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BACKGROUND: Moderately severe or major trauma (injury severity score (ISS) > 8) is common, often resulting in physical and psychological problems and leading to difficulties in returning to work. Vocational rehabilitation (VR) can improve return to work/education in some injuries (e.g. traumatic brain and spinal cord injury), but evidence is lacking for other moderately severe or major trauma. METHODS: ROWTATE is an individually randomised controlled multicentre pragmatic trial of early VR and psychological support in trauma patients. It includes an internal pilot, economic evaluation, a process evaluation and an implementation study. Participants will be screened for eligibility and recruited within 12 weeks of admission to eight major trauma centres in England. A total of 722 participants with ISS > 8 will be randomised 1:1 to VR and psychological support (where needed, following psychological screening) plus usual care or to usual care alone. The ROWTATE VR intervention will be provided within 2 weeks of study recruitment by occupational therapists and where needed, by clinical psychologists. It will be individually tailored and provided for ≤ 12 months, dependent on participant need. Baseline assessment will collect data on demographics, injury details, work/education status, cognitive impairment, anxiety, depression, post-traumatic distress, disability, recovery expectations, financial stress and health-related quality of life. Participants will be followed up by postal/telephone/online questionnaires at 3, 6 and 12 months post-randomisation. The primary objective is to establish whether the ROWTATE VR intervention plus usual care is more effective than usual care alone for improving participants' self-reported return to work/education for at least 80% of pre-injury hours at 12 months post-randomisation. Secondary outcomes include other work outcomes (e.g. hours of work/education, time to return to work/education, sickness absence), depression, anxiety, post-traumatic distress, work self-efficacy, financial stress, purpose in life, health-related quality of life and healthcare/personal resource use. The process evaluation and implementation study will be described elsewhere. DISCUSSION: This trial will provide robust evidence regarding a VR intervention for a major trauma population. Evidence of a clinically and cost-effective VR intervention will be important for commissioners and providers to enable adoption of VR services for this large and important group of patients within the NHS. TRIAL REGISTRATION: ISRCTN: 43115471. Registered 27/07/2021.
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Rehabilitación Vocacional , Reinserción al Trabajo , Heridas y Lesiones , Humanos , Análisis Costo-Beneficio , Inglaterra , Costos de la Atención en Salud , Estudios Multicéntricos como Asunto , Ensayos Clínicos Pragmáticos como Asunto , Calidad de Vida , Rehabilitación Vocacional/métodos , Rehabilitación Vocacional/economía , Factores de Tiempo , Resultado del Tratamiento , Heridas y Lesiones/psicología , Heridas y Lesiones/rehabilitación , Heridas y Lesiones/economíaRESUMEN
Specialized vocational rehabilitation (VR) programs in epilepsy have routinely performed more successfully than general or state-federal VR programs. This article presents the key areas of emphasis in successful epilepsy VR program development to include initial program drivers, choice of VR services model, perspectives on program elements, clients, staffing, service evaluation metrics, operational considerations, and the partnering sponsor's personnel support. Considerable emphasis is placed on the importance and diversity of funding in sustaining a specialized epilepsy VR program. This template of considerations provides potential program implementers with a general framework for successful epilepsy VR program development.
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Empleo/métodos , Epilepsia/rehabilitación , Desarrollo de Programa/métodos , Rehabilitación Vocacional/métodos , Empleo/economía , Empleo/psicología , Epilepsia/economía , Epilepsia/psicología , Humanos , Desarrollo de Programa/economía , Rehabilitación Vocacional/economía , Rehabilitación Vocacional/psicologíaRESUMEN
OBJECTIVES: To identify how social return on investment (SROI) analysis-traditionally used by business consultants-has been interpreted, used and innovated by academics in the health and social care sector and to assess the quality of peer-reviewed SROI studies in this sector. DESIGN: Systematic review. SETTINGS: Community and residential settings. PARTICIPANTS: A wide range of demographic groups and age groups. RESULTS: The following databases were searched: Web of Science, Scopus, CINAHL, Econlit, Medline, PsychINFO, Embase, Emerald, Social Care Online and the National Institute for Health and Care Excellence. Limited uptake of SROI methodology by academics was found in the health and social care sector. From 868 papers screened, 8 studies met the criteria for inclusion in this systematic review. Study quality was found to be highly variable, ranging from 38% to 90% based on scores from a purpose-designed quality assessment tool. In general, relatively high consistency and clarity was observed in the reporting of the research question, reasons for using this methodology and justifying the need for the study. However, weaknesses were observed in other areas including justifying stakeholders, reporting sample sizes, undertaking sensitivity analysis and reporting unexpected or negative outcomes. Most papers cited links to additional materials to aid in reporting. There was little evidence that academics had innovated or advanced the methodology beyond that outlined in a much-cited SROI guide. CONCLUSION: Academics have thus far been slow to adopt SROI methodology in the evaluation of health and social care interventions, and there is little evidence of innovation and development of the methodology. The word count requirements of peer-reviewed journals may make it difficult for authors to be fully transparent about the details of their studies, potentially impacting the quality of reporting in those studies published in these journals. PROSPERO REGISTRATION NUMBER: CRD42018080195.
