A Facilitated Early Return to Work Program at a Large Urban Medical Center

absenteeism

Bernacki EJ. Guidera J. Schaefer, JA. Tsai, S. Journal of Occupational and Environmental Medicine: December 2000 : Volume 42(12) : 1172-1177

False

An Early Return to Work Program was initiated at The Johns Hopkins Hospital and Associated Schools of Medicine, Hygiene and Nursing in Baltimore, Maryland, in April 1992 as part of a comprehensive effort to control the incidence and costs of work-related illnesses and injuries. The program was similar to others that incorporate employee and supervisory training and job accommodation, but it also included an industrial hygienist trained in ergonomics to facilitate the placement of individuals with restrictions. The return to work program was studied over a 10-year period, comparing the number of lost workday cases, lost workdays, and restricted duty days before (1989 to 1992) and after (1993 to 1999) initiation of the program. A significant decrease (55%) was observed in the rate of lost workday cases before versus after the return to work program. Furthermore, the number of lost workdays decreased from an average of 26.3 per 100 employees before, to 12.0 per 100 employees after, the return to work initiative, and the number of restricted duty days went from an average of 0.63 per 100 employees to 13.4 per 100 employees (a twentyfold increase). The study suggests that a well-structured early return to work program is an integral part of a comprehensive effort to control the duration of disability associated with occupational injuries and illness. It also indicates that to be most effective, an early return to work program must include participation by medical providers, safety professionals, injured employees, and supervisors. Our work suggests that even with these elements in place, the effectiveness of return to work programs may be increased by including an individual trained in ergonomics to facilitate the job placement process. Undoubtedly, the primary strategy to control workers' compensation costs is the reduction of environmental risk factors 1-4 (eg, machine guarding, adequate lighting and ventilation, etc) and increasing the training of workers in safe work practices. 3,5,6 Environments with few mechanical or ergonomic risk factors are associated with low accident frequency rates and workers' compensation costs. 3 Even in workplaces where risk factors are well controlled, programs that address medical and disability management, including an early return to work program, should be an integral part of a comprehensive loss control program. 5-12 Although not as well substantiated, there is evidence that these efforts are effective cost-containment strategies. 7-10,13-17 The authors have previously indicated that managed care techniques such as channeling workers to cost-effective medical providers and nurse case management, along with early return to work programs, are essential components of a comprehensive effort to manage the incidence and cost of occupation-related injuries and illnesses. 18-20 The purpose of this article is to present in greater detail the early return to work process associated with our previously described comprehensive cost-containment initiative and to quantify the effect of the job analytic process in facilitating acceptance by employees and supervisors of restricted work activities.

A Framework for Disease Management ROI Studies: A Health-Plan Perspective

ROI, Disease Management, Health Care Costs

O’Connell, J. Ph.D. and Kauffman, L. M.S.P.H. Disease Management. 2002. Volume 5, No. 2, ppg. 109-121.

False

Disease management programs generally target conditions that are high cost, that have a high prevalence, and that provide a clinical opportunity for effective intervention due to less than adequate compliance with national guidelines. Such conditions include asthma, diabetes, congestive heart failure, and cancer. The number of health plans with these programs, as well as the number of vendors that provide these services, has increased dramatically in the past few years. Disease management program goals include improving patient health while reducing medical costs. Although health plans, government agencies, and employer groups are very interested in the return-on-investment (ROI) for such programs, to date few ROI studies have been published. The findings of many are difficult to interpret due to small sample sizes and study design limitations. The goal of this article is to describe a framework for conducting a disease management program ROI study using examples from existing published research to illustrate important concepts. In describing the advantages and disadvantages of four different study designs, we attempt to portray the real world tradeoffs health plans make in conducting such studies. We hope this framework will be useful in designing ROI analyses for programs provided directly by health plans or through vendor contracts, and in interpreting the results of other published and nonpublished studies.

A Generic Model for Evaluating Payor Net Cost Savings from a Disease Management Program

Disease Management, Cost Benefit

McKay, N. Journal of Health Care Finance. Spring 2006; Vol. 32: ppg. 53-65.

