Development and evaluation of a quality assessment instrument for occupational physicians.
OBJECTIVE
To develop and apply a method for assessing the quality of the process of occupational health care for individual patients.


METHODS
The scientific literature was studied to develop a method to assess the quality of the process of occupational rehabilitation for workers with low back pain. The method was applied to health care and university workers with low back pain who were rehabilitated by their occupational physicians.


RESULTS
Assessment of quality of care is regarded as a four step approach. Firstly, guidelines should be developed and implemented. Secondly, indicators for quality and criteria to demarcate good and deviant quality were derived from the guidelines. Thirdly, a method for data collection was chosen. Finally, quality was scored. For occupational rehabilitation, there was some deviance from the guidelines for most cases, especially in continuity of care with a deviant rate of 47%. Other indicators deviated from 1.4%-17.4%. Occupational physicians agreed on the relevance of the indicators and criteria, but for three indicators they evaluated the criteria as too rigid. They did not agree with their own performance scores in 66% of the deviant cases.


CONCLUSIONS
Assessing the quality of the process of occupational health care with this method is an asset to present methods, but more specific criteria are needed for a more sensitive assessment.
Coronel Institute for Occupational and Environmental Health, University of Amsterdam. gsnel@worldaccess.nl
W E
WE
van der Weide
J H
JH
Verbeek
F J
FJ
van Dijk
C T
CT
Hulshof
D002983:Clinical Competence / Q000592:standards*; D005069:Evaluation Studies as Topic; D006801:Humans; D017116:Low Back Pain / Q000534:rehabilitation; D009787:Occupational Medicine / Q000592:standards*; D017410:Practice Guidelines as Topic; D011785:Quality Assurance, Health Care