Outcomes relevant for insurance medicine - an evaluation of Cochrane reviews and new initiative




Poster session 2 Thursday: Evidence synthesis - methods / improving conduct and reporting


Thursday 14 September 2017 - 12:30 to 14:00


All authors in correct order:

Hoving J1, Weida R2, de Boer W2, Vogel N2, Schaafsma F3, Kunz R2
1 Coronel Institute for Occupational Health, Academic Medical Center, Amsterdam, Netherlands
2 Evidence-based Insurance Medicine, Dept. Clinical Research, University Hospital Basel and University of Basel, Suisse
3 EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, Netherlands
Presenting author and contact person

Presenting author:

Jan Hoving

Contact person:

Abstract text
Background: Cochrane Insurance Medicine (CIM) promotes the use of evidence regarding sick leave certification, disability evaluation, prognosis of claim duration, treatment of disabling conditions, and return to work (RtW) interventions to inform decision‐making in a domain of high importance to society.

Objective: Using systematic review methodology, we performed two studies to: evaluate Cochrane reviews on their use of insurance medicine (IM) outcomes, and their characteristics to determine a potential need for a core outcome set on work participation.

Methods: Study 1: We used the Cochrane Priority list and identified reviews with health conditions relevant to IM. We determined prevalence and type of IM outcomes (including distinction between direct outcomes (sick leave, return to work –RtW-, cost) and indirect outcomes (hospitalisation, activity of daily living). Study 2: We searched the Cochrane library and reviewed Cochrane reviews that focused on work participation, both as an outcome and as a target for intervention. We listed and compared characteristics and definitions of work participation outcomes used in these reviews.

Results: Study 1: Although 90% (102/113) of Cochrane reviews covered a health condition with relevance for IM, only 52% (52/102) reviews reported on IM outcomes. Even less (17%, 19/113) reported on direct IM outcomes like RtW. Study 2: RtW and sick leave are frequently measured, using different methods, different follow up times, and heterogeneous definitions.

Conclusion: Cochrane reviews frequently lack information on insurance medicine outcomes. Those that include such outcomes lack consensus in their terminology, definitions and use. This finding confirms a need for a clear and universally agreed core outcome set for work participation that is relevant to CIM. Such an outcome set would allow reviewers to systematically compare and pool the results across RCTs and enable trial researchers to include this minimal set of outcomes in future trial protocols, alongside other outcomes. A new project is under way to develop an international core set of outcome measures on work participation relevant to the field of IM.