False

Private and public payors increasingly are turning to disease management programs as a means of improving the quality of care provided and controlling expenditures for individuals with specific medical conditions. This article presents a generic model that can be adapted to evaluate payor net cost savings from a variety of types of disease management programs, with net cost savings taking into account both changes in expenditures resulting from the program and the costs of setting up and operating the program. The model specifies the required data, describes the data collection process, and shows how to calculate the net cost savings in a spreadsheet format. An accompanying hypothetical example illustrates how to use the model.

A Health System Program To Reduce Work Disability Related to

Short-term Disability, Long-term Disability, Cost-Effectiveness

Abásolo, L. et al. Annals of Internal Medicine. 2005, Vol. 143: ppg. 404-414

False

Musculoskeletal disorders (MSDs) are a frequent cause of work disability, accounting for productivity losses in industrialized societies equivalent to 1.3% of the U.S. gross national product. The purpose was to evaluate whether a population-based clinical program offered to patients with recent-onset work disability caused by MSDs is cost-effective. Randomized, controlled intervention study. The inclusion and follow-up periods each lasted 12 months. The control group received standard primary care management, with referral to specialized care if needed. The intervention group received a specific program, administered by rheumatologists, in which care was delivered during regular visits and included 3 main elements: education, protocol-based clinical management, and administrative duties. Efficacy variables were 1) days of temporary work disability and 2) number of patients with permanent work disability. All analyses were done on an intention-to-treat basis. 13,077 patients were included in the study, 7,805 in the control group and 5,272 in the intervention group, generating 16,297 episodes of MSD-related temporary work disability. These episodes were shorter in the intervention group than in the control group (mean, 26 days compared with 41 days; P < 0.001), and the groups had similar numbers of episodes per patient. Fewer patients received long-term disability compensation in the intervention group (n = 38 [0.7%]) than in the control group (n = 99 [1.3%]) (P < 0.005). Direct and indirect costs were lower in the intervention group than in the control group. To save 1 day of temporary work disability, $6.00 had to be invested in the program. Each dollar invested generated a benefit of $11.00. The program’s net benefit was in excess of $5 million. Implementation of the program, offered to the general population, improves short- and long-term work disability outcomes and is cost-effective.

A Longitudinal Assessment of the Impact of Smoke-Free Worksite Policies on Tobacco Use

Smoking Cessation, Organizational Culture

Bauer, J., Hyland, A., Li, Q., Steger, C., Cummings, K. American Journal of Public Health. June 2005, Vol.95: ppg. 1024-1029

False

In this cohort study, we assessed the impact of smoke-free worksite policies on smoking cessation behaviors. Smokers were tracked as part of the Community Intervention Trial for Smoking Cessation. Telephone surveys were administered to 1967 employed smokers in 1993 and 2001. Data were gathered on personal and demographic characteristics, tobacco use behaviors, and restrictiveness of worksite smoking policies. People who worked in environments that changed to or maintained smoke-free policies between 1993 and 2001 were 1.9 times more likely (odds ratio [OR] = 1.92; 95% confidence interval [CI] = 1.11, 3.32) than people whose worksites did not do so to have stopped smoking by 2001. Continuing smokers decreased their average daily consumption by 2.57 cigarettes. People working in environments that had smoke-free policies in place in both 1993 and 2001 were 2.3 times more likely (OR = 2.29; 95% CI = 1.08, 4.45) than people not working in such environments to have quit by 2001, and continuing smokers reported a decline in average daily consumption of 3.85 cigarettes. Smoke-free worksite policies help employees reduce their cigarette consumption and stop smoking.

A Preliminary Investigation of the Effects of a Provider Network on Costs and Lost-Time in Workers’ Compensation

Lost-time, Medical Costs

Bernacki, E. MD, MPH, Tao, X. MD, PhD, Yuspeh, L. Journal of Occupational and Environmental Medicine. 2005;47:3–10.

False

We sought to compare lost-time days and average and median workers’ compensation claims costs between injured workers managed by OMNET Gold (OG) physicians and those managed by physicians not participating in OG. OG is a statewide health care provider network coordinated by occupational medicine physicians and established by the Louisiana Workers’ Compensation Corporation (LWCC) to manage the medical care of injured workers. We identified and contrasted 158 lost-time claims managed by OG physicians and 1,323 claims managed by physicians not participating in OG during the first year of network operation (August 1, 2003 to July 31, 2004). The average and median costs for a non-OG claim was $12,542 and $5,793, whereas the average and median costs for an OG claim was $6,749 and $3,015. The average and median number of lost-time days for an OG claim was 53.4 and 34.0 and 95.0 and 58.0 for a non-OG claim. The mean differences were statistically significant. A small network of physicians may have an effect on the duration of lost-time and workers’ compensation costs.

