Averting the collision between rising health care costs and corporate survival

No Abstract.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/63081/1/338_ftp.pd

Metabolic Syndrome in a Workplace: Prevalence, Co-Morbidities, and Economic Impact

Background: Although the prevalence of metabolic syndrome has been studied in nationally representative populations, little is known about its prevalence specifically among working adults. Because corporations are often the primary payers of health-care costs in the United States, they have a vested interest in knowing the impact of metabolic syndrome in employed individuals. Methods: A total of 4188 employees (83.4% male, 92.1% Caucasian, average age 40.8 years) of a midwestern U.S. manufacturing corporation participated in a health risk appraisal and biometric screening in 2006 and also used the company's medical plan. Those with metabolic syndrome were compared to those without metabolic syndrome in terms of their 2006 health risks, health conditions, health-care costs, pharmacy costs, short-term disability costs, and a measure of on-the-job productivity loss known as presenteeism. Results: A total of 30.2% of employees met the criteria for metabolic syndrome and were more likely to also have a variety of additional health risks and health conditions compared to those without metabolic syndrome. For example, 9.4% of those with metabolic syndrome self-reported having diabetes compared to 1.4% of those without metabolic syndrome. Health-care costs, pharmacy costs, and short-term disability costs were significantly higher for those with metabolic syndrome compared to those without metabolic syndrome, and increasing numbers of metabolic syndrome health risks were associated with greater numbers of employees reporting on-the-job productivity losses (presenteeism). Conclusions: Because metabolic syndrome is prevalent among the employees of this manufacturing company and is associated with significant economic costs, employers would be wise to address the health risks of employees through health promotion programs and benefit plan designs that help individuals improve their health and receive appropriate health screenings and medical care.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/78143/1/met.2009.0008.pd

Two-Year Outcomes Show Effectiveness of The Prevention Program in Lowering Health Risks and Costs

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/90501/1/pop-2E2011-2E0057.pd

The Burden and Management of Dyslipidemia: Practical Issues

Abstract The objective of this study is to describe briefly the burden of dyslipidemia, and to discuss and present strategies for health professionals to improve dyslipidemia management, based on a review of selected literature focusing on interventions for dyslipidemia treatment adherence. Despite the availability of effective lifestyle and pharmaceutical therapies for dyslipidemias, they continue to present a significant economic burden in the United States. Adherence to evidence-based guidelines for the treatment of dyslipidemias is unsatisfactory. The reasons for medication nonadherence are complex and specific to each patient. The lack of progress in achieving optimal lipid targets is caused by many factors: patient (medication adherence, cost of medication, literacy), medication (adverse effects, complexity of regimen), provider (lack of adherence to evidence-based practice guidelines, poor communication), and the US healthcare system (being focused on acute care rather than prevention, lack of continuity of care, general lack of use of an electronic health record). Combined interventions that target each part of the system have been effective in improving treatment adherence and achieving lipid goals. Patients, providers, pharmacists, and employers all play a role in management of dyslipidemia. No single approach will solve the complex issue of improving dyslipidemia management. The required lifestyle changes are known and effective medications are available. The challenge is for all interested parties?including nurses, nurse practitioners, doctors, pharmacists, other health care professionals, employers, and health plans?to help patients achieve behavioral changes. (Population Health Management 2012;15:302?308)Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/98471/1/pop%2E2011%2E0081.pd

Impact of Compliance to Oral Hypoglycemic Agents on Short-Term Disability Costs in an Employer Population

