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Improving reliability and transparency of Independent Medical Expertises (IMEs) and their usefulness to social judges, claimants and social insurance organisations

Applicant Kunz Regina
Number 144200
Funding scheme Project funding (Div. I-III)
Research institution Evidenzbasierte Versicherungsmedizin (EbIM) Universitätsspital Basel
Institution of higher education University of Basel - BS
Main discipline Rehabilitation
Start/End 01.10.2012 - 30.09.2016
Approved amount 410'659.00
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Keywords (6)

medical expertises; randomized controlled trial; disability assessment ; reliability; functional status assessment; psychiatry

Lay Summary (German)

Lead
Die Schweizer Öffentlichkeit äussert seit Längerem Bedenken wegen der unzureichenden Transparenz und Nachvollziehbarkeit von IV/UV-Gutachten. Dieses Projekt untersucht die Verlässlichkeit (Reliabilität) und Transparenz der psychiatrischen Begutachtung und Möglichkeiten zur Verbesserung.
Lay summary

Projekttitel

Reliable psychiatrische Begutachtung im Rentenverfahren RELY:

Verbesserung der Reliabilität (Verlässlichkeit) und Transparenz von psychiatrischen Gutachten und ihrem Nutzen für Sozialrichter, Antragsteller und Sozialversicherer

Inhalt und Ziel des Forschungsprojekts

Die Begutachtung der Arbeits(un)fähigkeit von IV/UV-Rentenantragstellern steht aktuell in der Kritik. Versicherungen, Betroffene und ihre Anwälte sowie Gerichte fordern mehr Transparenz und eine bessere Nachvollziehbarkeit, wie die Gutachter anhand des Gesprächs auf die Arbeits(un)fähigkeit schliessen.

Bis anhin war die Begutachtung auf die Defizite des Antragstellers gerichtet, und die Aussagen des Gutachters waren in frei formulierten Berichten festgehalten. Heute liegt der Fokus vermehrt auf den verbliebenen Leistungsfähigkeiten des Antragstellers, und die Begutachtung wurde in Richtung ‚funktionsorientierte Begutachtung‘ weiterentwickelt. Jedoch fehlen wissenschaftlich gestützte Erkenntnisse, welche den Prozess und die Auswirkungen auf Begutachtung und Rentenzusprache untersuchen.

In dieser Studie untersuchen wir, ob die funktionsorientierte Begutachtung tatsächlich die angestrebte Verbesserung bei der Verlässlichkeit und Transparenz von IV/UV Gutachten bringt. In einer ersten Studie (RELY-I) überprüfen wir, wie gut Gutachter in der funktionsorientierten Begutachtung bei der Bewertung der Arbeits(un)fähigkeit übereinstimmen. Bei akzeptablen Ergebnissen vergleichen wir anschliessend in einer randomisierten Studie, ob Gutachter mit der funktionsorientierten Begutachtung bei der Schätzung der Arbeits(un)fähigkeit besser übereinstimmen als mit der traditionellen Begutachtung (RELY-II) und wie die unterschiedlichen Akteure die Transparenz bewerten (RELY-III). Bei der Durchführung der Studie kommen Fragebogen, Interviews und Videoaufzeichnungen zur Anwendung.

Wissenschaftlicher und gesellschaftlicher Kontext

Die Begutachtung lebt vom Vertrauen aller beteiligten Parteien. Dieses Vertrauen ist aktuell beeinträchtigt. Mit der Studie gewinnen wir neue Informationen über den Begutachtungsprozess und tragen bei, den Prozess expliziter zu gestalten und die Entscheidungen für die Akteure transparenter zu machen. Damit hoffen wir, das Vertrauen in die Ergebnisse der Begutachtung zu verbessern. Durch die breite Einbindung der verschiedenen Interessenvertreter (Begleitgruppe) in die Studie und in die Bewertung der Ergebnisse hoffen wir, das Vertrauen der Öffentlichkeit in die Begutachtung und die Akzeptanz der Rentenentscheide der Sozialversicherungen zu stärken.