A Prospective Assessment Investigating the Relationship Between Work Productivity and Impairment With Premenstrual Syndrome

Productivity, Absenteeism

Dean, B. B. PhD and Borenstein, J. E. MD: Journal of Occupational and Environmental Medicine July, 2004, Volume 46, No. 7, ppg. 649-656.

False

The objective of this article was to assess life domain and work-related impairment in patients experiencing premenstrual syndrome (PMS). A sample of women, 18 to 45 years of age, completed the Daily Rating of Severity of Problems Form to record daily symptoms for two consecutive menstrual cycles. In the workplace, women with PMS reported higher absenteeism rates (2.5 days vs. 1.3 days; P < 0.006) and more workdays with 50% or less of typical productivity per month (7.2 days vs. 4.2 days; P < 0.0001). Women with PMS in one of two menstrual cycles reported a greater number of days with impairment in routine work, school, and household activities in comparison with women without PMS. Results indicate that PMS leads to substantial impairment in normal daily activities and occupational productivity and significantly increased work absenteeism.

A Prospective Study of Body Mass Index and the Risk of Developing Hypertension in Men

Hypertension, obesity, body mass index

Gelber, R.P. et al. (2007). A Prospective Study of Body Mass Index and the Risk of Developing Hypertension in Men. American Journal of Hypertension, Ltd. 20:370–377

False

Background: Although obesity is known to increase the risk of hypertension, few studies have prospectively evaluated body mass index (BMI) across the range of normal weight and overweight as a primary risk factor. Methods: In this prospective cohort, we evaluated the association between BMI and risk of incident hypertension. We studied 13,563 initially healthy, nonhypertensive men who participated in the Physicians’ Health Study. We calculated BMI from self-reported weight and height and defined hypertension as self-reported systolic blood pressure (BP) ≥140 mm Hg, diastolic BP ≥90 mm Hg, or new antihypertensive medication use. Results: After a median 14.5 years, 4920 participants developed hypertension. Higher baseline BMI, even within the “normal� range, was consistently associated with increased risk of hypertension. Compared to participants in the lowest BMI quintile (<22.4 kg/m2), the relative risks (95% confidence interval) of developing hypertension for men with a BMI of 22.4 to 23.6, 23.7 to 24.7, 24.8 to 26.4, and >26.4 kg/m2 were 1.20 (1.09 –1.32), 1.31 (1.19– 1.44), 1.56 (1.42–1.72), and 1.85 (1.69 –2.03), respectively (P for trend, <.0001). Further adjustment for diabetes, high cholesterol, and baseline BP did not substantially alter these results. We found similar associations using other BMI categories and after excluding men with smoking history, those who developed hypertension in the first 2 years, and those with diabetes, obesity, or high cholesterol at baseline. Conclusions: In this large cohort, we found a strong gradient between higher BMI and increased risk of hypertension, even among men within the “normal� and mildly “overweight� BMI range. Approaches to reduce the risk of developing hypertension may include prevention of overweight and obesity.

A Prospective Study of Body Mass Index and the Risk of Developing Hypertension in Men

Hypertension, obesity, body mass index

Gelber, R.P., Gaziano, J.M., Manson, J.E. et al. A Prospective Study of Body Mass Index and the Risk of Developing Hypertension in Men. American Journal of Hypertension. 2007;20:370–377

