Insurance medicine outcomes in Cochrane Reviews

Article type
Year
Authors
Weida R1, Ullmann-Kurz K1, von Allmen D1, Brouwer S2, Busse JW3, Alexanderson K4, de Boer W1, Kunz R1
1asim Research and Education, Department of Clinical Research, University of Basel Hospital, Basel, Switzerland
2University Medical Centre Groningen, The Netherlands
3McMaster University, Canada
4Karolinska Institutet, Sweden
Abstract
Background: Professionals in insurance medicine (IM) need easy access to scientific evidence to help them make informed decisions. Currently, IM professionals complain about challenges in retrieving relevant studies, including Cochrane Reviews.

Objectives: To identify types and frequency of IM outcomes reported in Cochrane Reviews; and to suggest approaches to improve retrieval of Cochrane evidence for IM professionals.

Methods: Based on the EUMASS (European Union of Medicine in Assurance and Social Security) classification of key topics in IM (sick leave certification; work disability assessment; return-to-work; assessment of causality), a group of IM experts defined, piloted and refined IM related outcomes. We classified them as narrow (e.g. return to work), broad (like hospitalisation) or cost-only (i.e. cost was the only IM outcome), depending on their proximity to the core content of IM. Next, we identified review groups with a focus related to IM. We screened to what degree reviews of these groups contained IM outcomes and whether these outcomes were primary (I°) or secondary (2°). We report frequency according to outcome (I°; 2°; narrow, broad) and review group. We tagged all reviews with the topic 'Insurance medicine' independent of outcome type.

Results: We identified 486 of 1564 (31%) screened reviews from 15 review groups as relevant to IM and classified them by key topic. Narrow-IM outcomes were found in 30% (149/486) of reviews, 75 of which were I° outcomes. 281/486 reviews (58%) included broad-IM outcomes (I°: n = 61), 63/486 (4%) reviews considered costs only (I°; n = 5 ). Altogether, in 141/486 (22%) reviews the I° outcome was related to IM. Most reviews with IM outcomes came from the following groups Schizophrenia (n = 136/486), Heart (n = 54/486), Common Mental Disorders (n = 50/486), Neuromuscular (n = 45/486), and Back & Neck (n = 39/486).

Conclusions: One-third of Cochrane reviews with interventions in the proximity to IM include IM related outcomes, 22% as I°, 78% as 2° outcomes. Tagging with the topic 'Insurance Medicine' in the Cochrane Library would facilitate retrieval by IM professionals searching for such outcomes.