or Illness

Research project puts work-health coaches in primary care practices to support patients

Unemployment due to illness or injury is a strong predictor of a wide variety of negative health outcomes, but clinicians often aren’t equipped to assist patients in managing the impact of a health condition on their ability to work. Through a new project, Dartmouth Health physicians and researchers are taking action to address this problem.

“Primary care physicians provide early injury and illness care, but they don’t get a lot of training on the intersections of employment and health,” says Karen Huyck, MD, PhD, MPH, the medical director for Vermont RETAIN, a project with the Vermont Department of Labor through a federal grant from the U.S. Department of Labor. “Physicians focus on the treatment but don’t often ask patients, ‘Are you able to do your job with your injury? Are you going to be out of work because of this?’ We as providers often don’t ask those questions because they’re seemingly outside the scope of our typical care plans.”

To fill that gap, Vermont RETAIN (Retaining Employment and Talent After Injury/Illness Network) is an early stay-at-work, return-towork program that aims to increase employment retention and decrease work disability by putting work-health coaches in primary care settings. These coaches connect patients with existing employment resources and services to help them stay at work or return to work quickly as they recover their health.

“The longer someone is out of work, the risk of not returning goes up significantly,” says Jon Lurie, MD, MS ’97, RES ’99, a hospitalist at Dartmouth Hitchcock Medical Center and an investigator on the outcomes of Vermont RETAIN. “It’s very hard to return to work after three months of unemployment, and after one year there’s an extremely low rate of return. The sooner you can get people moving toward the goal of getting back to work, the better chance you have of maintaining that.”

The most effective way to do that, Huyck and Lurie hypothesize, is through work-health coaching to help patients access existing services in Vermont. These coaches are trained in a variety of fields— nursing, social work, physical therapy, and other backgrounds—and they work as a team to address a patient’s specific need. The coaches also have access to other professionals who can advise on legal aid, mental health, employee assistance programs (EAPs), and many other specialties. To reduce the burden on the primary care practice, Huyck says, the patient can self-screen for risk of work disability and get support from a work-health coach to learn self-advocacy skills and how to navigate the available state resources.

“It can be an extraordinarily frustrating process to access government assistance, even though there are many services to help people stay in the workforce,” says Lurie, who is currently working

Jon Lurie, MD, MS ’97, RES ’99 Hospitalist at Dartmouth Hitchcock Medical Center

on phase 2 of the project. “People who are sick or injured and unable to work are not always in the best position to advocate for themselves.”

Vermont RETAIN has already enrolled more than 70 primary care practices to participate in the project, randomized into intervention or control groups. Both groups receive best-practice tips, resources, and provider access to phone consultations about patient work-health issues; intervention groups also are assigned a work-health coach to support patients. About 70 eligible patients are currently enrolled, and the goal is to enroll at least 2,000 as the study ramps up. As phase 2 continues, Lurie and the Dartmouth Health team are measuring participant outcomes to identify the most effective aspects of the intervention in order to refine and tailor it for the future.

So far, provider and patient feedback on the program has been promising.

“I received the resources you provided and have already reached out to the transportation resources directly to see if they can help with supporting my daily commute,” says Karen V., a patient participating in the study. “It is wonderful to know, all in one place, the many resources available to those who are disabled. You encourage me to keep being strong and to continue to participate meaningfully in this world in spite of my limitations!”

Huyck emphasizes that providers need to understand that patients who are unable to work may feel vulnerable and find it a difficult topic to discuss. Lurie agrees.

“New Englanders, and people in Vermont in particular, don’t like to ask for help,” Lurie says. “This program gives them permission and validates that it’s OK to ask for help.”

The Department of Medicine was an early leader in telehealth. They were doing telemedicine even before the pandemic.”

Katelyn Darling Director of Telespecialty Services and Outpatient Virtual Visits