False

Although obesity is known to increase the risk of hypertension, few studies have prospectively evaluated body mass index (BMI) across the range of normal weight and overweight as a primary risk factor. Methods: In this prospective cohort, we evaluated the association between BMI and risk of incident hypertension. We studied 13,563 initially healthy, nonhypertensive men who participated in the Physicians’ Health Study. We calculated BMI from self-reported weight and height and defined hypertension as self-reported systolic blood pressure (BP) _140 mm Hg, diastolic BP _90 mm Hg, or new antihypertensive medication use. Results: After a median 14.5 years, 4920 participants developed hypertension. Higher baseline BMI, even within the “normal� range, was consistently associated with increased risk of hypertension. Compared to participants in the lowest BMI quintile (_22.4 kg/m2), the relative risks (95% confidence interval) of developing hypertension for men with a BMI of 22.4 to 23.6, 23.7 to 24.7, 24.8 to 26.4, and _26.4 kg/m2 were 1.20 (1.09 –1.32), 1.31 (1.19– 1.44), 1.56 (1.42–1.72), and 1.85 (1.69 –2.03), respectively (P for trend, _.0001). Further adjustment for diabetes, high cholesterol, and baseline BP did not substantially alter these results. We found similar associations using other BMI categories and after excluding men with smoking history, those who developed hypertension in the first 2 years, and those with diabetes, obesity, or high cholesterol at baseline. Conclusions: In this large cohort, we found a strong gradient between higher BMI and increased risk of hypertension, even among men within the “normal� and mildly “overweight� BMI range. Approaches to reduce the risk of developing hypertension may include prevention of overweight and obesity.

A Return on Investment Evaluation of the Citibank, N.A., Health Management Program

Program Evaluation, Demand Management, Disease Management, Health Care Costs

Ozminkowski RJ, Dunn RL, Goetzel RZ, Cantor RI, Murnane J, Harrison M. American Journal of Health Promotion, September/October 1999; 14(1): 31-43.

False

Citibank, N.A. started a comprehensive health, demand and disease management program in 1994. The program focused interventions on high risk populations. Medical expendirures of program participants (N=11,194) and nonparticipants (N=11,644) were followed for 38 months before and after administration of a health risk appraisal. Regression models estimated the savings in medical costs associated with program participation and attempted to control for differences between participants and nonparticipants. The savings were compared to program costs to estimate the economic return. High risk participants had higher odds of incurring medical expenditures compared to low risk participants. The estimated return on investment was between $4.56 and $4.73 saved per dollar spent on the program, depending on the discount rate applied.

A stage of change approach to reducing occupational ill health

Health Promotion, Health Risks

Whysall, Z., Haslam, C., Haslam, R. Preventive Medicine. 2006: Vol. 43; ppg. 422-428.

False

Interventions targeted by stage of change have been shown to improve the efficacy of public health promotion initiatives in areas such as smoking cessation, alcohol reduction, and mammography screening. Targeted interventions are designed to tackle the key attitudes, beliefs, and intentions that underpin an individual's health-related behavior. Work-related ill health is an increasingly serious issue, the most common cause of which in both the UK and the US is musculoskeletal disorders. This study examined whether the stage approach could be applied to workplace interventions aimed at improving occupational health. A total of 24 multi-component occupational interventions aimed at reducing musculoskeletal disorders were monitored over a period of 4–6 months. In half of these cases, approaches were targeted according to workers' stage of change. Targeted interventions were found to be significantly more effective in promoting risk awareness and desired behavior change among workers. Significant reductions were also found in self-reported musculoskeletal discomfort among workers having received targeted interventions. No significant differences were found in self-reported musculoskeletal discomfort among workers following standard interventions. Stage-matched approaches may offer scope for substantially improving the efficacy of occupational health and safety interventions by increasing the uptake, implementation, and maintenance of risk-reducing measures.

A systematic review of randomized trials of disease management programs in heart failure

Disease Management

Finlay A. McAlister MD, MSc, a, Fiona M. E. Lawson MB, ChBb, Koon K. Teo MB, PhD, BChc and Paul W. Armstrong MD : The American Journal of Medicine : Volume 110 2001