This study evaluated the relationships between compliance with oral hypoglycemic agents and health care/short-term disability costs in a large manufacturing company. The retrospective analysis used an observational cohort drawn from active employees of Ford Motor Company. The study population consisted of 4978 individuals who were continuously eligible for 3 years (between 2001?2007) and who received a prescription for an oral hypoglycemic agent during that time. Medical, pharmacy, and short-term disability claims data were obtained from the University of Michigan Health Management Research Center data warehouse. Pharmacy claims/refill data were used to calculate the proportion of days covered (PDC); an individual was classified as compliant if his/her PDC was ≥80%. Model covariates included age, sex, work type, and Charlson comorbidity scores. The impact of compliance on disability and health care costs was measured by comparing the costs of the compliant with those of the noncompliant during a 1-year follow-up. Among these employees, compliant patients had lower medical, higher pharmacy, and lower short-term disability costs than did the noncompliant. After adjusting for demographics and comorbidity, noncompliance was associated with statistically higher short-term disability costs ($1840 vs.$1161, P<0.0001), longer short-term disability duration, and an increase in short-term disability incidence (21.5% of the noncompliant had a claim compared to 16.0% of the compliant, P<0.0001). These results suggest that medication compliance may be important in curtailing the rise of health care/disability costs in the workplace. Employers concerned with the total costs associated with diabetes should not overlook the impact of compliance on short-term disability. (Population Health Management 2014;17:35-41)Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/140180/1/pop.2013.0009.pd

Asthma Disease Management: A Worksite-Based Asthma Education Program

Asthma accounts for an estimated 3 million workdays lost each year in the United States in addition to reduced worker productivity. Although asthma disease management programs are relatively common in managed care organizations, they have generally not been offered at the workplace. Seventy-six employees participated in a five-session worksite-based asthma education program. A total of 47 of 76 (61.8%) employees completed baseline and 12-month follow-up Asthma Therapy Assessment Questionnaires (ATAQ). The ATAQ includes measurement of poor asthma control, behavior/attitude barriers, knowledge barriers, patient/provider communication barriers, and efficiency. Significant improvement was noted in measures of asthma control (p < 0.05), communication (p < 0.005), knowledge (p < 0.001), and the total ATAQ Index declined from 5.53 to 4.04 (p < 0.001). Employee satisfaction results for the program were exceptionally high. A worksite-based asthma education program should reduce medical care costs, worker absenteeism, and improve worker productivity. The worksite can be a very effective location for disease education programs.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/63128/1/109350701300038208.pd

Evaluation of Conventional and New Maximum Heart Rate Prediction Models for Individuals

In October of 1992 I submitted an abstract to the American College of Sports Medicine, co-authored with Dr. Schork and Dr. Edington from the University of Michigan, to present our study at the 1993 Annual Meeting. A few weeks later I received Volume 24, issue 10 of Medicine and Science in Sports and Exercise, where Whaley and colleagues had published a similar paper. Discouraged by the bad timing, I never tried to publish my own paper. Several years later, other similar papers have been published, arguing for a correction to the conventional 220-age formula for maximum heart rate. I realized I should have tried to publish my paper back in 1993! I have dug out the original poster presentation materials, scanned them, and prepared this document for the sake of teaching my students (who often quote Tanaka et al. and Gellish et al.) the importance of prompt publication of their work.The purpose of this study was to develop a regression model to predict maximum heart rate (HRmax) from basic sociodemographic variables and to compare it with the 220-age rule of thumb. Data were obtained from 635 adults of all ages, gender, and physical activity levels, rigorously tested for maximum aerobic capacity. HRmax was found to be significantly correlated (p<.05) to age, tobacco use in the past, current tobacco use, and self-reported physical activity. There was no evidence of a difference in HRmax between males and females (p=.997). Several significant (p<.00005) linear regression models involving these variables were developed, but their ability to explain the variation in HRmax was only slightly better than a model that relied on age alone. Based on R2 values, the age model was able to account for 44.9% of the variation in HRmax, compared to 48% when using the most complicated model. The 220-age rule of thumb also gave an r2 =.449 (44.9%), but the average estimate was biased (-8 beats per minute [b * min~l]). Individual estimates were highly inaccurate: 50.5% of the predicted values were off by 10 b * min-1 or more, compared to 27.6% with our simplest model based on age alone. Furthermore, both the 220-age rule and our regression models were very poor predictors when applied to ten-year age subgroups. It was concluded that in spite of a significant correlation between HRmax and other variables, regression models based on these variables are highly inaccurate in the prediction of individual HRmax values. Therefore, the practice of relying on them for individualized exercise prescription and as a criterion for graded exercise test termination is not warranted.UCR::Vicerrectoría de Docencia::Ciencias Sociales::Facultad de Educación::Escuela de Educación Físic