Keywords

reliability, medical expertises, randomized controlled trail, disability assessment, psychiatry, functional status assessment,

Weitere Informationen zu RELY-I finden Sie auf unserer Homepage: www.unispital-basel.ch/asim/RELY

Direct link to Lay Summary Last update: 24.05.2013

Responsible applicant and co-applicants

Employees

Publications

Publication
The reproducibility of psychiatric evaluations of work disability: two reliability and agreement studies
Kunz Regina, von Allmen David Y., Marelli Renato, Hoffmann-Richter Ulrike, Jeger Joerg, Mager Ralph, Colomb Etienne, Schaad Heinz J., Bachmann Monica, Vogel Nicole, Busse Jason W., Eichhorn Martin, Bänziger Oskar, Zumbrunn Thomas, de Boer Wout E. L., Fischer Katrin (2019), The reproducibility of psychiatric evaluations of work disability: two reliability and agreement studies, in BMC Psychiatry, 19(1), 205-205.
Inter-rater agreement in evaluation of disability: systematic review of reproducibility studies
Barth Jürgen, de Boer Wout E L, Busse Jason W, Hoving Jan L, Kedzia Sarah, Couban Rachel, Fischer Katrin, von Allmen David Y, Spanjer Jerry, Kunz Regina (2017), Inter-rater agreement in evaluation of disability: systematic review of reproducibility studies, in BMJ, j14-j14.
Use of a structured functional evaluation process for independent medical evaluations of claimants presenting with disabling mental illness: rationale and design for a multi-center reliability study.
Bachmann Monica, de Boer Wout, Schandelmaier Stefan, Leibold Andrea, Marelli Renato, Jeger Joerg, Hoffmann-Richter Ulrike, Mager Ralph, Schaad Heinz, Zumbrunn Thomas, Vogel Nicole, Bänziger Oskar, Busse Jason W, Fischer Katrin, Kunz Regina (2016), Use of a structured functional evaluation process for independent medical evaluations of claimants presenting with disabling mental illness: rationale and design for a multi-center reliability study., in BMC psychiatry, 16, 271-271.
Attitudes towards evaluation of psychiatric disability claims: a survey of Swiss stakeholders
Schandelmaier S, Leibold A, Fischer K, Mager R, Hoffmann-Richter U, Bachmann MS, Kedzia S, Busse JW, Guyatt GH, Jeger J, Marelli R, De Boer, Kunz R (2015), Attitudes towards evaluation of psychiatric disability claims: a survey of Swiss stakeholders, in Swiss Medical Weekly, 145.
Evaluation of work capacity in Switzerland: a survey among psychiatrists about practice and problems
Schandelmaier S, Fischer K, Mager R, Hoffmann-Richter U, Leibold A, Bachmann MS, Kedzia S, Jeger J, Marelli R, Kunz R, De Boer (2013), Evaluation of work capacity in Switzerland: a survey among psychiatrists about practice and problems, in Swiss Medical Weekly, 143.

Collaboration

Group / person Country
Types of collaboration
Begutachtungszentren, asim Basel, MEDAS Luzern/Interlaken, IV Stelle Zürich, ZMB Basel Switzerland (Europe)
- Research Infrastructure
- Industry/business/other use-inspired collaboration
SIM Swiss Insurance Medicine Switzerland (Europe)
- in-depth/constructive exchanges on approaches, methods or results
- Industry/business/other use-inspired collaboration
SGVP Swiss Society of Insurance Psychiatrists Switzerland (Europe)
- in-depth/constructive exchanges on approaches, methods or results
- Industry/business/other use-inspired collaboration
SGPP Swiss Society for Psychiatry and Psychotherapy Switzerland (Europe)
- in-depth/constructive exchanges on approaches, methods or results
- Industry/business/other use-inspired collaboration