False

Disease management programs are often advocated for the care of patients with chronic disease. This systematic review was conducted to determine whether these programs improve outcomes for patients with heart failure. Randomized clinical trials of disease management programs in patients with heart failure were identified by searching Medline 1966 to 1999, Embase 1980 to 1998, Cinahl 1982 to 1999, Sigle 1980 to 1998, the Cochrane Controlled Trial Registry, the Cochrane Effective Practice and Organization of Care Study Registry, and the bibliographies of published studies. We also contacted experts in the field. Studies were selected and data extracted independently by two investigators, and summary risk ratios (RR) and 95% confidence intervals (CI) were calculated using both the random and fixed effects models. A total of 11 trials (involving 2,067 patients with heart failure) were identified. Disease management programs were cost saving in 7 of the 8 trials that reported cost data and also appeared to have beneficial effects on prescribing practices. Hospitalizations (RR = 0.87, 95% CI: 0.79 to 0.96) but not all-cause mortality (RR = 0.94, 95% CI: 0.75 to 1.19) were reduced by the programs. However, there were considerable differences in the effects of various interventions on hospitalization rates; specialized follow-up by a multidisciplinary team led to a substantial reduction in the risk of hospitalization (RR = 0.77, 95% CI 0.68 to 0.86, N = 1366), whereas trials employing telephone contact with improved coordination of primary care services failed to find any benefit (RR = 1.15, 95% CI 0.96 to 1.37, N = 646). Disease management programs for the care of patients with heart failure that involve specialized follow-up by a multidisciplinary team reduce hospitalizations and appear to be cost saving. Data on mortality are inconclusive. Further studies are needed to establish the incremental benefits of the different elements of these programs.

A Validity Analysis of the Work Productivity Short Inventory (WPSI) Instrument Measuring Employee Health and Productivity

Productivity

Ozminkowski, Ronald J. PhD; Goetzel, Ron Z. PhD; Long, Stacey R. MS : Journal of Occupational and Environmental Medicine: Volume 45(11) November 2003 pp 1183-1195.

False

The Work Productivity Short Inventory (WPSI) was developed to quickly estimate decrements in productivity associated with 15 common disease conditions. Three versions of the WPSI were developed that differed according to the length of the recall period (12 months, 3 months, or 2 weeks). The content, predictive, and construct validity of metrics generated from the WPSI were assessed based on response patterns found in the 3 versions and via comparison to information in national data sources or in the subject company's medical care claims and short-term disability program files. The WPSI provided evidence of content and construct validity to support its intended purpose. Evidence for predictive validity was weaker but still present. The WPSI can be used to provide information on the relative importance of health conditions that affect productivity at work for a large group of employees.

Absence Proves Costly

Absenteeism, Productivity

Lee Fletcher. Business Insurance. Chicago: Jul 10, 2000. Vol. 34, Iss. 28; pg. 3, 2 pgs

False

Lost productivity from employee absence is far more costly to employers than the costs related to programs designed to keep workers healthy and at work, according to a recent study. In the study, the San Francisco based Integrated Benefits Institute analyzed revenue data collected from 11 U.S.-based telecommunications companies. The IBI's analysis revealed that lost work time resulted in an estimated $11.5 billion in lost productivity in 1999the equivalent of 8% of total revenue for the participating companies. Incidental absence, such as sick days, and absences taken under the Family and Medical Leave Act account for almost half of that total, according to the IBI.

Addiction in the Workplace

Addiction, Productivity

Lowe, C. Behavioral Health Management. Sep/Oct 2004. Vol.24, Iss. 5; pg. 27, 3 pgs.

False

Behavioral health professionals can help employers and employees alike increase productivity and improve workplace health. Here, Lowe offers some thoughts for behavioral health professionals to keep in mind when working with individuals with addiction about securing or retaining employment.

Age-Specific Impact of Obesity on Prevalence and Costs of Diabetes and Dyslipidemia

Obesity, Health Care Costs, Diabetes, Dyslipidemia

Finkelstein, E., Brown, D., Trogdon, J., Segel, J., Ben-Joseph, R. Value in Health. 2007; Vol. 10: ppg. S45-S51

False

The objective of this study was to estimate the differential impact of obesity on prevalence and medical costs overall and for three major obesity-related complications (diabetes, dyslipidemia, and their joint occurrence) over the life cycle. The impact of obesity on age-specific medical costs and diagnosed prevalence was estimated using econometric analyses of the 2001–03 Medical Expenditure Panel Survey data. Obesity was measured using body mass index. Obesity increases the risks for diabetes and dyslipidemia at all ages. Obesity also increases per person medical costs and the magnitude of the increase is greater at older ages. Although obese individuals represent 49% of the population with diabetes, they are responsible for 56% of total diabetes costs. They also represent 34% of the population with dyslipidemia yet are responsible for 52% of total dyslipidemia costs. These results highlight the potential savings over the life cycle resulting from effective interventions that target obesity and/or its comorbid disorders. Targeting individuals with both obesity and comorbidities is particularly important given the high medical costs associated with this subset of the obese population. Effective strategies that improve the comorbidity profile of these individuals may have the best chance of showing a positive financial return.