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Atención a la Salud/economía , Rehabilitación Vocacional/economía , Bienestar Social/economía , Análisis Costo-Beneficio , Humanos , Evaluación de Programas y Proyectos de Salud , Participación SocialRESUMEN
BACKGROUND: The Union Construction Workers' Compensation Program (UCWCP) was developed in 1996 as an alternative workers' compensation arrangement. The program includes use of a preapproved medical and rehabilitation network and alternative dispute resolution (ADR), and prioritizes a quick and safe return-to-work. The aim of this study is to determine if differences in recovery-related outcomes exist between UCWCP and the statutory workers' compensation system (SWCS). METHODS: Claims data from 2003 to 2016 were classified as processed through UCWCP or SWCS. Outcomes included: temporary total disability (TTD), vocational rehabilitation (VR), claim duration and costs, and permanent partial disability (PPD). The relative risk of incurring TTD, VR, and PPD in UCWCP vs SWCS was calculated using log-binomial regression. Linear regression examined the relationship between programs and continuous outcomes including costs and duration. Estimates were adjusted for age, sex, wage, and severity. RESULTS: The UCWCP processed 15.8% of claims; higher percentages of UCWCP claimants were older and earned higher wages. Results point to positive findings of decreased TTD incidence and cost, lower risk of TTD extending over time, higher likelihood of VR participation, and less attorney involvement and stipulation agreements associated with UCWCP membership. Differences were more apparent in workers who suffered permanent physical impairment. CONCLUSION: Findings suggest that the defining programmatic elements of the UCWCP, including its medical provider and rehabilitation network and access to ADR, have been successful in their aims. Claims with increased severity exhibited more pronounced differences vs SWCS, potentially due, in part, to greater use of programmatic elements.
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Industria de la Construcción/economía , Traumatismos Ocupacionales/economía , Reinserción al Trabajo/economía , Ausencia por Enfermedad/economía , Indemnización para Trabajadores/estadística & datos numéricos , Adulto , Industria de la Construcción/organización & administración , Femenino , Humanos , Sindicatos , Masculino , Persona de Mediana Edad , Traumatismos Ocupacionales/epidemiología , Traumatismos Ocupacionales/rehabilitación , Rehabilitación Vocacional/economía , Salarios y Beneficios , Factores de Tiempo , Estados Unidos/epidemiología , Evaluación de Capacidad de Trabajo , Indemnización para Trabajadores/economía , Indemnización para Trabajadores/organización & administraciónRESUMEN
BACKGROUND: Over the past decades research has shown that employment has a positive impact on quality of life, global functioning and recovery in individuals with schizophrenia. However, access to vocational rehabilitation services for this group is limited and unemployment rates remain high. In this study we explore the potential cost-effectiveness of a novel vocational rehabilitation program (The Job Management Program - JUMP) earmarked for individuals with schizophrenia in Norway. METHODS: The JUMP study was a vocational rehabilitation program augmented with either cognitive behaviour therapy or cognitive remediation. In addition to the JUMP protocol, we extracted treatment cost data from comprehensive and mandatory health and welfare registers. The costs over a two-year follow-up period were compared with the costs over the two-year period prior to inclusion in the study. We also compared the cost-effectiveness of JUMP with a treatment as usual group (TAU). RESULTS: We identified significant reductions in inpatient services in the JUMP group, both for those who obtained employment and those who did not. Significant reductions were also found in the TAU group, but adjusted for baseline differences the total cost for JUMP participants were 10,621 lower than in the TAU group during the follow-up period. CONCLUSION: In addition to supporting individuals with schizophrenia obtain employment, JUMP appears to have reduced the reliance on mental health services, which should be of interest to stakeholders. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01139502 . Retrospectively registered on 6 February 2010.
