Use of a Decision Support Tool on Prognosis of Work Ability in Work Disability Assessments: An Experimental Study Among Insurance Physicians.
I Louwerse, M A Huysmans, H J van Rijssen and 3 others
PMID 32529340WHAT IT FOUND
Insurance physicians' prognosis matched the tool in 47% of judgments, changed in 11% after seeing it, and confidence fell when they disagreed.
Most were unsure or unwilling to use it.
Key findings
01Before seeing the tool, physicians' prognosis matched the prediction model in 82 of 174 judgments (47%); after seeing it, only 19 judgments (11%) changed.
02Consulting the tool lowered physicians' confidence by 0.5 points on the 0 to 10 scale from 7.1 to 6.6 points; when their prognosis disagreed with the tool, confidence fell from 7.0 to 6.0 points.
03Only 28% (n = 8) of physicians said they would be willing to use such a tool in future assessments; 55% (n = 16) were unsure and 17% (n = 5) probably would not.
STILL TO COME
How it was doneWhat they found
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What it does not show
The study used case vignettes, not real claimants, so it cannot show whether actual work ability, return to work, or benefit decisions changed. The prediction model was not externally validated in this study, and the paper could not assess prognostic accuracy. Only 29 insurance physicians took part, and they volunteered, so they may have been more interested in decision support tools than other physicians. The tool was shown after physicians made their own prognosis, which may have reduced its effect. The findings concern insurance physicians' judgments, not physical therapy, occupational therapy, or speech-language therapy patient outcomes.
The easy way to misread this
Do not conclude that this tool improves real work disability decisions or patient outcomes. It was tested only on physicians' judgments of case vignettes, and the paper did not measure actual claimant work ability at follow-up.