Alcohol intake, smoking, sleeping hours, physical activity and

Metabolic syndrome; Life styles; Physical activity; Smoking; Alcohol consumption

Santos, A., Ebrahim, S., Barros, H. Alcohol intake, smoking, sleeping hours, physical activity and the metabolic syndrome. Preventive Medicine. 44 (2007) 328–334

False

To evaluate the association between physical activity, sleeping hours, alcohol intake and smoking and metabolic syndrome. Methods: Social, demographic, personal and family medical histories and behavioral characteristics were collected as self-reported for 2164 participants (1332 women; 832 men), aged 18–92 years old, randomly selected during 1999–2003, among residents in Porto, Portugal, evaluated in the Department of Epidemiology of Porto Medical School. Metabolic syndrome was defined according to the NCEP-ATPIII. Associations between metabolic syndrome and lifestyles factors were computed as odds ratios (OR) and 95% confidence intervals (95% CI). Results: After adjustment, higher total physical activity (OR=0.63 95% CI%: 0.43, 0.94—females; OR=0.55 95% CI: 0.33, 0.91—males) and work activity levels in females (OR=0.55; 95% CI: 0.33, 0.91) were significantly associated with lower prevalence of the metabolic syndrome. More sleeping hours were positively associated with metabolic syndrome (OR=1.25; 95% CI: 1.13, 1.38–females; OR=1.19; 95% CI: 1.04, 1.36— males). Regarding smoking, the only statistically significant association was found in women that smoked less than 10 cigarettes per day (OR=0.32 95% CI: 0.11, 0.92). No statistically significant association was found between ethanol intake and metabolic syndrome. Conclusions: An association between decreased physical activity, increased sleeping hours and metabolic syndrome was found. No association was found between cigarette smoking, alcohol intake and the metabolic syndrome.

American Productivity Audit Shows Top Health Conditions

Performance loss, headache, depression, cold/flu, arthritis

http://www.corporate-ir.net/ireye/ir_site.zhtml?ticker=advp&script=410&layout=&item_id=303011

False

A study by AdvancePCS (Nasdaq:ADVP), the nation's leading health improvement company, puts a dollar figure on lost productive time in the workplace caused by common health conditions. The top five conditions alone -- headache/pain, cold/flu, fatigue/depression, digestive problems, and arthritis -- cost employers more than $180 billion annually. These are the first national estimates that capture the number of hours that U.S. workers lose when they are at work but unable to perform due to health conditions -- often called "presenteeism" -- as well as the hours they are absent due to illness. Although presenteeism accounts for more than two-thirds of health-related lost labor costs, the impact is often invisible to employers. The AdvancePCS findings are unique in that they capture data on the entire U.S. workforce -- not simply selected employers -- include information on both presenteeism and absenteeism, and cover health conditions that have an impact on work.

An Assessment of the Total Population Approach for Evaluating Disease Management Program Effectiveness

Program Evaluation, Disease Management

Ariel Linden DrPH, MS ; John L. Adams PhD ; Nancy Roberts MPH Disease Management : Volume: 6 Number: 2 Page: 93 -- 102

False

A key challenge currently facing the disease management industry is accurately demonstrating program effectiveness at controlling utilization of services and medical costs of populations with chronic disease. The most common method used in the disease management industry to date for determining financial outcomes is referred to as the "total population approach." This model is a pretest-posttest design, which is a relatively weak research and evaluation technique. This paper describes the "total population approach," details many of the biases and confounding factors that may influence outcomes using this method, and illustrates the potential consequences of these factors.