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Terapia Cognitivo-Conductual/métodos , Remediación Cognitiva/métodos , Análisis Costo-Beneficio/estadística & datos numéricos , Rehabilitación Vocacional/economía , Rehabilitación Vocacional/métodos , Esquizofrenia/rehabilitación , Adulto , Terapia Cognitivo-Conductual/economía , Remediación Cognitiva/economía , Análisis Costo-Beneficio/economía , Empleo/economía , Empleo/psicología , Empleo/estadística & datos numéricos , Femenino , Humanos , Masculino , Noruega , Estudios Retrospectivos , Esquizofrenia/economía , Resultado del TratamientoRESUMEN
INTRODUCTION: Unlike other forms of evaluation, social return on investment (SROI) methodology offers a way of placing values on personal, social and community outcomes, not just economic outcomes. Developed in 2000, there have been calls for greater academic involvement in development of SROI, which to date has been more typically implemented in-house or by consultants. This protocol describes a systematic review of SROI analysis conducted on health and social care programmes which represent a significant sector of social enterprise internationally. The aims of the systematic review are to (1) identify the extent to which academics have adopted SROI methodology, (2) how academics have interpreted, used and developed SROI methodology and (3) to assess the quality of studies published under peer review. METHODS AND ANALYSIS: The systematic review will include peer-reviewed studies since 2000 published in English. Search terms will be 'social return on investment' or 'SROI'. Health and social care interventions will be identified in the initial screening given the proliferation of possible key words in these areas. Databases to be searched include Web of Science, Scopus, Medline, Social Care Online and National Institute for Health and Care Excellence. Two reviewers will independently conduct initial screening based on titles and abstracts against the inclusion criteria. Data extracted will include date of intervention, country, study design, aim of intervention/programme, participants and setting, health and social care measures used, and SROI ratio. The quality of studies will be assessed by two reviewers using a SROI quality framework designed for the purpose of this study. ETHICS AND DISSEMINATION: The systematic review will review existing published academic literature; as such, ethics approval is not required for this study. A paper of the systematic review will be submitted to a peer-reviewed journal. PROSPERO REGISTRATION NUMBER: CRD42018080195.
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Atención a la Salud/economía , Rehabilitación Vocacional/economía , Ajuste Social , Bienestar Social/economía , Análisis Costo-Beneficio , Humanos , Evaluación de Programas y Proyectos de Salud , Participación Social , Australia del Sur , Revisiones Sistemáticas como AsuntoRESUMEN
BACKGROUND: Up to 160,000 people incur traumatic brain injury (TBI) each year in the UK. TBI can have profound effects on many areas of human functioning, including participation in work. There is limited evidence of the clinical effectiveness and cost-effectiveness of vocational rehabilitation (VR) after injury to promote early return to work (RTW) following TBI. OBJECTIVE: To assess the feasibility of a definitive, multicentre, randomised controlled trial (RCT) of the clinical effectiveness and cost-effectiveness of early, specialist VR plus usual care (UC) compared with UC alone on work retention 12 months post TBI. DESIGN: A multicentre, feasibility, parallel-group RCT with a feasibility economic evaluation and an embedded mixed-methods process evaluation. Randomisation was by remote computer-generated allocation. SETTING: Three NHS major trauma centres (MTCs) in England. PARTICIPANTS: Adults with TBI admitted for > 48 hours and working or studying prior to injury. INTERVENTIONS: Early specialist TBI VR delivered by occupational therapists (OTs) in the community using a case co-ordination model. MAIN OUTCOME MEASURES: Self-reported RTW 12 months post randomisation, mood, functional ability, participation, work self-efficacy, quality of life and work ability. Feasibility outcomes included recruitment and retention rates. Follow-up was by postal questionnaires in two centres and face to face in one centre. Those collecting data were blind to treatment allocation. RESULTS: Out of 102 target participants, 78 were recruited (39 randomised to each arm), representing 39% of those eligible and 5% of those screened. Approximately 2.2 patients were recruited per site per month. Of those, 56% had mild injuries, 18% had moderate injuries and 26% had severe injuries. A total of 32 out of 45 nominated carers were recruited. A total of 52 out of 78 (67%) TBI participants responded at 12 months (UC, n = 23; intervention, n = 29), completing 90% of the work questions; 21 out of 23 (91%) UC respondents and 20 out of 29 (69%) intervention participants returned to work at 12 months. Two participants disengaged from the intervention. Face-to-face follow-up was no more effective than postal follow-up. RTW was most strongly related to social participation and work self-efficacy. It is feasible to assess the cost-effectiveness of VR. Intervention was delivered as intended and valued by participants. Factors likely to affect a definitive trial include deploying experienced OTs, no clear TBI definition or TBI registers, and repatriation of more severe TBI from MTCs, affecting recruitment of those most likely to benefit/least likely to drop out. LIMITATIONS: Target recruitment was not reached, but mechanisms to achieve this in future studies were identified. Retention was lower than expected, particularly in UC, potentially biasing estimates of the 12-month RTW rate. CONCLUSIONS: This study met most feasibility objectives. The intervention was delivered with high fidelity. When objectives were not met, strategies to ensure feasibility of a full trial were identified. Future work should test two-stage recruitment and include resources to recruit from 'spokes'. A broader measure covering work ability, self-efficacy and participation may be a more sensitive outcome. TRIAL REGISTRATION: Current Controlled Trials ISRCTN38581822. FUNDING: This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 22, No. 33. See the NIHR Journals Library website for further project information.
