Content analysis to locate assistive technology in Queensland's motor injury insurance rehabilitation legislation and guidelines.

INTRODUCTION: Reforms to Australia's disability and rehabilitation sectors have espoused the potential of assistive technology as an enabler. As new insurance systems are being developed it is timely to examine the structure of existing systems. This exploratory study examined the policies guiding assistive technology provision in the motor accident insurance sector of one Australian state. METHODS: Policy documents were analyzed iteratively with a set of qualitative questions to understand the intent and interpretation of policies guiding assistive technology provision. Content analysis identified relevant sections and meaningful terminology, and context analysis explored the dominant perspectives informing policy. RESULTS AND DISCUSSION: The concepts and language of assistive technology are not part of the policy frameworks guiding rehabilitation practice in Queensland's motor accident insurance sector. The definition of rehabilitation in the legislation is consistent with contemporary international interpretations that focus on optimizing functioning in interaction with the environment. However, the supporting documents are focused on recovery from injuries where decisions are guided by clinical need and affordability. CONCLUSION: The policies frame rehabilitation in a medical model that separates assistive technology provision from the rehabilitation plan. The legislative framework provides opportunities to develop and improve assistive technology provision as part of an integrated approach to rehabilitation.

Adapting to a marketised system: Network analysis of a personalisation scheme in early implementation.

As governments worldwide turn to personalised budgets and market-based solutions for the distribution of care services, the care sector is challenged to adapt to new ways of working. The Australian National Disability Insurance Scheme (NDIS) is an example of a personalised funding scheme that began full implementation in July 2016. It is presented as providing greater choice and control for people with lifelong disability in Australia. It is argued that the changes to the disability care sector that result from the NDIS will have profound impacts for the care sector and also the quality of care and well-being of individuals with a disability. Once established, the NDIS will join similar schemes in the UK and Europe as one of the most extensive public service markets in the world in terms of numbers of clients, geographical spread, and potential for service innovation. This paper reports on a network analysis of service provider adaptation in two locations-providing early insight into the implementation challenges facing the NDIS and the reconstruction of the disability service market. It demonstrates that organisations are facing challenges in adapting to the new market context and seek advice about adaptation from a stratified set of sources.

Hearing loss and disability exit: Measurement issues and coping strategies.

Hearing loss is one of the most common conditions related to aging, and previous descriptive evidence links it to early exit from the labor market. These studies are usually based on self-reported hearing difficulties, which are potentially endogenous to labor supply. We use unique representative data collected in the spring of 2005 through in-home interviews. The data contains self-reported functional and clinically-measured hearing ability for a representative sample of the Danish population aged 50-64. We estimate the causal effect of hearing loss on early retirement via disability benefits, taking into account the endogeneity of functional hearing. Our identification strategy involves the simultaneous estimation of labor supply, functional hearing, and coping strategies (i.e. accessing assistive devices at work or informing one's employer about the problem). We use hearing aids as an instrument for functional hearing. Our main empirical findings are that endogeneity bias is more severe for men than women and that functional hearing problems significantly increase the likelihood of receiving disability benefits for both men and women. However, relative to the baseline the effect is larger for men (47% vs. 20%, respectively). Availability of assistive devices in the workplace decreases the likelihood of receiving disability benefits, whereas informing an employer about hearing problems increases this likelihood.

[Update assessment of mental health diseases for sick pay--experience of the AWMF guideline]. / Update Begutachtung bei psychischen Erkrankungen in der Krankentagegeldversicherung--Erfahrungen mit der AWMF-Leitlinie.

In August 2012, we reported (VersMed 1/2014, S. 9) the results for the first 12 months following implementation of AWMF guideline 051-029 in the medical assessment of mental health diseases with a view to sick pay and supplementary disability insurance (BU). Today we provide an update of the experience gained in the last three years. We are glad to report that the results have remained stable.

Attitudes towards evaluation of psychiatric disability claims: a survey of Swiss stakeholders.

