title: Quality of rehabilitation among workers with adjustment disorders according to practice guidelines; a retrospective cohort study.
abstract: OBJECTIVE
  To assess the quality of occupational rehabilitation for patients with adjustment disorders and to determine whether high quality of care is related to a shorter period of sickness absence.
  
  
  METHODS
  A retrospective cohort study was conducted by means of an audit of 100 files of patients with adjustment disorders who visited their occupational physicians. Quality of rehabilitation was assessed by means of 10 performance indicators, derived from the guidelines for the treatment of employees with mental health disorders. Performance was dichotomised into optimal and deviant care according to explicit criteria. The performance rates were related to time until work resumption during a one year follow up period. Kaplan-Meier survival analyses and Cox proportional hazards analysis were used to study this relation.
  
  
  RESULTS
  Four of 10 performance rates were below 50%: continuity of care (34%), interventions aimed at providers of care in the curative sector (39%), assessment of impediments in the return to work process (41%), and assessment of symptoms (45%). The highest performance rate concerned assessment of work related causes (94%). Overall optimal care was found in 10% of the cases. Median time to complete recovery was 195 days (IQR 97 to 365), and 73% of all patients recovered completely after one year. Optimal continuity of care was significantly related to a shorter time to both partial and complete work resumption (hazard ratio (HR) 0.3; CI 0.2 to 0.6) independently of other performance indicators. Performance regarding interventions aimed at the organisation was also related to a shorter time until first return to work (HR 0.5; CI 0.3 to 0.9).
  
  
  CONCLUSIONS
  This study shows that the rehabilitation process of employees with adjustment disorders leaves significant room for improvement, especially with regard to continuity of care. Quality of care was partly related to a better outcome. More rigorous study designs are needed to corroborate these findings.
authors.affiliation: Coronel Institute for Occupational and Environmental Health, Academic Medical Center, AmCOGG, University of Amsterdam, Netherlands. K.Nieuwenhuijsen@amc.uva.nl
authors.forename: K
authors.initials: K
authors.lastname: Nieuwenhuijsen
authors.forename: J H A M
authors.initials: JH
authors.lastname: Verbeek
authors.forename: J C M J
authors.initials: JC
authors.lastname: Siemerink
authors.forename: D
authors.initials: D
authors.lastname: Tummers-Nijsen
mesh_terms: D000275:Adjustment Disorders / Q000534:rehabilitation*; D000328:Adult; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D009787:Occupational Medicine / Q000592:standards*; D017410:Practice Guidelines as Topic; D019984:Quality Indicators, Health Care; D012050:Rehabilitation, Vocational / Q000592:standards*; D012189:Retrospective Studies; D018582:Sick Leave; D014938:Work Capacity Evaluation