An Employer-Based Cost-Benefit Analysis

Smoking cessation, pharmacotherapy

Jackson, K.C., Nahoopii, R., Said, Q. et al. An Employer-Based Cost-Benefit Analysis of a Novel Pharmacotherapy Agent for Smoking Cessation. Journal of Occupational Environmental Medicine 2007;49:453–460

False

An employer-based cost-benefit analysis for varenicline versus bupropion was conducted using clinical outcomes from a recently published trial. Methods: A decision tree model was developed based on the net benefit of treatment to produce a nonsmoker at 1 year. Sensitivity analyses were conducted based on quit rates with placebo and varenicline and the cost of varenicline. Results: Estimated 12-month employer cost savings per non-smoking employee were $540.60 for varenicline, $269.80 for bupropion SR generic, $150.80 for bupropion SR brand, and $81.80 for placebo. Varenicline was more cost beneficial than placebo, which had quit rates of 16.9% or less. The quit rate with varenicline would have to be _16.9% to lose cost benefit over bupropion SR generic. Conclusions: The economic benefit of varenicline is improved over bupropion, despite the increased initial cost of varenicline.

An Intervention to Promote Appropriate Management of Allergies in a Heavy Manufacturing Workforce: Evaluating Health and Productivity Outcomes

Allergies, Program Evaluation, Productivity

Allen, Harris M. Jr., PhD; Borden, Spencer IV, MD, MBA; Pikelny, Dan B. MBA, MA, CEBS; Paralkar, Sadhna MBBS, MPH; Slavin, Thomas MS, MBA; Bunn, William B. III, MD, JD, MPH Journal of Occupational and Environmental Medicine: Volume 45(9) September 2003 pp 956-972

False

This work presents the evaluation of a first-of-its-kind intervention to improve the management of allergies among workers in a largely blue-collar industrial setting. This intervention implemented eight educational strategies focusing on appropriate medication use in the context of a controlled, nonrandomized, pre-post quasi-experimental study design. Program implementation occurred during summer 2001, with change assessed by means of measures of health and productivity, developed from employee surveys timed to occur at the height of the spring and fall allergy seasons, and measures of contemporaneous adverse events developed from administrative databases. Evidence of improvement was found at one experimental site but not at the other experimental sites or the control site. Tests using exploratory and confirmatory analyses were conducted of two hypotheses linking the gains of this site's allergy group to 1) intervention process changes and 2) changes in allergy severity caused by seasonality. Neither hypothesis is found to fully account for the explained variation between sites. Similar pre-post productivity gains for other disease groups at this site relative to the other sites suggest that the inclusion of other unmeasured variables would improve explanation; e.g., the responses of employees with chronic disease to notably challenging labor negotiations at this site. The implications for promoting behavioral change in the management of the impact of disease on productivity are explored. Workplace intervention strategies for allergy sufferers have been studied in white-collar populations 1 but not in the manufacturing environment. In a companion article in this issue, an observational study of allergies among the workforce at International Truck & Engine Corporation shows the significant impact of allergies on the health, safety, and productivity of workers and indicates the capacity of medication use to reduce this impact. 2 Another companion article validates the use of key study measures. 3 The third phase of that project was to develop and implement an intervention strategy to improve the management of the condition at certain company locations and compare these facilities to a similar central facility.

An Introduction to Predictive Modeling for Disease Management Risk Stratification

Disease Management, Health Risks

Cousins, M. Ph.D., Shickle, L. M.S., and Bander, J. M.S. Disease Management. 2002 Volume 5, Number 3, 157-167.

False

Predictive modeling tools are used by disease management programs to risk-stratify members in order to optimize the utilization of available clinical resources. This paper provides an introduction to predictive modeling within the context of disease management by describing how predictive modeling tools can be used, how they work, and how modeling results should be evaluated. These topics will be described at a relatively general level to provide a basic understanding for non-statisticians.