Worker Productivity Loss Associated with Arthritis

This study at a major financial services corporation sought to investigate the association of arthritis with on-the-job productivity, also termed "presenteeism." Using a modified version of the Work Limitations Questionnaire (WLQ) incorporated into a Health Risk Appraisal (HRA), 17,685 employees responded to the survey in 2002. Of the 16,651 respondents meeting inclusion criteria, 2,469 (14.8%) reported having arthritis, and 986 (39.9% of those with arthritis) also reported that they were under medical care and/or taking medication for arthritis. Employees with arthritis were older, predominantly female, and reported a higher number of comorbidities. Although all four domains of the WLQ (physical, time, mental, and output) were impacted by arthritis, the greatest productivity effect, as expected, was on physical work tasks. Health risks also play a role in the relationship between arthritis and presenteeism, with high-risk individuals reporting 7%–10% additional loss of productivity compared to lowrisk individuals. In addition, those who reported receiving medication and/or treatment for arthritis had a 2.5% excess productivity loss independently attributed to their arthritis, which equals approximately $1,250 per employee per year, or$5.4 million to the corporation. This arthritis effect was discernible in those with low and moderate levels of health risk, but was not as evident in those with high health risks; in that group, health-associated decrements in productivity were much larger. Arthritis is associated with work productivity loss. Disease management programs should focus on pain management and arthritis-associated health risks and comorbidities in order to significantly decrease arthritis-related losses in on-the-job productivity.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/63221/1/dis.2006.9.131.pd

Exercise-induced reversal of age-related declines of oxidative reactions, mitochondrial yield, and flavins in skeletal muscle of the rat

The ability of gastrocnemius muscle homogenates to catalyze the oxidation of succinate, glutamate + malate, pyruvate + malate, palmitoyl-coenzyme A, decanoylcarnitine and palmitoylcarnitine in the presence of ADP decreased by approximately 32% in sedentary male Sprague-Dawley rats between the ages of 9 and 25 months. Following 21 weeks of treadmill training (running), such homogenates from 25-month-old animals catalyzed oxidations 55% more rapidly than those from 25-month-old sedentary rats, and 17% faster than those from 9-month-old sedentary rats. Total and peptide-bound flavin of gastrocnemius muscles also declined between 9 and 25 months of age and were elevated in the 25-month-old endurance trained rats to levels greater than both 9- and 25-month-old sedentary animals. The yield of protein in the mitochondrial fraction from the quadriceps femoris muscle decreased between 9 and 25 months and was restored to the 9-month level by endurance training. The kinetic characteristics of the isolated mitochondria were not influenced by age or exercise. These data indicate that 2-year-old rats retain the capacity to increase skeletal muscle oxidative capacity and mitochondrial population density in response to endurance training.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/24891/1/0000318.pd

Tissue coenzyme Q (ubiquinone) and protein concentrations over the life span of the laboratory rat

The coenzyme Q (ubiquinone) concentrations of a number of tissues have been determined over the life span of the male laboratory rat. Coenzyme Q increased between 2 and 18 months and decreased significantly at 25 months in the heart and kidney, and the gastrocnemius, oblique and deep aspect (red) vastus lateralis muscles. The coenzyme Q concentration of liver increased over the life span, while it remained relatively constant in brain, lung, and the superficial aspect (white) of the vastus lateralis muscle. Data are also included for organ weights and protein contents of tissues over the life span. The various roles of coenzyme Q in cellular electron transfer and its regulation, energy conservation in oxidative phosphorylation, and its clinical efficacy in diseases of energy metabolism are discussed. It is hypothesized that coenzyme Q serves as a free radical quencher in the mitochondrion, a major site of free radical formation, in addition to its other roles in cellular energy metabolism, and that its cellular diminution may contribute to the loss of cellular function accompanying ageing.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/25514/1/0000055.pd