Quality management and evaluation of the optimized dermatologist's procedure and of the corresponding administrative multi-step-intervention procedure for occupational skin diseases

Status:

completed 02/2010

Aims:

Primary objectives of the research project were the evaluation of the quality of dermatology reports, the handling of the optimized dermatologist's procedure used by the reporting dermatologist and the step intervention approach in the insurance-administrations.
With this particular study design we had the opportunity to analyze one procedure of the accident insurance comprehensively. Primary goal criteria were the stay in employment, the course of the disease and satisfaction of the insurant and the dermatologists.

Activities/Methods:

Since 01.09.2007, a research project ("EVA-Haut") is conducted at the University of Osnabrueck to evaluate the efficacy of the above measures. Therefore, about 10 % of the annually reported cases in Germany with suspected OD in 2007 have been selected at random (N = 1,600). Follow-up period was one year. The main cohort comprised cases in which dermatological and/or preventive intervention has taken place within the dermatologist's procedure. Patients and dermatologists involved were interviewed as well.

Results:

It could be shown that acceptance of dermatologist's procedure by dermatologists and patients is good. Treatment by the dermatologists was assessed in nearly 67 % as good or excellent by the participating patients (grades 1 to 6, 1 = excellent; 2 = good to 6 = insufficient); the support offered by the statutory accident insurance was assessed in 63,5 % as good or excellent. It could be shown that company physicians were involved in less than 10 % of the cases (N = 140); further integration of this stakeholder group even in small & medium sized companies is necessary to improve management of patients with OD. Overall quality of analyzed dermatologist's reports is high; nevertheless options for optimizing procedures & forms could be identified. These aspects will be part of CME-seminars in occupational dermatology (e.g. improved documentation of sick leave or recommendation of skin protection seminars). Cooperation with the accident insurance administrations was estimated as generally effective by the notifying dermatologists. There was a good agreement in the judgement on the quality of the evaluated notifications by the expert reviewers and insurance administrators. However, there were also cases without further intervention even though the indication was seen by the expert reviewers. In some of these cases reasons could be identified (e.g. patient was non- compliant), in some cases not. It could also be shown that job loss because of OD was significantly higher if no suitable preventive or therapeutic strategies were implemented (N = 1,019; x² = 13.0; df = 3; p = 0.005). Concluding dermatologist's procedure and hierarchichal multistep intervention are suitable instruments in OD-patient management; early implementation of suitable preventive (incl. skin protection seminars) and therapeutic strategies should be aimed at as it this crucial for the outcome of OD.

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