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Lesiones Traumáticas del Encéfalo/rehabilitación , Terapia Ocupacional/organización & administración , Rehabilitación Vocacional/economía , Rehabilitación Vocacional/métodos , Reinserción al Trabajo , Actividades Cotidianas , Adolescente , Adulto , Análisis Costo-Beneficio , Inglaterra , Femenino , Recursos en Salud/economía , Recursos en Salud/estadística & datos numéricos , Humanos , Masculino , Salud Mental , Persona de Mediana Edad , Terapia Ocupacional/economía , Calidad de Vida , Proyectos de Investigación , Autoeficacia , Participación Social , Factores de Tiempo , Centros Traumatológicos , Índices de Gravedad del Trauma , Adulto JovenRESUMEN
BACKGROUND: Individual Placement and Support (IPS) is an evidence-based approach to help people with severe mental illness achieve competitive employment. This article provides insight into an organizational and a financial implementation strategy for IPS in the Netherlands by exploring the perceived facilitators and barriers among participating stakeholders. The goal of this multifaceted strategy was to improve IPS implementation by improving the collaboration between all organizations involved, and realising secured IPS funding with a 'pay for performance' element. METHODS: A qualitative, explorative study among practitioners (n = 8) and decision makers (n = 7) in mental health care and vocational rehabilitation was performed using semi-structured interviews to collect rich information about the possible facilitators and barriers with regard to the organizational and financial implementation strategy for IPS. RESULTS: Important perceived facilitators were the key principles of the IPS model, regular meetings of stakeholders in mental health care and vocational rehabilitation, stakeholders' experienced ownership of IPS and collaboration, the mandate and influence of the decision makers involved and secured IPS funding. Important perceived barriers included the experienced rigidity of the IPS model fidelity scale and lack of independent fidelity reviewers, the temporary and fragmented character of the secured funding, lack of communication between decision makers and practitioners and negative attitudes and beliefs among mental health clinicians. Changes in legislation were experienced as a facilitator as well as a barrier. CONCLUSIONS: The results of this study suggest that the collaboration and IPS funding were experienced as improved by applying an organizational and a financial implementation strategy. However, considerable effort is still necessary to overcome the remaining barriers identified and to make the implementation of IPS a success in practice.
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Empleos Subvencionados/organización & administración , Trastornos Mentales , Rehabilitación Vocacional , Participación de los Interesados , Barreras de Comunicación , Humanos , Comunicación Interdisciplinaria , Trastornos Mentales/psicología , Trastornos Mentales/rehabilitación , Motivación , Países Bajos , Investigación Cualitativa , Mejoramiento de la Calidad , Rehabilitación Vocacional/economía , Rehabilitación Vocacional/métodos , Reembolso de IncentivoRESUMEN
(1) Purpose: This systematic review aims to assess the effectiveness of strategies used in the professional (re)integration of persons with mental disorders (MD) in European countries; (2) Methods: We conducted a search for scientific publications available in relevant electronic databases (Medline, PsycINFO, CDR-HTA, CDR-DARE, and Cochrane Library). The present study collected evidence on the effectiveness, from 2011 to 2016, of employment strategies for persons with MDs; (3) Results: A total of 18 studies were included, representing 5216 participants (aged 18â»65, mean age of 38.5 years old) from 7 countries. Job access programs demonstrated effectiveness in four out of six studies. Return to work (RTW) interventions showed significant positive results in two studies, while four studies did not refer to effectiveness. There were inconsistent results in another four studies; (4) Conclusions: Our findings highlight the complexities of the implementation of employment strategies (job access and return to work). Job access strategies seem to improve employment outcomes. The effectiveness of return to work strategies remains unclear. The involvement and commitment of physicians, employment specialists, and employers, and employees capacity for self-care seem decisive for employment re-integration success. Further analyses are needed to assess the cost-effectiveness of these interventions and corroborate our results, with longer follow-ups.
