Journal of Occupational and Environmental Medicine | Year: 2013
OBJECTIVE:: To describe integrated worker health protection and promotion (IWHPP) program characteristics, to discuss the rationale for the integration of occupational safety and health and worksite health promotion programs, and to summarize what is known about the impact of these programs on health and economic outcomes. METHODS:: A descriptive assessment of the current state of the IWHPP field and a review of studies on the effectiveness of IWHPP programs on health and economic outcomes were undertaken. RESULTS:: Sufficient evidence of effectiveness was found for IWHPP programs when health outcomes were considered. Impact on productivity-related outcomes is considered promising, but inconclusive, whereas insufficient evidence was found for health care expenditures. CONCLUSIONS:: Existing evidence supports an integrated approach in terms of health outcomes but will benefit significantly from research designed to support the business case for employers of various company sizes and industry types. Copyright © 2013 by American College of Occupational and Environmental.
Rolnick S.J.,HealthPartners Research Foundation |
Pawloski P.A.,HealthPartners Research Foundation |
Hedblom B.D.,HealthPartners Research Foundation |
Asche S.E.,HealthPartners Research Foundation |
Clinical Medicine and Research | Year: 2013
Objective: Despite evidence indicating therapeutic benefit for adhering to a prescribed regimen, many patients do not take their medications as prescribed. Non-adherence often leads to morbidity and to higher health care costs. The objective of the study was to assess patient characteristics associated with medication adherence across eight diseases. Design: Retrospective data from a repository within an integrated health system was used to identify patients ≥18 years of age with ICD-9-CM codes for primary or secondary diagnoses for any of eight conditions (depression, hypertension, hyperlipidemia, diabetes, asthma or chronic obstructive pulmonary disease, multiple sclerosis, cancer, or osteoporosis). Electronic pharmacy data was then obtained for 128 medications used for treatment. Methods: Medication possession ratios (MPR) were calculated for those with one condition and one drug (n=15,334) and then for the total population having any of the eight diseases (n=31,636). The proportion of patients adherent (MPR ≥80%) was summarized by patient and living-area (census) characteristics. Bivariate associations between drug adherence and patient characteristics (age, sex, race, education, and comorbidity) were tested using contingency tables and chi-square tests. Logistic regression analysis examined predictors of adherence from patient and living area characteristics. Results: Medication adherence for those with one condition was higher in males, Caucasians, older patients, and those living in areas with higher education rates and higher income. In the total population, adherence increased with lower comorbidity and increased number of medications. Substantial variation in adherence was found by condition with the lowest adherence for diabetes (51%) and asthma (33%). Conclusions: The expectation of high adherence due to a covered pharmacy benefit, and to enhanced medication access did not hold. Differences in medication adherence were found across condition and by patient characteristics. Great room for improvement remains, specifically for diabetes and asthma. ©2013 Marshfield Clinic.
Solomon D.H.,Brigham and Womens Hospital |
Patrick A.R.,Brigham and Womens Hospital |
Schousboe J.,HealthPartners |
Losina E.,Brigham and Womens Hospital
Journal of Bone and Mineral Research | Year: 2014
Fractures related to osteoporosis are associated with $20 billion in cost in the United States, with the majority of cost born by federal health-care programs, such as Medicare and Medicaid. Despite the proven fracture reduction benefits of several osteoporosis treatments, less than one-quarter of patients older than 65 years of age who fracture receive such care. A postfracture liaison service (FLS) has been developed in many health systems but has not been widely implemented in the United States. We developed a Markov state-transition computer simulation model to assess the cost-effectiveness of an FLS using a health-care system perspective. Using the model, we projected the lifetime costs and benefits of FLS, with or without a bone mineral density test, in men and women who had experienced a hip fracture. We estimated the costs and benefits of an FLS, the probabilities of refracture while on osteoporosis treatment, as well as the utilities associated with various health states from published literature. We used multi-way sensitivity analyses to examine impact of uncertainty in input parameters on cost-effectiveness of FLS. The model estimates that an FLS would result in 153 fewer fractures (109 hip, 5 wrist, 21 spine, 17 other), 37.43 more quality-adjusted life years (QALYs), and save $66,879 compared with typical postfracture care per every 10,000 postfracture patients. Doubling the cost of the FLS resulted in an incremental cost-effectiveness ratio (ICER) of $22,993 per QALY. The sensitivity analyses showed that results were robust to plausible ranges of input parameters; assuming the least favorable values of each of the major input parameters results in an ICER of $112,877 per QALY. An FLS targeting patients post-hip fracture should result in cost savings and reduced fractures under most scenarios. © 2014 American Society for Bone and Mineral Research.
Pronk N.P.,HealthPartners |
Pronk N.P.,HealthPartners Institute for Education and Research |
Pronk N.P.,Health Science University
Annual Review of Public Health | Year: 2015
Fitness matters for the prevention of premature death, chronic diseases, productivity loss, excess medical care costs, loss of income or family earnings, and other social and economic concerns. The workforce may be viewed as a corporate strategic asset, yet its fitness level appears to be relatively low and declining. Over the past half-century, obesity rates have doubled, physical activity levels are below par, and cardiorespiratory fitness often does not meet minimum acceptable job standards. During this time, daily occupational energy expenditure has decreased by more than 100 calories. Employers should consider best practices and design workplace wellness programs accordingly. Particular attention should be paid to human-centered cultures. Research should address ongoing surveillance needs regarding fitness of the US workforce and close gaps in the evidence base for fitness and business-relevant outcomes. Policy priorities should consider the impact of both state and federal regulations, adherence to current regulations that protect and promote worker health, and the introduction of incentives that allow employers to optimize the fitness of their workforce through supportive legislation and organizational policies. Copyright © 2015 by Annual Reviews. All rights reserved.
American Journal of Preventive Medicine | Year: 2010
Unhealthy behavior is a leading cause of morbidity, mortality, and rising healthcare costs. Well-managed, comprehensive, effective worksite-based health promotion programs are an important health plan strategy for improving member health and limiting healthcare costs. © 2010 American Journal of Preventive Medicine.