Evaluation of medical decisions' effectiveness: a 4-year evidence-based study in a health care setting.
OBJECTIVE
Specific studies evaluating the effectiveness of the judgement of fitness for work formulated by occupational physicians (OP) are needed. The evaluation consists in investigating OPs' decisions by measuring their impact on health with specific indicators. This specific study aims at assessing, through outcome indicators, the effectiveness of medical decisions in 61 cases leading to preventive interventions.


METHODS
A 3-step pre-post observational study was carried out in a 4-year period. About 61 clinical cases of health care workers were studied according to the following steps: (1) a medical examination resulting in an evidence-based judgement of fitness for work including prescriptions for an appropriate intervention, (2) the application of the preventive intervention, (3) a second medical examination and completion of a questionnaire by the workers. Two outcome measures were chosen to investigate changes occurred after the intervention: the first measured the perceived and the objective health condition, the second measured satisfaction and working capacity.


RESULTS
Results show a statistically significant increase in subjects presenting a perceived (36/61; chi 2 = 44.099, P < 0.001) and an objective (28/61; chi 2 = 12.190, P < 0.01) improvement of health conditions after the intervention, together with an increased satisfaction in working conditions. An overall improvement of health condition was shown in 44/61 workers (72%).


CONCLUSIONS
Decisions made on the basis of a comprehensive process founded on scientific evidence, searched and appraised according to the paradigm of Evidence Based Occupational Health, result in effective outcomes.
School of Medicine and Postgraduate School of Occupational Medicine, University of Modena and Reggio Emilia, Azienda Ospedaliera-Universitaria Policlinico di Modena, Largo del Pozzo, 71, 41100 Modena, Italy. franco@unimore.it
Giuliano
G
Franco
Pamela
P
Grandi
D000328:Adult; D003657:Decision Making; D019317:Evidence-Based Medicine; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D009784:Occupational Diseases / Q000175:diagnosis / Q000517:prevention & control*; D054538:Occupational Health Physicians; D009786:Occupational Health Services; D010043:Outcome and Process Assessment, Health Care; D010809:Physical Fitness; D010818:Practice Patterns, Physicians' / Q000592:standards; D019984:Quality Indicators, Health Care