Longterm Persistence and Scalability of a Coordinated Return to Work Model in Healthcare: A Registry-Based Study Across Clinical Pathways

PURPOSE: To examine the long-term persistence of an individualized coordinated return to work (CRTW) model on the return-to-work (RTW) duration among hip and knee arthroplasty patients and the immediate effectiveness of the model after implementation in cardiology patients. METHODS: Electronic health records (EHRs) from five regions in Finland were used to identify working-age employees. Long-term sickness absence days were calculated between the date of admission and the final day of full-time sickness absence. Fixed effects linear models were used for region-level comparisons in hip and knee arthroplasty patients and difference-in-difference approach for cardiology patients. RESULTS: Mean RTW was 74.7 (SD 48.5) days in hip and 89.3 (55.1) days in knee arthroplasty in the CRTW region over the follow-up. Mean difference in RTW between the CRTW and control regions was - 9.8 days (95% CI: - 15.8, - 3.9; p = 0.001) for hip and - 6.9 days (95% CI: - 12.6, - 1.2; p = 0.018) for knee arthroplasty patients. Mean RTW days among cardiology patients were 57.4 (67.1) in pre- and 46.1 (51.5) in post-implementation period in the CRTW region. No statistically significant difference in RTW duration between the CRTW and control region was observed in cardiology patients. CONCLUSION: Hip and knee arthroplasty patients in the CRTW regions continued to return to work sooner than those in the control regions even several years after the CRTW model implementation. Among cardiology patients, no evidence of systematic differences in level between the regions were seen. Future studies with larger sample sizes are needed confirm the effectiveness of the CRTW model in cardiology.