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Empleo/estadística & datos numéricos , Trastornos Mentales , Rehabilitación Vocacional , Análisis Costo-Beneficio , Empleo/economía , Europa (Continente) , Humanos , Trastornos Mentales/economía , Trastornos Mentales/epidemiología , Rehabilitación Vocacional/economíaRESUMEN
OBJECTIVE: The individual enabling and support (IES) model was effective in gaining competitive employment for people with affective disorders compared with traditional vocational rehabilitation (TVR) services in a randomized controlled trial in a Swedish setting. The object of this study is to perform a cost-effectiveness analysis of IES comparing to TVR. METHODS: We considered the costs of intervention and productivity gain due to increased competitive employment. We estimated quality of life using EuroQol 5 Dimension (EQ-5D) and Manchester Short Assessment of Quality of Life (MANSA) scale. EQ-5D was translated into quality-adjusted life-years (QALY), using the UK, Danish, and Swedish tariffs. We performed the analysis from a societal perspective with a one-year timeframe. RESULTS: The cost of IES was 7247 lower per person per year (2014 prices) compared to TVR. There were no significant differences in QALY improvement within or between groups. However, quality of life measured by the MANSA scale significantly improved over the study period in IES. LIMITATIONS: Besides the small sample size, details on the intervention costs for both IES and TVR group were unavailable and had to be obtained from external sources. CONCLUSIONS: Implementation of IES for people with affective disorders is most likely cost-saving and is potentially even dominating TVR, although a larger trial is required to establish this.
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Análisis Costo-Beneficio/economía , Empleos Subvencionados/economía , Trastornos del Humor/economía , Trastornos del Humor/terapia , Adulto , Análisis Costo-Beneficio/métodos , Empleos Subvencionados/métodos , Femenino , Estudios de Seguimiento , Humanos , Masculino , Trastornos del Humor/epidemiología , Calidad de Vida , Años de Vida Ajustados por Calidad de Vida , Rehabilitación Vocacional/economía , Rehabilitación Vocacional/métodos , Suecia/epidemiología , Adulto JovenRESUMEN
BACKGROUND: Evidence suggests mental disorders are associated with substantial economic burden. However, as the status of mental illness tends to change over time, estimating the burden based on cross-sectional presence or severity of illness may be problematic. An approach based on illness staging may provide a more stable estimate. AIMS OF THE STUDY: We aim to explore whether three predefined stages of mental illness (i.e. early active, remitted, chronic) have differential impact on employment and earnings. METHODS: A community survey of household population aged 18 and over in a university hospital's catchment area within Bangkok Metropolitan Region (BMR) was conducted (N=3877). The third version of the World Health Organization-Composite International Diagnostic Interview (WHO-CIDI) was administered to assess lifetime and 12-month common major mental disorders and the Kessler Psychological Distress Scale (K6) to assess current psychological distress. Multivariate approaches were used to estimate the observed and expected annual earnings and employment for persons with mental illness at each stage, controlling for sociodemographic variables. RESULTS: Increasing level of chronicity, from the early active to the remitted and then to the chronic stage, was associated with increasing reduction in earnings (beta --0.14 95% CI -0.15 to --0.13, p = 0.004). All stages of illness were significantly associated with reduced earnings, with individuals at chronic stage having 12-month earnings averaging 78,522 Thai baht (USD 2,356) less than those without a history of mental illness, followed by those at remitted (38,703 baht or USD 1,161) and early active stages (25,870 baht or USD 776), with the same values for control variables. Remitted and chronic stages, but not early active one, were associated with reduced odds of paid employment. The estimated societal-level loss in earnings was 26.9 billion baht (USD 808.2 million) in the total BMR population. DISCUSSION: The findings suggest that all stages of mental disorders, particularly chronic one, are associated with substantial individual- and societal-level burden, and highlight differences in employment and earnings gaps among individuals at each stage of illness. IMPLICATIONS FOR HEALTH CARE PROVISION AND USE: Mental health service should be provided in close coordination with vocational and welfare services in order to alleviate financial and work difficulties faced by mentally ill people at various stages of illness. IMPLICATIONS FOR HEALTH POLICIES: There is a need to tailor disability benefits and employment promotion schemes to the needs of mentally ill people at each stage in order to maximize their productivity and quality of life. IMPLICATIONS FOR FURTHER RESEARCH: Direct and other indirect costs of mental illness should be further investigated. Longitudinal studies would help to clarify how much of the reported association is due to mental illness causing unemployment and reduced earnings or vice versa.