Applying a Stepped-care Approach to the Treatment of Obesity

Obesisty

Carels, R., Darby, L., Cacciapaglia, H., Douglass, O., Harper, J., Kaplar, M., Konrad, K, Rydin, S., Tonkin, K. Journal of Psychosomatic Research. 2005, Vol. 59: ppg. 375– 383

False

In a stepped-care (SC) approach to treatment, more intensive interventions are implemented when less intensive interventions prove to be insufficient. It was hypothesized that a behavioral weight loss program with SC (BWLP+SC) would evidence superior treatment outcomes when compared with a BWLP without SC (BWLP). Forty-four obese, sedentary adults were randomly assigned to a BWLP+SC [i.e., problem-solving therapy (PST)] or a BWLP. Participants in the BWLP+SC lost significantly more weight and body fat, reported greater physical activity and greater improvements in diet, and were more likely to achieve their within-treatment weight loss goals than BWLP participants. Participants in the BWLP+SC who received PST (BWLP+SC [PST]) also evidenced superior treatment outcomes including superior weight loss maintenance (through 12 months posttreatment) compared with BWLP participants matched on SC eligibility [BWLP (SC matched)]. BWLP+SC may improve treatment outcomes and participant motivation to achieve preestablished weight loss goals.

Are Your Employees as Healthy as They Believe?

Lifestyle, Prevention

Schutz, C. Employee Benefit Plan Review. 2005, Vol. 60: ppg. 12-15

False

In business offices across the nation today, a significant number of employees think they are a lot healthier than they actually are. Many are dragging themselves into work, but getting little done. These distressing facts emerge from a recent, nationwide survey and the wise employer will take action to address them. Conducted last December by a respected independent research firm, the survey's results support expert claims that up to 75% of health care spending traces to conditions that can be avoided or delayed through preventive measures and healthy lifestyle choices. They drive home the point that without vastly increased consumer education and engagement, America's health care cost-inflation problem will never be adequately addressed. For employers, the good news is that taking action is neither impossible nor impossibly costly. To one degree or another, even owners of small businesses can implement the four-step formula outlined in this article. Best of all, the return on investment will appear not only on the bottom line, but also in the form of a happier, more productive workforce.

Assessing the Burden of Disease Among an Employed Population: Implications for Employer-Sponsored Prevention Program

Disease Management, Health Care Costs

Friedman, Carol DO; McKenna, Matthew T. MD, MPH; Ahmed, Faruque MD, PhD; Krebs, Jane G. PhD; Michaud, Catherine MD, PhD; Popova, Yuliya BA; Bender, Joel PhD, MD; Schenk, Thomas W. PhD, MPH: Journal of Occupational and Environmental Medicine: Volume 46(1) January 2004 pp 3-9

False

Escalating healthcare costs have led employers to identify ways to assess the actual burden of disease among their employees. One such measure is the use of disability-adjusted life-years (DALYs). DALYs were calculated for the General Motors (GM) population for 1994 through 1998 using data from GM's Mortality Registry, published life tables, and age- and sex-specific disease incidence and disability data from the U.S. Burden of Disease Study. Chronic diseases accounted for 45% (245,844 of 540,450) of total DALYs lost. Ischemic heart disease, stroke, lung cancer, and chronic obstructive pulmonary disease led the list for both men and women and accounted for 39% and 31%, respectively, of the top 10 DALYs lost. Disease burden among employees could be reduced through targeted interventions aimed at the risk factors associated with the leading causes of DALYs. Employers' health insurance premium costs increased 12.7% in 2002, which represents the largest increase in premiums since 1990. 1 In an effort to contain the steeply rising costs of providing health insurance coverage for their employees, employers are implementing measures to reconcile the strong demand for medical services with the means to pay for them. Among these measures are increases in employee contributions to health coverage through various cost-sharing mechanisms and the creation of personal health accounts. 2-4 In addition to cost-sharing, employers have supported health promotion efforts, and used healthcare benchmarking and quality scorecards as other means to control the rising cost of health care. To help guide employers in targeting interventions that would have the greatest impact in promoting health and reducing costs, methods to summarize fatal and nonfatal health outcomes into a single measure of disease burden are needed. One such measure that has been used at the national and international level is the disability-adjusted life-year (DALY), which was introduced by the World Bank in 1993. 5 The DALY metric attempts to combine the healthy lived time lost to premature mortality, or years of life lost, with the time lost to nonfatal suffering, or years lived with disability. 6 Both developed and developing countries and a large urban county in the United States have used DALYs to measure disease burden. 7-10 We used DALYs to assess the burden of disease and injury in a well-insured and well-paid population of one of the largest employers in the United States. The objective of the study was to understand the impact of specific diseases on individual employees and on employers in terms of lived time lost and cost. It was hoped that such a study would enable the company to identify targeted interventions that would have the greatest impact.