Scientific events

Active participation

Title Type of contribution Title of article or contribution Date Place Persons involved
EUMASS Council, European Union of Medicine in Assurance and Social Security, Seminar 2019 Talk given at a conference The reproducibility of psychiatric evaluations of work disability. Invited lecture 11.10.2019 Paris, France Kunz Regina;
EUMASS European Union of Medicine in Assurance and Social Security Congress 2018 Talk given at a conference Interrater agreement in evaluation of disability: findings from a systematic review. 05.10.2018 Maastricht, Netherlands Kunz Regina; von Allmen David Yoh; DeBoer Wout;
EUMASS European Union of Medicine in Assurance and Social Security Congress 2018 Talk given at a conference The reliability of real life work disability evaluations using the functional approach: The RELY studies. 05.10.2018 Maastricht, Netherlands Kunz Regina;
EUMASS European Union of Medicine in Assurance and Social Security Congress 2018 Talk given at a conference Training psychiatricts in functional interviewing: Experiences from the RELY studies. 05.10.2018 Maastricht, Netherlands DeBoer Wout;
EUMASS European Union of Medicine in Assurance and Social Security Congress 2018 Talk given at a conference The reliability of medical assessments. Symposium of four presentations 05.10.2018 Maastricht, Netherlands Kunz Regina;
EUMASS European Union of Medicine in Assurance and Social Security Congress 2018 Talk given at a conference Reporting activity limitations: IFAP, the Instrument of Functional Assessment in Psychiatry and training needs. 05.10.2018 Maastricht, Netherlands von Allmen David Yoh; Kunz Regina;
DICIM Dutch International Congress on Insurance Medicine 2017 Talk given at a conference Reliability in medical assessments - a topic of concern. What level of agreement among medical experts can society expect and what does evidence tell us? A matter of discussion. 09.11.2017 Almere, Netherlands Kunz Regina;
WPA XVII World Congress of Psychiatry 2017 Talk given at a conference The reliability of medical assessments for disability benefits in patients with mental disorders - can a structured approach improve the reproducibility of expert judgments? A four presentation symposium 10.10.2017 Berlin, Germany DeBoer Wout; Kunz Regina; von Allmen David Yoh;
WPA XVII World Congress of Psychiatry 2017 Talk given at a conference Work disability assessment in claimants with mental disorders: its reliability when using the functional approach - the RELY study 10.10.2017 Berlin, Germany Kunz Regina;
WPA XVII World Congress of Psychiatry 2017 Talk given at a conference Interrater agreement in evaluation of disability: findings from a systematic review. 10.10.2017 Berlin, Germany von Allmen David Yoh; Kunz Regina; DeBoer Wout;
WPA XVII World Congress of Psychiatry 2017 Talk given at a conference Functional interviewing and the IFAP instruments: the process. 10.10.2017 Berlin, Germany von Allmen David Yoh;
EUMASS European Union of Medicine in Assurance and Social Security Congress 2016 Talk given at a conference Requirement for reliable assessments in social insurance: Talk about work! 09.06.2016 Ljubljana, Slovenia DeBoer Wout; Bachmann Monica; von Allmen David Yoh; Vogel Nicole; Schandelmaier Stefan; Kunz Regina;
EUMASS European Union of Medicine in Assurance and Social Security Congress 2016 Talk given at a conference The adoption of the ICF framework for disability assessments in Switzerland 09.06.2016 Ljubljana, Slovenia von Allmen David Yoh; Vogel Nicole; Kunz Regina; Bachmann Monica; Schandelmaier Stefan; DeBoer Wout;