QUESTIONS: In Switzerland, evaluation of work capacity in individuals with mental disorders has come under criticism. We surveyed stakeholders about their concerns and expectations of the current claim process. METHODS: We conducted a nationwide online survey among five stakeholder groups. We asked 37 questions addressing the claim process and the evaluation of work capacity, the maximum acceptable disagreement in judgments on work capacity, and its documentation. RESULTS: Response rate among 704 stakeholders (95 plaintiff lawyers, 285 treating psychiatrists, 129 expert psychiatrists evaluating work capacity, 64 social judges, 131 insurers) varied between 71% and 29%. Of the lawyers, 92% were dissatisfied with the current claim process, as were psychiatrists (73%) and experts (64%), whereas the majority of judges (72%) and insurers (81%) were satisfied. Stakeholders agreed in their concerns, such as the lack of a transparent relationship between the experts' findings and their conclusions regarding work capacity, medical evaluations inappropriately addressing legal issues, and the experts' delay in finalising the report. Findings mirror the characteristics that stakeholders consider important for an optimal work capacity evaluation. For a scenario where two experts evaluate the same claimant, stakeholders considered an inter-rater difference of 10%‒20% in work capacity at maximum acceptable. CONCLUSIONS: Plaintiff lawyers, treating psychiatrists and experts perceive major problems in work capacity evaluation of psychiatric claims whereas judges and insurers see the process more positively. Efforts to improve the process should include clarifying the basis on which judgments are made, restricting judgments to areas of expertise, and ensuring prompt submission of evaluations.

Low IQ has become less important as a risk factor for early disability pension. A longitudinal population-based study across two decades among Swedish men.

BACKGROUND: Low IQ has been shown to be an important risk factor for disability pension (DP) but whether the importance has changed over time remains unclear. It can be hypothesised that IQ has become more important for DP over time in parallel with a more demanding working life. The aim of this study was to investigate the relative risk of low IQ on the risk of DP before age 30 between 1971 and 2006. METHODS: This study covered the entire Swedish male population born between 1951 and 1976, eligible for military conscription. Information about the study subjects was obtained by linkage of national registers. Associations between IQ and DP over time were analysed by descriptive measures (mean values, proportions, etc) and by Cox proportional hazards regressions. Analyses were adjusted for educational level. RESULTS: The cohort consisted of 1 229 346 men. The proportion that received DP before the age of 30 increased over time, from 0.68% in the cohort born between 1951 and 1955 to 0.95% in the cohort born between 1971 and 1976. The relative risk of low IQ (adjusted for education) in relation to high IQ decreased from 5.68 (95% CI 4.71 to 6.85) in the cohort born between 1951 and 1955 to 2.62 (95% CI 2.25 to 3.05) in the cohort born between 1971 and 1976. CONCLUSIONS: Our results gave no support to the idea that the importance of low IQ for the risk of DP has increased in parallel with increasing demands in working life. In fact, low IQ has become less important as a risk factor for DP compared with high IQ between the early 1970s and 1990s. An increased educational level over the same time period is likely to be part of the explanation.

¿Limitación o incapacidad laboral? / Occupational limitation or disability?

La dificultad a la hora de plantearnos si un trabajador con limitaciones físico-psíquicas para su puesto de trabajo sería candidato a una incapacidad permanente, nos ha llevado a la elaboración de un protocolo. Son fundamentales la valoración médica del trabajador y la técnica de su puesto de trabajo, y confrontar las limitaciones que presenta con las tareas que debe efectuar. Se debe explicar adecuadamente al trabajador la imposibilidad de realizar las tareas principales de su puesto de trabajo por las limitaciones que presenta debidas a su patología, no siendo posible su adaptación. Por último no se debe olvidar la posibilidad de consultar con la Unidad Médica de la Dirección Provincial del Instituto Nacional de la Seguridad Social (INSS) para la orientación y asesoría (AU)

The difficult situation to differentiate if a worker, with physical-physic limitation, would be a candidate for a permanent incapacity performing his/her job, lead us to elaborate a protocol. The medical evaluation and the knowing of the tasks of the job are essential, and confront the limitations that represent the tasks that the worker must perform. The impossibility to perform the main tasks of her/his job due to the pathology must be properly explained to the worker. Finally we can not forget the possibility to enquiry witch the Medical Unit of the Provincial Direction of the Nacional Social Security (INSS) for the correct orientation and advice (AU)

Outcome variation in the social security disability insurance program: the role of primary diagnoses.