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Países en Desarrollo , Empleo/economía , Renta/estadística & datos numéricos , Gobierno Local , Trastornos Mentales/economía , Adolescente , Adulto , Anciano , Progresión de la Enfermedad , Femenino , Humanos , Comunicación Interdisciplinaria , Colaboración Intersectorial , Masculino , Trastornos Mentales/epidemiología , Trastornos Mentales/psicología , Trastornos Mentales/rehabilitación , Persona de Mediana Edad , Calidad de Vida/psicología , Rehabilitación Vocacional/economía , Encuestas y Cuestionarios , Tailandia , Adulto JovenRESUMEN
BACKGROUND: An acquired brain injury (ABI) is a complex injury often followed by a broad range of cognitive, physical, emotional, and behavioral disabilities. Because of these disabilities, vocational rehabilitation (VR) is a challenging task, however, of great importance, since approximately 75% of the patients with ABI are of working age. Thus, standardized clinically effective and cost-effective methodologies regarding VR for patients with ABI are highly needed. Therefore, the aim of this study is to evaluate the effect of an individually targeted manual-based VR for patient with ABI compared to conventional VR (usual care). METHODS: This study is an interventional, two-arm, six-month follow-up, cluster randomized controlled trial involving four municipalities in the Zealand Region and the Capital Region of Denmark. A total of 84 patients with ABI evenly distributed across four municipalities will be included in the study. The patients will randomly be allocated in a 1:1 ratio to the VR intervention provided by a specialized Brain Injury Centre or the conventional VR provided by the municipalities (usual care). The six- to nine-month intervention will consist of individual and group therapies as well as a work placement program including supported employment. Furthermore, the intervention will include a family intervention program followed up by support to one individual family caregiver. The primary outcomes are increased work or study rate at six-month follow-up. Moreover, a budget impact analysis and possibly a cost-utility analysis of the intervention will be performed. DISCUSSION: This study consists of a comprehensive multidiciplinary VR intervention involving several parties such as the municipalities, a specialized rehabilitation team, and patients' own family caregivers. If this intervention is proven successful when compared to the conventional VR, it will provide evidence for a manual-based individualized holistic approach in returning to work after an ABI. Furthermore, the study will contribute with novel knowledge regarding feasibility and clinical effectiveness of the VR intervention relevant to clinicians, researchers, and policymakers. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03086031 . Registered on 21 March 2017.
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Lesiones Encefálicas/rehabilitación , Rehabilitación Vocacional/métodos , Adolescente , Adulto , Lesiones Encefálicas/diagnóstico , Lesiones Encefálicas/fisiopatología , Lesiones Encefálicas/psicología , Presupuestos , Cuidadores/psicología , Protocolos Clínicos , Análisis Costo-Beneficio , Dinamarca , Empleos Subvencionados , Terapia Familiar , Femenino , Costos de la Atención en Salud , Humanos , Masculino , Persona de Mediana Edad , Nueva Zelanda , Grupo de Atención al Paciente , Recuperación de la Función , Rehabilitación Vocacional/economía , Proyectos de Investigación , Reinserción al Trabajo , Factores de Tiempo , Resultado del Tratamiento , Evaluación de Capacidad de Trabajo , Adulto JovenRESUMEN
Objective Quantification of the economic burden for society and the German Statutory Pension Insurance due to early retirement in schizophrenia. Methods Based on empirical data of the German Statutory Pension Insurance, productivity losses were calculated using the human capital approach. Results The total expenditures of the German Statutory Pension Insurance due to pension payments for schizophrenic insurants amounted to â450 million. Total indirect costs due to morbidity and mortality were estimated at â2,3 million. Average indirect costs per patient ranged between â17â000â-â28â000, depending on rates for discounting and inflation. Conclusion Regarding substantial economic consequences, preventive measures and therapeutic procedures should aim to prevent reduction in earning capacity and to promote occupational reintegration of schizophrenic patients.