EUMASS European Union of Medicine in Assurance and Social Security Congress 2016 Talk given at a conference Adoption of functional interviewing in disability evaluation 09.06.2016 Ljubljana, Slovenia von Allmen David Yoh; Schandelmaier Stefan; Kunz Regina; Vogel Nicole; DeBoer Wout; Bachmann Monica;
DICIM Dutch International Congress on Insurance Medicine 2015 Talk given at a conference Turning clinicians into ICF adopters 06.11.2015 Almere, Netherlands DeBoer Wout; Kunz Regina; Schandelmaier Stefan; Bachmann Monica; Vogel Nicole; von Allmen David Yoh;
DICIM Dutch International Congress on Insurance Medicine 2015 Talk given at a conference The inter-rater reliability of evaluation of work capacity: A systematic review 05.11.2015 Almere, Netherlands DeBoer Wout; Vogel Nicole; Bachmann Monica; Kunz Regina; von Allmen David Yoh; Schandelmaier Stefan;
SGPP Schweizerische Gesellschaft für Psychiatrie und Psychotherapie Jahreskongress 2015 Talk given at a conference Umsetzung des Trainings für das funktionsorientierte Interview 04.09.2015 Bern, Switzerland DeBoer Wout; von Allmen David Yoh; Schandelmaier Stefan; Kunz Regina; Vogel Nicole; Bachmann Monica;
SGPP Schweizerische Gesellschaft für Psychiatrie und Psychotherapie Jahreskongress 2015 Talk given at a conference Die funktionsorientierte Begutachtung in der Psychiatrie - Die RELY-Studie 04.09.2015 Bern, Switzerland Bachmann Monica; Vogel Nicole; DeBoer Wout; Schandelmaier Stefan; Kunz Regina; von Allmen David Yoh;
SGPP Schweizerische Gesellschaft für Psychiatrie und Psychotherapie Jahreskongress 2015 Talk given at a conference Die funktionsorientierte Begutachtung in der Psychiatrie (Symposium asim). Die funktionsorientierte Begutachtung - eine Einführung 04.09.2015 Bern, Switzerland Bachmann Monica; Vogel Nicole; DeBoer Wout; Schandelmaier Stefan; Kunz Regina; von Allmen David Yoh;
SGPP Schweizerische Gesellschaft für Psychiatrie und Psychotherapie Jahreskongress 2015 Talk given at a conference Interviews mit den Gutachtern 04.09.2015 Bern, Switzerland DeBoer Wout; Kunz Regina; von Allmen David Yoh; Bachmann Monica; Schandelmaier Stefan; Vogel Nicole;
1. Interdisziplinäres Versicherungsmedizinisches Kolloquium 2015. Suva Talk given at a conference Validität/Reliabilität - Zuverlässigkeit in der Begutachtung 18.06.2015 Luzern, Switzerland Vogel Nicole; DeBoer Wout; von Allmen David Yoh; Schandelmaier Stefan; Bachmann Monica; Kunz Regina;
1. Interdisziplinäres Versicherungsmedizinisches Kolloquium 2015. Suva Talk given at a conference Ergebnisse der RELY-Studie 18.06.2015 Luzern, Switzerland Schandelmaier Stefan; DeBoer Wout; Vogel Nicole; Bachmann Monica; Kunz Regina; von Allmen David Yoh;
Gutachter Treff, RAD Regionaler Ärztlicher Dienst 2015 Talk given at a conference Update zur RELY-Studie 28.05.2015 Zürich, Switzerland Bachmann Monica; von Allmen David Yoh; Kunz Regina; Schandelmaier Stefan; DeBoer Wout; Vogel Nicole;
EUMASS European Union of Medicine in Assurance and Social Security Congress 2014 Talk given at a conference Development of an intervention in psychiatric assessment of work capacity 11.09.2014 Stockholm, Sweden Schandelmaier Stefan; DeBoer Wout; Kunz Regina; Bachmann Monica;
Swiss Public Health Conference 2014 Talk given at a conference RELY-I - The study on Reliable disability EvaLuation of work capacity in psychiatrY. A study protocol 21.08.2014 Olten, Switzerland Bachmann Monica; Kunz Regina; DeBoer Wout; Schandelmaier Stefan;
DGPPN 2013 Deutsche Gesellschaft für Psychiatrie und Psychotherapie, Psychosomatik und Nervenheilkunde Talk given at a conference Das Instrument für funktionelles Assessment in der Psychiatrie als Instrument für die Begutachtung 30.11.2013 Berlin, Germany Kunz Regina; Schandelmaier Stefan; DeBoer Wout;