Based on the adjudicative process, the author classifies claimant-level data over an 8-year period (1997-2004) into four mutually exclusive categories: (1) initial allowances, (2) initial denials not appealed, (3) final allowances, and (4) final denials. The ability to predict those outcomes is explored within a multilevel modeling framework, with applicants clustered by state and primary diagnosis code. Variance decomposition suggests that medical diagnoses play a substantial role in explaining individual-level variation in initial allowances. Moreover, there is statistically significant high positive correlation between the predictions of an initial allowance and a final allowance across the diagnoses. This finding suggests that the ordinal ranking of impairments between these two adjudicative outcomes is widely preserved. In other words, impairments with a higher expectation of an initial allowance also tend to have a higher expectation of a final allowance.

Validation of the EUMASS Core Set for medical evaluation of work disability.

OBJECTIVE: To perform a content validation of the EUMASS Core Set across six European social insurance systems. The EUMASS Core Set contains 20 categories to describe the functional (in-) capacity of claimants for disability benefits. METHODS: We performed an exploratory, cross-sectional study. We used the EUMASS Core Set, added scales to rate the relevance of the 20 categories and added additional questions concerning comprehensiveness, usefulness and sufficiency of the instrument. Medical examiners from European countries filled in this instrument in 10 consecutive claim assessments. RESULTS: Forty-eight medical examiners in six different countries evaluated 446 claimants. The medical examiners used all categories to describe the claimants' functional (in-) capacity. Medical examiners missed 41 different categories, often mental functions (n = 17). They rated the instrument as useful in 68.4% and as sufficient in 63.2% of the claims. Perceived usefulness varied among countries, but not among disease groups. Perceived sufficiency varied among countries and disease groups. CONCLUSION: The EUMASS Core Set is promising for reporting about functional (in-) capacities. It contains relevant categories for disability evaluation among countries and disease groups. Adding more mental functions might make it more applicable. Medical examiners found it useful and sufficient to evaluate functional (in-) capacity. Implications for Rehabilitation In medical reports of evaluation of work disability, reporting about functional capacity is often unstructured in free text, making the reports difficult to understand. The EUMASS Core Set contains common definitions for expressing functional capacity and is expected to support taking decisions, to improve the quality of decisions and to allow national and international comparisons. Our study suggests the EUMASS core set to be comprehensive, useful and sufficient to express functional capacity in disability evaluation.

Prevención y discapacidad: modelo de gestión participativo / Prevention and disability: participatory management system

A partir del estudio de los accidentes del Grupo AMICA en los años 2006-2009 se determinó que ésta no era homogénea existiendo 2 puntos críticos: - AMICA: la movilización de personas con discapacidad en los centros de alojamiento, suponía más del 50% de los accidentes ocurridos. - SAEMA EMPLEO SL (Centro Especial de Empleo): aumento de la siniestralidad en un 50% entre los años 2006 a 2009. Frente a la reducción producida en el Grupo AMICA. Gerencia propuso desarrollar un plan de actuación específico para cada punto crítico, basado en la colaboración entre trabajadores y empresa, contando con el asesoramiento del ICSST. La aplicación práctica se llevó a cabo creando un grupo de trabajo en cada entidad compuesto por: - 2 delegados de prevención. - 2 técnicos del servicio de prevención. - 2 mandos intermedios. - Dirección técnica de AMICA / SAEMA EMPLEO SL. La dinámica de trabajo se estructuró realizando reuniones periódicas, en las que se analizaban los resultados de las medidas de mejora implantadas y se presentaban nuevas propuestas de actuación. Grupo de trabajo AMICA: a partir de los resultados de la evaluación ergonómica realizada, se decidió actuar sobre la formación de los trabajadores y mejorar las ayudas técnicas disponibles en los centros de trabajo. Grupo de trabajo SAEMA EMPLEO SL: se propuso mejorar la formación e información que reciben los trabajadores y revisar las condiciones de trabajo, actuando sobre las causas más frecuentes y las susceptibles de provocar los accidentes más graves (AU)

