an important part. Additionally, it includes a one-day training session to teach the methodology and a software tool to support the method’s steps with automation.
The step-by-step working method, the training, and the software tool of ‘Prognosable’ are being studied. In a feasibility study with 30 (social insurance) physicians, the 'Prognosable' intervention has recently been tested. Participants received a one-day training where the working method was taught using a case study. Meanwhile, the Prognosable software tool usage was trained. A consideration on the prognosis was made before and after the training to get an impression of its effectiveness on quality. In order to measure the workability of the intervention, questions on acceptance, appropriateness, feasibility and usability were asked. The results of this study are expected by the end of 2024.
Email: s.p.snoeck-krygsman@amsterdamumc.nl
Date last updated: November 4th, 2024.