Self-organised

Title Date Place
Symposium RELY Ergebnisse 2019 03.07.2019 Basel, Switzerland

Knowledge transfer events

Active participation

Title Type of contribution Date Place Persons involved
Canadian Pain Society Annual Meeting. Can. J. Pain. Inter-rater agreement of disability evalutation: A systematic review of reproducibility studies. (Research Poster Abstract) Poster 27.01.2017 Hamilton, Canada DeBoer Wout; Kunz Regina; von Allmen David Yoh;
Tag der Forschung, DKF Universitätsspital Basel. Adoption of function-oriented interview in disability evaluation. Poster 19.01.2017 Basel, Switzerland DeBoer Wout; Kunz Regina; Vogel Nicole; von Allmen David Yoh;
SGPP Schweizerische Gesellschaft für Psychiatrie und Psychotherapie Jahreskongress 2016. Functional interviewing in disability evaluation. Poster 17.08.2016 Basel, Switzerland Vogel Nicole; Kunz Regina; DeBoer Wout; von Allmen David Yoh;
3rd International Congress of Medical Assessors 2013. Functional assessment in psychiatrie: using the right instrument Talk 18.04.2016 Maribor, Slovenia DeBoer Wout; Kunz Regina; Schandelmaier Stefan;
Bethesda Spital Basel. Die funktionsorientierte Begutachtung in der RELY-Studie Talk 10.12.2015 Basel, Switzerland DeBoer Wout; von Allmen David Yoh; Vogel Nicole; Schandelmaier Stefan; Kunz Regina; Bachmann Monica;
asim Fortbildungsveranstaltung Medjus. Werden Kliniker zu ICF Anwendern? Talk 09.12.2015 Basel, Switzerland Schandelmaier Stefan; Kunz Regina; Bachmann Monica; von Allmen David Yoh; Vogel Nicole; DeBoer Wout;
IV-Stellenkonferenz. Die funktionsorientierte Begutachtung in der RELY-Studie Talk 25.06.2015 Luzern, Switzerland Bachmann Monica; Vogel Nicole; DeBoer Wout; Kunz Regina; Schandelmaier Stefan; von Allmen David Yoh;
Swiss Insurance Medicine, SIM. Die funktionsorientierte Begutachtung in der RELY-Studie Talk 17.06.2015 Luzern, Switzerland Bachmann Monica; von Allmen David Yoh; Kunz Regina; Schandelmaier Stefan; DeBoer Wout; Vogel Nicole;
Universitäre Psychiatrische Kliniken. Funktionsorientierte Begutachtung und Mini ICF Talk 24.03.2015 Basel, Switzerland Schandelmaier Stefan; von Allmen David Yoh; Kunz Regina; DeBoer Wout; Vogel Nicole; Bachmann Monica;
Rheinfelder Tage. Qualität der Begutachtung und Leitlinien Talk 11.12.2014 Rheinfelden, Switzerland Vogel Nicole; Kunz Regina; DeBoer Wout; Bachmann Monica; Schandelmaier Stefan;
Rheinfelder Tage «Psychosomatik und Arbeit» Vertrauen, Qualität und Kompetenz. Qualitätsverbesserung der medizinischen Begutachtung Talk 11.12.2014 Rheinfelden, Switzerland Bachmann Monica; Kunz Regina; DeBoer Wout; Schandelmaier Stefan; Vogel Nicole;
Formation continue en expertise médicale Sion. Petit poucet en Evidencie: Médecine d’assurance basée sur données probantes. Talk 13.11.2014 Sion, Switzerland DeBoer Wout; Kunz Regina; Bachmann Monica; Schandelmaier Stefan; Vogel Nicole;
Swiss Public Health Conference. Development of an instrument for functional assessment of work capacity in psychiatry Talk 21.08.2014 Zürich, Switzerland Kunz Regina; Bachmann Monica; Schandelmaier Stefan; DeBoer Wout;
Fachtagung für IV-Gutachterinnen und IV-Gutachter. IV-Stelle Zürich. Mehr Transparenz in der psychiatrischen Begutachtung Talk 30.01.2014 Zürich, Switzerland Schandelmaier Stefan; Kunz Regina; Bachmann Monica; DeBoer Wout;
Journée annuelle de l'ARPEM Association romande des praticiens en expertise médicale. Qualité de l’expertise médicale. Talk 19.09.2013 Lausanne, Switzerland Schandelmaier Stefan; DeBoer Wout; Kunz Regina;