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Costo de Enfermedad , Eficiencia , Renta/estadística & datos numéricos , Programas Nacionales de Salud/economía , Rehabilitación Vocacional/economía , Esquizofrenia/economía , Esquizofrenia/rehabilitación , Psicología del Esquizofrénico , Seguridad Social/economía , Adulto , Investigación Empírica , Femenino , Alemania , Humanos , Masculino , Persona de Mediana Edad , Jubilación , Esquizofrenia/epidemiologíaRESUMEN
BACKGROUND: Little is known about the economic benefits of cognitive remediation and supported employment (CR + SE). The present study aimed to investigate the cost-effectiveness of CR + SE compared with traditional vocational services (TVS). METHOD: Individuals with mental illness and low cognitive function were recruited at six sites in Japan. A total of 111 participants were randomly allocated to the CR + SE group or the TVS group. Clinical and vocational outcomes were assessed at baseline and 12-month follow-up. Service utilization data were collected monthly. The data on outcomes and costs were combined to examine cost-effectiveness. RESULTS: The data were obtained from a total of 92 participants. The CR + SE group resulted in better vocational and clinical outcomes (employment rate, 62.2%; work tenures, 78.6 days; cognitive improvement, 0.5) than the TVS group (19.1%, 24.9 days and 0.2). There was no significant difference in mean total costs between the groups (CR + SE group: $9823, s.d. = $6372, TVS group: $11 063, s.d. = $11 263) with and without adjustment for covariates. However, mean cost for medical services in the CR + SE group was significantly lower than that in the TVS group after adjusting covariates (Β = -$3979, 95% confidence interval -$7816 to -$143, p = 0.042). Cost-effectiveness acceptability curves for vocational outcomes illustrated the high probabilities (approximately 70%) of the CR + SE group being more cost-effective than TVS when society is not willing to pay additional costs. CONCLUSIONS: CR + SE appears to be a cost-effective option for people with mental illness who have low cognitive functioning when compared with TVS.
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Disfunción Cognitiva/rehabilitación , Remediación Cognitiva/economía , Análisis Costo-Beneficio , Empleos Subvencionados/economía , Trastornos Mentales/rehabilitación , Evaluación de Resultado en la Atención de Salud , Rehabilitación Vocacional/economía , Adulto , Remediación Cognitiva/métodos , Empleos Subvencionados/métodos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Rehabilitación Vocacional/métodos , Adulto JovenRESUMEN
Background: The role of psychological comorbidities as a risk factor associated with a further chronification in low back pain is evident. In this paper we explore, whether psychological comorbidities recorded in the discharge letters have a time-stable and from other risk factors independent impact on a pension for reduced earning capacity. Methods: A sample of 10% is drawn from a routine data set provided by the German Pension Fund. Several risk factors are defined and presented descriptively. The survival analysis will be accomplished by cox regressions. Results: Younger patients (≤ 55 years) with at least one comorbid mental disorder have a 1.93 times higher chance of getting a pension for reduced earning capacity in the follow-up period. The influence is time stable and independent from other risk factors. Conclusion: A screening of psychological symptoms with a risk stratified therapy could increase the effectiveness.
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Personas con Discapacidad/rehabilitación , Renta/estadística & datos numéricos , Seguro por Discapacidad/economía , Trastornos Mentales/economía , Trastornos Mentales/rehabilitación , Rehabilitación Vocacional/economía , Adulto , Personas con Discapacidad/estadística & datos numéricos , Femenino , Alemania/epidemiología , Humanos , Seguro por Discapacidad/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Pensiones , Prevalencia , Rehabilitación Vocacional/estadística & datos numéricos , Factores de RiesgoRESUMEN
The Department of Veterans Affairs (VA) is establishing a grant program (Veterans Employment Pay for Success (VEPFS)) under the authority of the U.S.C. to award grants to eligible entities to fund projects that are successful in accomplishing employment rehabilitation for Veterans with service-connected disabilities. VA will award grants on the basis of an eligible entity's proposed use of a Pay for Success (PFS) strategy to achieve goals. This interim final rule establishes regulations for awarding a VEPFS grant, including the general process for awarding the grant, criteria and parameters for evaluating grant applications, priorities related to the award of a grant, and general requirements and guidance for administering a VEPFS grant program.
