Current challenges in disability evaluation and the need for a goal-oriented approach based on the ICF: a qualitative stakeholder analysis in the context of the Swiss accident insurance

Abstract

Purpose By using the eligibility determination process of the Swiss accident insurance (Suva) as a case in point, we aimed to examine current challenges and the need for a goal-oriented ICF-based approach in disability evaluation as experienced by different stakeholder groups. Materials and methods Descriptive qualitative design involving semi-structured expert interviews with five main stakeholder groups of the eligibility determination process (i.e., Suva insurance officers, Suva insurance physicians, treating physicians, lawyers and judges). Interviews were thematically analyzed and their results reflected upon in focus groups with selected interview participants. Results Forty-three interviews and three focus groups were conducted. Participants pointed to challenges related to standardization, transparency, objectivity, efficiency and contextual factors. An ICF-based standard documenting claimant-job mismatches and their determinants was deemed promising for ensuring comprehensible and valid eligibility decisions, systematic and uniform reporting and a goal-oriented eligibility determination process. Concerns primarily addressed a potential pseudo-accuracy when using the standard for eligibility decisions. Conclusions Implementing a goal-oriented ICF-based standard may help to approach current challenges in disability evaluation. Our findings support the development of such a standard for Suva’s eligibility determination, but also point at the importance of involving key stakeholders to ensure its applicability and cross-disciplinary acceptance. IMPLICATIONS FOR REHABILITATION Poor standardization and transparency as well as objectivity and efficiency issues represent key challenges in disability evaluation, as experienced by the different stakeholder groups involved in an eligibility determination process. A standardized ICF-based approach focusing on the documentation of claimant-job mismatches and their determinants is promising for improving transparency, validity and comparability of eligibility decisions. With its focus on claimants’ ability to participate at work such an ICF-based standard has the potential to ensure a goal-oriented planning of assessments and interventions in the eligibility determination process. Our study provides specific targets for optimizing eligibility determination in disability evaluation but also for ensuring a customized and effective return to work after sustaining an injury.