Self-organised

Title Date Place
Meeting mit der Begleitgruppe der RELY Studie 05.11.2019 Basel, Switzerland
Symposium RELY Ergebnisse 03.07.2019 Basel, Switzerland
asim Fortbildung, Psychiatrie Fachaustausch. Stand RELY Studie 25.11.2015 Basel, Switzerland

Communication with the public

Communication Title Media Place Year
Media relations: print media, online media Arbeitsfähigkeit: Training verkleinert Unterschiede bei Gutachten SNF Newsroom German-speaking Switzerland 2019
Media relations: print media, online media Arbeitsfähigkeit: Training verkleinert Unterschiede bei Gutachten Universität Basel News International German-speaking Switzerland 2019
Media relations: print media, online media Capacité de travail: une formation réduit les écarts entre les expertises SNF Newsroom Western Switzerland Rhaeto-Romanic Switzerland 2019
Media relations: print media, online media RELY Studie EbIM Forschung und Bildung Webseiten International German-speaking Switzerland 2019
Media relations: print media, online media Work capability assessments: making them more consistent SNF Newsroom International Western Switzerland German-speaking Switzerland Rhaeto-Romanic Switzerland Italian-speaking Switzerland 2019
Media relations: print media, online media RELY‐Studie: Zwischenergebnisse vom März 2015 Universitätsspital Basel Webseiten German-speaking Switzerland 2015
Media relations: print media, online media RELY-Studie Universitätsspital Basel Webseiten German-speaking Switzerland International 2013

Abstract

BACKGROUND: Patients, lawyers, insurances, and regulatory authorities have raised concern about the lack of transparency and reliability of independent medical expertises (IMEs). This problem affects thousands of claimants for disability benefits in Switzerland and has implications for expenditures of billions of Swiss Francs. This grant describes a research program designed to develop and test a novel approach to improving the transparency and reliability of psychiatric IMEs for social insurance benefits. The program includes the following studies: Needs assessment of psychiatrists; design of new instruments to facilitate functional assessment; development of a training program; a study to test the reliability of the new approach; a randomized control trial to compare the new and existing approaches; and if testing proves successful, the outline of an implementation strategy. The initial phases of the program are complete or near completion. We ask financial support from the SNF ONLY FOR THE RELIABILITY STUDY and the RANDOMIZED CONTROLLED TRIAL.HYPOTHESIS: In claimants for disability benefit for psychiatric reasons, an enhanced process (i.e. training in optimal interviewing, functional status assessment, detailed information about the claimant's last job, and a structured summary addressing the claimant’s work incapacity) will improve both, transparency and agreement regarding the claimant’s percentage work incapacity. We refer to the enhanced process as "the functional approach”.DESIGN: We propose to conduct a multi-center observational study addressing the psychometric properties of the functional approach ("RELIABILITY STUDY"), and a multi-center randomized controlled trial comparing the functional approach versus current assessments practices for psychiatric disability for social insurance ("RCT").OUTCOME: Primary outcome in both studies is the degree of agreement among psychiatrists in percentage work incapacity for the claimant’s last job and for any suitable work; in the RCT we will compare agreement in the experimental versus the standard assessment group. We will explore the psychiatrists’ certainty in their judgments and address the transparency of the functional and the traditional report for the various users.
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