1. Evidence-based knowledge in European insurance medicine Søren Brage and Corina Oancea Congress presentation June 9, 2016 EUMASS – UEMASS REPORT

2. Background Collaboration between – EUMASS – Cochrane Insurance Medicine Fragmented evidence based knowledge in IM Enhance standards for research and practice Uncover present status of EBK in insurance medicine by conducting a minor survey that will not be representative, but be exploratory

3. Evidence based medicine is a part of evidence based knowledge Medicine Social work Law Costs Public Health

4. Survey questions Sent to 19 EUMASS council members March 2015 In what area of insurance medicine is evidence- based knowledge lacking most in your country? Do you have an example of successful use of evidence-based knowledge in insurance medicine in your country? 15 replies (12 countries)

5. Areas Private or social insurance IP’s work task – Disability evaluation – Sick leave management and RTW Medical conditions - pathologies

6. Lack of EBK In social insurance4 In private insurance3 For mental disorders4 For CFS1

7. Lack of EBK Domain Specific field Work disability evaluation Disability evaluation Assessment of partial disability (hours per week) Disability assessment of persons with mental disorders, CFS, and comorbid conditions Sick-leave management and RTW Guidelines for sick leave Sick-leave prevention Effects of interventions for RTW Disease-specific sick leave Outcomes and side effects of sick leave Impairment assessment and causality Not mentioned Health care monitoring Not mentioned Risks for acceptance for life insurance Risk assessment in life/disability insurance Evaluation of incapacity to participate in community/society Not mentioned

8. Success stories Social insurance 14 Private insurance 1 No replies that specified medical conditions

9. Success stories DomainSpecific field Work-disability evaluationDisability evaluation guidelines/protocols based on EBK Scientifically tested tools for work-disability assessment Scientifically tested methods for disability evaluation EBK to support conclusions in disability reports «Case law»: examples built on EBK Sick-leave management and RTWSick-leave certification guidelines Interventions for RTW that are proven effective Impairment assessment and causalityReferral to proven causes in occupational diseases Health care monitoringAssessment of drug effectiveness Risks for acceptance for life insuranceDisease-specific criteria Evaluation of incapacity to participate in non-work life Not mentioned

10. Conclusions Unclear field – A need to increase the understanding of evidence- based knowledge and evidence-based medicine – Should guidelines be based on consensus, on sound scientific evidence, or on sound and relevant scientific evidence Clinical studies are often less relevant and valuable than studies with RTW as outcome Use as many systematic reviews as possible, ask for them Read and use guidelines critically

11. Conclusions Disability evaluation and sick-leave management are mentioned both as deficit areas and as success stories In addition, interventions for return to work lack an evidence base Report will be published on www.eumass.euwww.eumass.eu Extended survey?