Table_3_Designing an evidence-based working method for medical work disability prognosis evaluation–an intervention mapping approach.pdf

PurposePerforming evidence-based work disability prognosis evaluation (WDPE) of clients on sick leave is a difficult task for physicians. The aim was to develop a working method to support physicians in performing evidence-based WDPE and to improve WDPE quality.
Materials and methodsIntervention Mapping (IM) supplemented with elements of the Behavior Change Wheel (BCW) guided project planning for developing the working method. This approach allowed combination with other frameworks and, e.g., behavior change theories. WDPE quality challenges were analyzed on various ecological levels, e.g., the individual (i.e., the physician), interpersonal (i.e., the client) and organizational level, culminating into a multilevel logic model of the problem. Determinants that contributed to this problem, e.g., lack of physicians’ knowledge on performing evidence-based WDPE, were identified. Performance objectives were formulated that could contribute to a desired change in WDPE quality. From the performance objectives and determinants (e.g., knowledge), change objectives were derived. In order to achieve these change objectives, suitable intervention functions (e.g., education) and policy categories (e.g., service provision) were identified, allowing the formulation of intervention components. Behavior change techniques (e.g., feedback on outcomes of a behavior) were selected to serve the intervention functions to deliver the desired change. This led to the conceptualization of an intervention plan.
ResultsThe intervention “Prognosable” is presented. It consists of a stepwise working method (SWM) for evidence-based WDPE. The SWM offers an overview of important aspects (e.g., medical condition, clients’ confidence in return-to-work) to consider in individual clients’ WDPE. The SWM helps physicians to identify crucial functional limitations, find and appraise evidence-based information, weigh all relevant prognostic aspects and it supports physicians to conclude with an evidence-based WDPE, tailored to the individual client. The intervention “Prognosable” was designed, which also includes an educational program and a supportive software tool to enable implementation of the SWM.
ConclusionIM combined with BCW elements guided the development of a SWM for evidence-based WDPE. The SWM will be delivered through an educational program for physicians supported by a digital tool. The SWM, educational program and digital tool are ready to be implemented and evaluated in practice as the intervention “Prognosable.”

研究目的：对病假患者开展循证工作残疾预后评估（work disability prognosis evaluation，WDPE）是临床医师面临的一项艰巨任务。本研究旨在开发一套可辅助医师完成循证WDPE的实操方法，以提升该类评估的质量。
材料与方法：本研究采用结合行为改变轮（Behavior Change Wheel，BCW）要素的干预映射（Intervention Mapping，IM）方法指导工作方法的开发规划。该方法可与其他研究框架（如行为改变理论）相结合。研究从多个生态层面分析了WDPE质量面临的挑战，涵盖个体层面（即医师）、人际层面（即患者）与组织层面，并最终构建了该问题的多维度逻辑模型。研究识别了导致该问题的各类决定因素，例如医师缺乏循证WDPE相关专业知识。研究制定了可助力提升WDPE质量的绩效目标。基于绩效目标与各类决定因素（如知识储备不足），推导得出了相应的变更目标。为实现这些变更目标，研究确定了适配的干预功能（如教育培训）与政策类别（如服务供给），由此可构建干预组件。研究还遴选了行为改变技术（如行为结果反馈）以支撑相关干预功能，从而达成预期的改变效果，最终形成了干预计划的概念框架。
研究结果：本研究提出了名为“Prognosable”的干预方案。该方案包含一套用于循证WDPE的分步工作方法（stepwise working method，SWM）。该分步工作方法梳理了开展个体患者WDPE时需考量的关键要素，例如患者的病情状况、其对重返工作岗位的信心等。该方法可协助医师识别关键功能受限情况，查找并评估循证信息，权衡所有相关预后要素，并辅助医师得出针对个体患者的循证WDPE结论。“Prognosable”干预方案还包含一项教育培训项目与一款支持性软件工具，以助力分步工作方法的落地实施。
研究结论：结合行为改变轮要素的干预映射方法指导了循证WDPE分步工作方法的开发。该分步工作方法将通过面向医师的教育培训项目，并依托数字化工具予以落地。作为“Prognosable”干预方案，该分步工作方法、教育培训项目与数字化工具均已准备就绪，可在实际场景中开展实施与评估。