From the study of accidents of AMICA's Group in the years 2006 - 2009, it was determined that the accident rate was not homogeneous, there were two critical points: AMICA: moving and handling of disabled people in accommodation centers, was more than 50% of accidents. SAEMA EMPLEO S.L.: the accident rate increased by 50% between the years 2006-2009, against the reduction that took place in AMICA´s Group. Management proposed to develop a specific action plan for each critical point, based on the collaboration between workers and the company, with the advice of the ICASST. The practical application took place by creating a working party on each entity. They were composed of: 2 safety workers. 2 safety technicians of the Preventive Service. 2 senior managers. Technical manager of AMICA / SAEMA EMPLEO SL. Working dynamics was structured by holding regular meetings, where the results of the implemented improvement measures were analysed and new proposals for action were presented. AMICA working party: from the results of the ergonomic assessment, it was decided to act on the training of workers and to improve the technical aids available at the workplace. SAEMA EMPLEO SL working party: the proposal was to improve the training and information that workers receive and to review working conditions, acting on the most frequent accident causes and on the most likely to cause the most serious accidents (AU)

Incapacidad temporal por enfermedad común y accidente no laboral en Cataluña, 2007-2010 / Nonoccupational temporary sickness absence in Catalonia, 2007-2010

Objetivos: Describir los episodios de incapacidad temporal por enfermedad común y accidente no laboral (ITcc) registrados en Cataluña entre 2007 y 2010. Métodos: Se analizaron 4.273.601 procesos de ITcc certificados en los Centros de Atención Primaria de Cataluña con alta entre 2007 y 2010. Se estimó para cada año la incidencia de episodios de ITcc por cada 100 afiliados en la Seguridad Social, la duración mediana y la duración media de días de baja por afiliado según el sexo, la edad, la provincia, el régimen de la seguridad social y la familia diagnóstica de la CIE-10.Resultados: Se observa una tendencia consistente en descenso de la duración media de días de baja por afiliado (de12,2 días en 2007 a 10,8 en 2010) y de la incidencia (de 34,4 a 30,4 casos por 100 afiliados). Este patrón se observa tanto en hombres como en mujeres, aunque los hombres presentan una incidencia, duración mediana y días de baja por afiliado menor que las mujeres. La mayoría de los diagnósticos fueron por enfermedades respiratorias (alrededor de 7 episodios porcada 100 afiliados), osteomusculares (que desciende de 6,9 a 3,2 en el periodo de estudio) e infeccionas (alrededor de 4). En cuanto a la duración mediana de los episodios destacan las enfermedades tumorales (sobre 50 días), mentales (sobre 30 días)y cardiovasculares (entre 20 y 30 días). Conclusiones: Las tendencias mostradas pueden servir como valores de referencia para la planificación y evaluación delas políticas de gestión de la ITcc(AU)

Objectives: To describe nonoccupational temporary sickness absence episodes registered in Catalonia between 2007and 2010.Methods: We analysed 4,273,601 sickness absence episodes (SA) that came to closure between 2007 and 2010, registered through Catalonian Primary Health centers. Annual incidence rates per 100 workers, and median and mean duration of days lost per worker were examined by gender, age, province, social security scheme, and major ICD-10 diagnostic groups. Results: There was a consistent downward trend in mean duration of days lost per worker (from 12.2 days in 2007 to10.8 in 2010), and in incidence rates (from 34.4 to 30.4 cases per 100 workers). This pattern was observed in both men and women, although overall men had a lower incidence, median duration and mean days lost per worker than women. The most frequent diagnostic groups were respiratory diseases (about 7 episodes per 100 workers), musculoskeletal disorders (decreasing from 6.9 to 3.2 over the study period), and infections (about 4 episodes per 100 workers). The longest median durations were those associated with neoplasms (about 50 days), mental disorders (30 days) and cardiovascular diseases (between 20and 30 days)(AU)

