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Nicollet, MN, United States

Terry P.E.,StayWell Health Management | Xi M.,Park Nicollet Institute
Population Health Management | Year: 2010

The objective of this study was to assess the validity of 3 scoring techniques for presenteeism measures by exploring their relationship with patient activation, health, job satisfaction, and socioeconomic characteristics. The sample consisted of 631 employees from 2 predominantly white-collar employee groups in the northern Midwest. Employees completed the World Health Organization's Health and Work Performance Questionnaire, a wellness profile, and the Patient Activation Measure. Absolute measures reflect self-rated performance, while relative and stratified measures compare self-rated performance to that of co-workers. Multivariate analyses were used to validate scoring measures. All measures of presenteeism were positively correlated with being nonwhite, income, and smoking. The significance of age, employment, mental health, and patient activation depends on how presenteeism is defined. Practitioners must carefully consider which scoring method best addresses their program goals and objectives. Clearer measurement guidelines are needed. (Population Health Management 2010;13:297-307) © 2010, Mary Ann Liebert, Inc.

Schousboe J.T.,Park Nicollet Institute | Kerlikowske K.,Veterans Affairs Medical Center | Loh A.,California Pacific Medical Center Research Institute | Cummings S.R.,Coordinating Center
Annals of Internal Medicine | Year: 2011

Background: Current guidelines recommend mammography every 1 or 2 years starting at age 40 or 50 years, regardless of individual risk for breast cancer. Objective: To estimate the cost-effectiveness of mammography by age, breast density, history of breast biopsy, family history of breast cancer, and screening interval. Design: Markov microsimulation model. Data Sources: Surveillance, Epidemiology, and End Results program, Breast Cancer Surveillance Consortium, and the medical literature. Target Population: U.S. women aged 40 to 49, 50 to 59, 60 to 69, and 70 to 79 years with initial mammography at age 40 years and breast density of Breast Imaging Reporting and Data System (BI-RADS) categories 1 to 4. Time Horizon: Lifetime. Perspective: National health payer. Intervention: Mammography annually, biennially, or every 3 to 4 years or no mammography. Outcome Measures: Costs per quality-adjusted life-year (QALY) gained and number of women screened over 10 years to prevent 1 death from breast cancer. Results of Base-Case Analysis: Biennial mammography cost less than $100 000 per QALY gained for women aged 40 to 79 years with BI-RADS category 3 or 4 breast density or aged 50 to 69 years with category 2 density; women aged 60 to 79 years with category 1 density and either a family history of breast cancer or a previous breast biopsy; and all women aged 40 to 79 years with both a family history of breast cancer and a previous breast biopsy, regardless of breast density. Biennial mammography cost less than $50 000 per QALY gained for women aged 40 to 49 years with category 3 or 4 breast density and either a previous breast biopsy or a family history of breast cancer. Annual mammography was not cost-effective for any group, regardless of age or breast density. Results of Sensitivity Analysis: Mammography is expensive if the disutility of false-positive mammography results and the costs of detecting nonprogressive and nonlethal invasive cancer are considered. Limitation: Results are not applicable to carriers of BRCA1 or BRCA2 mutations. Conclusion: Mammography screening should be personalized on the basis of a woman's age, breast density, history of breast biopsy, family history of breast cancer, and beliefs about the potential benefit and harms of screening. Primary Funding Source: Eli Lilly, Da Costa Family Foundation for Research in Breast Cancer Prevention of the California Pacific Medical Center, and Breast Cancer Surveillance Consortium. © 2011 American College of Physicians.

Ensrud K.E.,University of Minnesota | Ensrud K.E.,Veterans Affairs Medical Center | Schousboe J.T.,University of Minnesota | Schousboe J.T.,Park Nicollet Institute
New England Journal of Medicine | Year: 2011

A 72-year-old woman presents with a 2-month history of increasing pain in her lower back, which has not improved with ibuprofen and is causing difficulty with walking and dressing. On questioning, she reports having lost about 5 cm (2 in.) of height since she was a young woman. On examination, there is mild kyphosis in her lower thoracic spine but no point tenderness. A lateral spine radiograph reveals that the L2 vertebra is biconcave in appearance, a finding that is consistent with a vertebral fracture (Fig. 1). How should this case be managed? Copyright © 2011 Massachusetts Medical Society. All rights reserved.

Park Nicollet Institute | Date: 2014-01-22

A glucose evaluation system operates to evaluate and display glucose data. The glucose data is evaluated and a display is generated that presents the glucose data in a form that quickly conveys key information to a caregiver, without requiring the caregiver to spend a great deal of time studying the data or the display.

Parker D.L.,Park Nicollet Institute | Bejan A.,Park Nicollet Institute | Brosseau L.M.,University of Minnesota
American Journal of Industrial Medicine | Year: 2012

Background: About 223,000 people are employed in approximately 34,500 auto collision repair businesses. In general, employees and owners in these establishments lack knowledge of health and safety practices and do not have the technical expertise to make their place of work safer. Methods: Three employee and three owner focus groups were conducted. The goal of these focus groups was to characterize health and safety beliefs of owners and employees and to determine the best methods for motivating safety improvements in collision repair shops. Results: A total of 11 owners and 19 workers participated in these focus groups. Employees and owners were aware of a wide range of hazards. Both groups noted difficulty in staying informed. Employers were hesitant to set and enforce safety and health rules. Employees perceive owners to be unwilling to dedicate the resources to make the workplace safer and provide personal protective equipment. Both groups felt insurance reimbursement practices placed undue pressure on employees. Conclusions: Focus groups provide important insights into intervention development in very small enterprises in general and auto collision shops in specific. Employers were conflicted about allowing employees a certain level of independence while also maintaining a safe workplace. From the employee perspective, owners frequently fail to provide adequate personal protective equipment and make improvements needed to ensure safe work. The unique managerial needs of very small enterprises must be accounted for if health and safety programs are to be implemented in these establishments. © 2012 Wiley Periodicals, Inc.

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