Asunto(s)
Personas con Discapacidad/legislación & jurisprudencia , Personas con Discapacidad/rehabilitación , Empleo/economía , Empleo/legislación & jurisprudencia , Rehabilitación Vocacional/economía , Veteranos/legislación & jurisprudencia , Humanos , Estados UnidosRESUMEN
BACKGROUND: Early withdrawal or exclusion from the labor market leads to significant personal and societal costs. In Norway, the increasing numbers of young adults receiving disability pension is a growing problem. While a large body of research demonstrates positive effects of Supported Employment (SE) in patients with severe mental illness, no studies have yet investigated the effectiveness of SE in young adults with a range of social and health conditions who are receiving benefits. METHODS/DESIGN: The SEED-trial is a randomized controlled trial (RCT) comparing traditional vocational rehabilitation (TVR) to SE in 124 unemployed individuals between the ages of 18-29 who are receiving benefits due to various social- or health-related problems. The primary outcome is labor market participation during the first year after enrollment. Secondary outcomes include physical and mental health, health behaviors, and well-being, collected at baseline, 6, and 12 months. A cost-benefit analysis will also be conducted. DISCUSSION: The SEED-trial is the first RCT to compare SE to TVR in this important and vulnerable group, at risk of being excluded from working life at an early age. TRIAL REGISTRATION: Clinicaltrials.gov, registration number NCT02375074 . Registered on December 3rd 2014.
Asunto(s)
Personas con Discapacidad/rehabilitación , Empleos Subvencionados/organización & administración , Rehabilitación Vocacional/métodos , Adolescente , Adulto , Análisis Costo-Beneficio , Empleos Subvencionados/economía , Femenino , Humanos , Masculino , Trastornos Mentales/rehabilitación , Noruega , Rehabilitación Vocacional/economía , Adulto JovenRESUMEN
The majority of people with serious mental illnesses want to work. Individual placement and support services, an evidence-based supported employment intervention, enables about 60 percent of people with serious mental illnesses who receive the services to gain competitive employment and improve their lives, but the approach does not lead to fewer people on government-funded disability rolls. Yet individual placement and support employment services are still unavailable to a large majority of people with serious mental illnesses in the United States. Disability policies and lack of a simple funding mechanism remain the chief barriers. A recent federal emphasis on early-intervention programs may increase access to employment services for people with early psychosis, but whether these interventions will prevent disability over time is unknown.
Asunto(s)
Personas con Discapacidad/psicología , Empleos Subvencionados/economía , Enfermos Mentales/psicología , Rehabilitación Vocacional/economía , Empleos Subvencionados/psicología , Humanos , Estados UnidosRESUMEN
Purpose Case management is widely accepted as an effective method to support medical rehabilitation and vocational reintegration of accident victims with musculoskeletal injuries. This study investigates whether more intensive case management improves outcomes such as work incapacity and treatment costs for severely injured patients. Methods 8,050 patients were randomly allocated either to standard case management (SCM, administered by claims specialists) or intensive case management (ICM, administered by case managers). These study groups differ mainly by caseload, which was approximately 100 cases in SCM and 35 in ICM. The setting is equivalent to a prospective randomized controlled trial. A 6-year follow-up period was chosen in order to encompass both short-term insurance benefits and permanent disability costs. All data were extracted from administrative insurance databases. Results Average work incapacity over the 6-year follow-up, including contributions from daily allowances and permanent losses from disability, was slightly but insignificantly higher under ICM than under SCM (21.6 vs. 21.3 % of pre-accident work capacity). Remaining work incapacity after 6 years of follow-up showed no difference between ICM and SCM (8.9 vs. 8.8 % of pre-accident work incapacity). Treatment costs were 43,500 Swiss Francs (CHF) in ICM compared to 39,800 in SCM (+9.4 %, p = 0.01). The number of care providers involved in ICM was 10.5 compared to 10.0 in ICM (+5.0 %, p < 0.001). Conclusions Contrary to expectations, ICM did not reduce work incapacity as compared to SCM, but did increase healthcare consumption and treatment costs. It is concluded that the intensity of case management alone is not sufficient to improve rehabilitation and vocational reintegration of accident victims.