Cómo valoran los pacientes en situación de baja laboral al médico inspector: la experiencia del Institut Català d’Avaluacions Mèdiques (ICAM) en Cataluña / How the patients on sick leave assess the Medical Inspector: The Institut Català d’Avaluacions Mèdiques (ICAM) experience in Catalonia

Objetivo. Analizar la opinión que tienen los pacientes en incapacidad laboral de los médicos evaluadores/inspectores y explorar si esta valoración está condicionada por el resultado del dictamen médico. Material y métodos. Estudio descriptivo, transversal, basado en encuestas telefónicas a una muestra aleatoria de pacientes atendidos en Cataluña por incapacidad laboral temporal (IT) o permanente (IP). El estudio de campo ha sido realizado en noviembre de 2011. Muestreo por conglomerados considerando: tiempo desde la consulta y provincia donde fue atendido. Se utilizó una escala valorada mediante coeficiente de Correlación Intraclase (0,93, IC 95% 0,92-0,94) y prueba de Spearman-Brown de la división por mitades (0,93). Resultados. Respondieron 609 pacientes, de los que 400 (65,7%) realizaron una valoración positiva de la atención del médico. Cuando la IP fue denegada la valoración del médico fue peor (p=0,002); no sucedió igual en la IT. Los pacientes en IP que no continuaron en esta situación manifestaron que las decisiones del médico respondían a otros intereses distintos a la salvaguarda de los derechos del paciente (Odds Ratio 2,8; IC95% 1,7-4,8). Cuando el dictamen es negativo los pacientes centraron sus críticas en el médico evaluador (p<0,001) y no en la organización. Conclusiones. Un dictamen negativo en el caso de IP se asocia a una valoración negativa de la actuación, capacidad e independencia de criterio del médico. No sucede lo mismo en el caso de la IT (AU)

Objective. To analyse the patient perception of the medical inspector, and to examine whether this perception is related with the outcome of the medical report. Material and Methods. A cross-sectional study based on telephone interviews with a random sample of patients visited in Catalonia in 2010 for temporary (TSL) or permanent (PSL) sick leave. The study was conducted in November 2011. A stratified sample considering the time from the consultation and province where patients were visited was used. The scale was assessed by Intraclass Correlation coefficient (0.93, 95% CI; 0.92-0.94) and testing with the Spearman-Brown split-half coefficient (0.93). Results. A total of 609 patients were surveyed. A majority of them (400; 65.7%) had a positive opinion of the medical inspector. When PSL was denied, the assessment was worse (P=.002), this was different when TSL was cancelled. Patients who did not continue in PSL stated that doctor's decisions were determined by non-medical interests, and not oriented to the defence of the patient's rights (odds ratio 2.8, 95% CI; 1.7 to 4.8). When the perceptions were negative, patients focus their criticism on the role of medical inspector (P<.001), and not about the organisational aspects. Conclusions. When inspectors cancel PSL, patient's perception is strongly associated with a negative assessment of their performance, capacity and independence of the physician. This is not so in the case of TSL (AU)

Workplace injuries and the take-up of Social Security disability benefits.

Workplace injuries and illnesses are an important cause of disability. State workers' compensation programs provide almost $60 billion per year in cash and medical-care benefits for those injuries and illnesses. Social Security Disability Insurance (DI) is the largest disability insurance program in the United States, with annual cash payments to disabled workers of $95 billion in 2008. Because injured workers may also receive DI benefits, it is important to understand how those two systems interact to provide benefits. This article uses matched state workers' compensation and Social Security data to study the relationship between workplace injuries and illnesses and DI benefit receipt. We find that having a lost-time injury substantially increases the probability of DI receipt, and, for people who become DI beneficiaries, those with injuries receive DI benefits at younger ages. This relationship remains robust even after we account for important personal and work characteristics.

