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- Kärrholm, Johan, 1951, et al.
(författare)
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Effects on work resumption of a co-operation project in vocational rehabilitation. Systematic, multi-professional, client-centred and solution-oriented co-operation
- 2006
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Ingår i: Disabil Rehabil. - : Informa UK Limited. - 0963-8288 .- 1464-5165. ; 28:7, s. 457-67
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: The present aim was to evaluate the effect of systematic multi-professional co-ordinated rehabilitation (the Stockholm Co-operation Project) on the number of days' sick leave during the first and second half-years after the rehabilitation co-ordination period, compared to the year before. Another aim was to evaluate the economic effects at national level. METHOD: A matched-pairs design was used. The study group was based on 64 rehabilitees employed by a public employer in Stockholm, who took part in a systematic multi-professional co-operation project. To obtain pairs, the 64 individuals were individually matched with 64 people who received conventionally organised rehabilitation. Thus, there were 128 subjects altogether. RESULTS: The study group had substantially less sick leave days per month than the comparison group during the second half-year after the rehabilitation co-ordination period. The effect was even greater in a subgroup with more previous sick leave. During the first half-year after the intervention the comparison group had relatively more sick leave. No effect was found for a subgroup with less previous sick leave. The economic benefit of the intervention was estimated to 1,278 euros per month and person based on the whole group, and to 2,405 euros per month and person based on those with more sick leave. CONCLUSIONS: People who undergo co-ordinated rehabilitation have more working days after the intervention period than those with conventional rehabilitation. This way for rehabilitation actors to co-operate gives better outcomes for rehabilitation cases with long previous sick leave, but not for cases with less previous sick leave. It also generates economic gains at several levels.
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- Kärrholm, Jenny
(författare)
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Co-operation among rehabilitation actors for return to working life
- 2007
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The overall aim was to increase knowledge of the problems and the advantages of multi-sectoral co-operation in vocational rehabilitation, with focus on systematic multi-professional team meetings. One of the aims was to quantify the effects of co-operation in vocational rehabilitation on sick leave days, using comparison groups. Another aim was to elucidate the problems and achievements of co-operation in vocational rehabilitation in the Nordic countries. A study of the registers from the National Social Insurance Board of days on sick leave and the types of benefit paid, for a 12-months-period prior to a multi-sectoral co-operation intervention, 0-6 months after the intervention as well as for the subsequent 6-12 months, was conducted. Economic gains for society were also estimated. Sixty four municipal employees on long term sick leave who participated in the intervention were compared with matched controls who were subjected to “treatment as usual”. A questionnaire study was conducted involving 95 immediate superiors employed by the same municipality, who conveyed their views on co-operation both prior to and during the multi-sectoral co-operation intervention. A six-year follow-up of the same intervention, with the same 64 subjects and their controls was carried out with the same outcome measures: days on sick leave, types of benefit paid by social insurance and economic gains for society. A qualitative study was conducted with 23 semi-structured research interviews of 27 strategically chosen informants in the five Nordic countries, who were asked about what chief actors are involved in the vocational rehabilitation, what models of co-operation, collaboration or co-ordination exist, if problems exist with clients being referred from one instance to another without having their problems solved (“pillar-to-post”), if there is a need for co-operation and also what the differences are between possibilities and obstacles in co-operation in vocational rehabilitation. The results showed that there was an overall difference in sick leave of 5.7 days per month and person over the six-year-period studied. When that much more time was spent working instead of on sickness absence, economic gains for society were generated at € 36600 per person over the 6-year-period and at a total of € 2.3 million for the actual intervention carried out for the 64 subjects. Effects were not demonstrable until the second half-year after closure of the intervention. The immediate superiors described the multi-sectoral co-operation as successful in reducing problems. They reported that the co-operation intervention in fact led to combined responsibility in finding solutions and better opportunities than previously for employees to resume regular or other jobs. Despite differences between the Nordic countries, the “pillar-to-post” problems are described by all informants. Co-operative solutions however differ. New reforms have recently been implemented in Norway and Denmark. Social insurance, employment and part of social services are all organized under one and the same authority on a local basis at municipal level in these two countries. Both countries have also distinguished between the management of planning and following-up rehabilitation activities from managing disbursements. The models for co-operation described share some common features, but there are still reports of differences in the possibilities and obstacles of co-operation from the different Nordic countries. The studies demonstrate that multi-sectoral co-operation in vocational rehabilitation has a good effect on preventing sick leave days, generating substantial economic gains for society and that this effect lasts for at least six years. The results also show that good results may be accomplished for people on long term sick leave. There are many different versions of co-operative solutions in the different Nordic countries, all offering interesting examples for the future. Successful co-operation is possible to achieve without legislative enforcement.
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- Kärrholm, Jenny, et al.
(författare)
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Systematic co-operation between employer, occupational health service and social insurance office : A 6-year follow-up of vocational rehabilitation for people on sick-leave, including economic benefits
- 2008
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Ingår i: Journal of Rehabilitation Medicine. - : Medical Journals Sweden AB. - 1650-1977 .- 1651-2081. ; 40:8, s. 628-636
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To evaluate the effects of systematic co-operation among municipal employees on the number of sick-leave days per month and the type of benefit granted by the Social Insurance Office. A further aim was to evaluate the economic consequences for society.Design: A 6-year follow-up study with a matched-pairs design.Methods: Days on sick-leave were calculated for each subject one year before the intervention started and yearly for the following 6-year period. Statistical mixed-model analysis was used. The economic benefit of the intervention was estimated as the increased production stemming from fewer days on sick-leave.Subjects: Sixty-four employees on long-term sick-leave were individually matched with controls from another Social Insurance Office in a county with a socioeconomic structure similar to that of the study group.Results: The study group had 5.7 fewer days on sick-leave per month and person over the 6-year period (p=0.003). The estimated average economic benefit of the intervention was (sic)36,600 per person over the 6-year period. In conclusion, those who received systematic co-operation in vocational rehabilitation had fewer days on sick-leave than their ""treatment-as-usual"" peers. This effect persisted over 6 years, generating substantial net economic gains for society.
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- Kärrholm, Jenny, et al.
(författare)
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The views of sick-listed employees' immediate superiors on co-operation in vocational rehabilitation.
- 2007
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Ingår i: Work. - 1051-9815 .- 1875-9270. ; 29:2, s. 101-111
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: The purpose of this research was to investigate the views of sick-listed employees' immediate superiors on co-operation in vocational rehabilitation before and during a systematic, multi-professional, client-centred, solution-oriented co-operation project in vocational rehabilitation (SMVR intervention). METHOD: A same-subject study with a questionnaire was used, with 95 immediate superiors giving their views on co-operation both before and during the SMVR intervention. RESULTS AND CONCLUSIONS: The immediate superiors felt that the SMVR intervention was successful in promoting co-operation, and reported a significant decrease in referrals of employees from one organisation to another without the problem being resolved. Hence SMVR co-operation was experienced positively by the immediate superiors and in fact led to a joint responsibility in finding solutions. The immediate superiors saw greater possibilities than before for employees to resume regular or other jobs during the SMVR intervention. A more elaborate co-operation model such as the SMVR intervention increased the immediate superiors' experience of successful vocational rehabilitation. Organizations seeking to increase efficiency in vocational rehabilitation might well analyse their work methods and improve their forms of co-operation.
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