The primary aim of this research is to determine whether an intervention, the Occupational Work Evaluation (OWE), which has successfully shortened the interval between myocardial infarction (MI) and return to work in low risk patients can be successfully transported from a research to a practice environment. The OWE consists of a treadmill exercise test performed 10 - 21 days after clinically uncomplicated MI, a counseling session with the patient and spouse regarding the results of this test and a formal recommendation to patient and referring physician that the patient return to work 21 - 35 days after MI. The OWE is a standardized method for generating individualized recommendations for return to work. It broadens the application of post-MI exercise testing to include not only assessment of prognosis and functional capacity but the capacity for low risk patients to resume occupational work soon after MI. This intervention was applied to patients referred from 4 kaiser Permanente (K-P) hospitals in the San Francisco Bay area to a university research clinic. The proposed project will evaluate whether the intervention is equally effective in the busy practice environment of these same hospitals. A secondary aim is to evaluate the process by which the OWE diffuses into treatment practice. Five hundred previously-employed men and women aged 60 who are medically eligible to undergo symptom-limited treadmill testing 3 weeks after MI will be randomized to Occupational Work Evaluation or usual care. The primary endpoint of the study is the interval between MI and return to work. Performance of the Occupational Work Evaluation by cardiologists and nurses within K-P hospitals and the use of computer-generated reports to convey the return to work recommendation to attending physicians and patients are expected to facilitate the diffusion of OWE into treatment practice. incremental costs of the OWE approximate $200/patient whereas the savings to patients, employers and disability insurors resulting from reduction of disability approximate $4000/patient. Personnel, equipment and facilities required to implement the OWE currently exist within community hospitals. The proposed research will speed the adoption of this promising innovation by community hospitals and provide and understanding of ways to enhance the diffusion of other medical innovations.