Incidencia y variabilidad de la incapacidad temporal por trastornos de ansiedad en la Comunidad Valenciana durante el 2009 / Incidence and variability of temporary disability due to anxiety disorders during 2009 in the Valencia Community, Spain

Fundamentos: Los trastornos de ansiedad, disociativos y somatomorfos (Cod300) constituyen la segunda causa de incapacidad temporal (IT) en España. Esta razón justifica que el presente trabajo se centre en analizar la variabilidad en la prescripción de procesos de IT por estas patologías en los centros de salud y consultorios (CS) de la Comunidad Valenciana (CV). Métodos: Se realizó un estudio epidemiológico poblacional transversal de variabilidad de los procesos de IT iniciados en 2009 correspondientes al Cod300 en los 739 CS, de los 23 departamentos de salud de la CV, donde se prescribieron un total de 25.859 procesos de IT por Cod300. Se utilizaron los estadísticos de variabilidad habituales en el análisis de áreas pequeñas para determinar la variabilidad observada en la tasa de incidencia (TI) de los procesos de IT. El análisis de la varianza se utilizó para determinar el porcentaje de explicación de cada factor estudiado. Resultados: La TI media por 100 individuos es de 1,08 con un rango de variación de 0,01 a 1,97 entre los percentiles P5 a P95. En el análisis de componentes de la varianza, el factor departamento de salud es el que explica mayor porcentaje de variabilidad (22,12%) seguido del factor provincia (20,21%), litoralidad (4,65%), acreditación para la docencia (2,44%) y tamaño poblacional asignado al CS (2,40%). Conclusiones: Se observa una variabilidad notable en las TI de las prescripciones de IT por Cod300. Los factores departamento y provincia son los que más explican esta variabilidad. Los CS con mayor presión poblacional y los acreditados tienen mayores tasas de incidencia(AU)

Background: Anxiety, dissociative and somatoform disorders (WHO-Code 300) are the second cause of Temporary Disability (TD) in Spain. This is the main reason that justifies the analysis of the variability among primary health care centers (PHC) of the Valencian Community in the prescription processes of Temporary Disability for these disorders. Methods: Epidemiological cross-sectional descriptive study of variability of TD processes initiated in 2009 corresponding to diagnosis code 300 in 739 PHC from 23 health districts in the Valencian Community, where 25,859 TD processes for the diagnosis code 300 were prescribed. Traditional indicators of variation developed for the analysis of small areas were used to determine variability in the incidence rate ofTD processes. The analysis of variance was used to determine the percentage of explanation of the factors studied. Results: The average incidence rate obtained was of 1.08 for 100 individuals. The variation range was between 0.01 and 1.97 for percentiles P5 to P95. In the variance components analysis, the factor of health district explains the highest percentage of variability (22.12), followed by the factor province (20.21%), coastal areas (4.65%), teaching accreditation (2.44%) and the size of population assigned to each PHC (2.40%). Conclusions: Significant differences were observed in the incidence rate of TD processes for the diagnosis code 300. The PHCs with greater population pressure and those that are accredited had the highest rates of incidence(AU)

The European influence on workers' compensation reform in the United States.

Workers' compensation law in the United States is derived from European models of social insurance introduced in Germany and in England. These two concepts of workers' compensation are found today in the federal and state workers' compensation programs in the United States. All reform proposals in the United States are influenced by the European experience with workers' compensation. In 2006, a reform proposal termed the Public Health Model was made that would abolish the workers' compensation system, and in its place adopt a national disability insurance system for all injuries and illnesses. In the public health model, health and safety professionals would work primarily in public health agencies. The public health model eliminates the physician from any role other than that of privately consulting with the patient and offering advice solely to the patient. The Public Health Model is strongly influenced by the European success with physician consultation with industry and labor.