title: Implementation of the Danish return-to-work program: process evaluation of a trial in 21 Danish municipalities.
abstract: OBJECTIVE
  The aim of this study was to evaluate the implementation of the Danish national return-to-work (RTW) program in 21 Danish municipalities.
  
  
  METHODS
  We conducted a structured process evaluation on (i) reach and recruitment, (ii) fidelity, (iii) dose-delivered, (iv) dose-received, and (v) context by formulating 29 implementation criteria and analyzing qualitative and quantitative data from administrative records, interviews, field notes, and questionnaires.
  
  
  RESULTS
  All municipalities integrated the basic features of the RTW program into the existing framework of the sickness benefit management system to an acceptable degree, ie, establishment of RTW teams, participation of RTW team members in the training courses, and following the general procedures of the program. However, the level of implementation varied considerably between the municipalities, particularly with respect to fidelity (defined as implementation consistent with the principles of the interdisciplinary RTW process). Five municipalities had high and eight had low fidelity scores. Similar large differences were found with regard to dose-delivered, particularly in the quality of cooperation with beneficiaries, employers, and general practitioners. Only 50% of the first consultations with the RTW coordinator were conducted in time. Among participants who were employed when their sickness absence period started, only 9% had at least one meeting with their workplace.
  
  
  CONCLUSIONS
  It was feasible to implement the basic features of the Danish RTW program, however, large variations existed between municipalities. Establishment of well-functioning interdisciplinary RTW teams might require more time and resources, while ensuring early assessment and more frequent cooperation with employers might need more general adjustments in the Danish sickness benefit system.
authors.affiliation: National Research Centre for the Working Environment, Lersø Parkalle 105, DK-2100 Copenhagen, Denmark. bma@nrcwe.dk.
authors.forename: Birgit
authors.initials: B
authors.lastname: Aust
authors.forename: Maj Britt D
authors.initials: MB
authors.lastname: Nielsen
authors.forename: Gry
authors.initials: G
authors.lastname: Grundtvig
authors.forename: Helle L
authors.initials: HL
authors.lastname: Buchardt
authors.forename: Linnea
authors.initials: L
authors.lastname: Ferm
authors.forename: Irene
authors.initials: I
authors.lastname: Andersen
authors.forename: Trine L
authors.initials: TL
authors.lastname: Lund
authors.forename: Martin Ohmann Claudio
authors.initials: MO
authors.lastname: Jelle
authors.forename: Malene F
authors.initials: MF
authors.lastname: Andersen
authors.forename: Jørgen V
authors.initials: JV
authors.lastname: Hansen
authors.forename: Torill
authors.initials: T
authors.lastname: Tverborgvik
authors.forename: Trine
authors.initials: T
authors.lastname: Helverskov
authors.forename: Jakob Bue
authors.initials: JB
authors.lastname: Bjorner
authors.forename: Reiner
authors.initials: R
authors.lastname: Rugulies
authors.forename: Palle
authors.initials: P
authors.lastname: Ørbæk
authors.forename: Glen
authors.initials: G
authors.lastname: Winzor
authors.forename: Ute
authors.initials: U
authors.lastname: Bültmann
authors.forename: Otto M
authors.initials: OM
authors.lastname: Poulsen
mesh_terms: D006801:Humans; D016272:Occupational Health; D015397:Program Evaluation; D062707:Return to Work; D018582:Sick Leave; D014505:Urban Population; D014938:Work Capacity Evaluation