A multi-worksite analysis of the relationships among body mass index, medical utilization, and worker productivity.

BACKGROUND: The relationships between worker health and productivity are becoming clearer. However, few large scale studies have measured the direct and indirect cost burden of overweight and obesity among employees using actual biometric values. The objective of this study was to quantify the direct medical and indirect (absence and productivity) cost burden of overweight and obesity in workers. MEASURES: A cross-sectional study of 10,026 employees in multiple professions and worksites across the United States was conducted. The main outcomes were five self-reported measures of workers' annual health care use and productivity: doctor visits, emergency department visits, hospitalizations, absenteeism (days absent from work), and presenteeism (percent on-the-job productivity losses). Multivariate count and continuous data models (Poisson, negative binomial, and zero-inflated Poisson) were estimated. RESULTS: After adjusting for covariates, obese employees had 20% higher doctor visits than normal weight employees (confidence interval [CI] 16%, 24%, P < 0.01) and 26% higher emergency department visits (CI 11%, 42%, P < 0.01). Rates of doctor and emergency department visits for overweight employees were no different than those of normal weight employees. Compared to normal weight employees, presenteeism rates were 10% and 12% higher for overweight and obese employees, respectively (CI 5%, 15% and 5%, 19%, all P < 0.01). Taken together, compared to normal weight employees, obese and overweight workers were estimated to cost employers $644 and $201 more per employee per year, respectively. CONCLUSIONS: This study provides evidence that employers face a financial burden imposed by obesity. Implementation of effective workplace programs for the prevention and management of excess weight will benefit employers and their workers.

Improved oxygen prescribing using a nurse-facilitated reminder.

Poor oxygen prescribing and administration is well documented despite junior doctor education and oxygen prescription charts. This prescribing behaviour can be harmful to patients. This study examines whether oxygen prescribing and the appropriateness of oxygen therapy would be increased by medical admissions unit (MAU) nurse education and a nurse-mediated reminder strategy to junior medical staff. A quality improvement study was carried out involving a prospective single centre audit, educational intervention to MAU nurses, and implementation of a nurse-facilitated oxygen prescribing reminder strategy with prospective re-audit. The study took place in a 26-bed MAU in a 678-bed teaching hospital with a lung centre serving a population of 540,000. Fifty-one patients were involved in the initial and re-audits and two nurses were involved in the audit team. A team of 10 acute medical nurses were involved in facilitating the appropriate administration and prescription of oxygen by liaison with junior medical staff. Oxygen prescription and appropriateness of oxygen therapy were measured. Results showed an improvement in oxygen prescribing from 0% to 49% (p < 0.0001). Non-significant improvements in appropriate oxygen prescription (pre- versus post-intervention) overall (70.6% versus 76.5%, p = 0.65); more marked reduction in type 1 respiratory failure errors (18.4% versus 3.8%, p = 0.13) and less marked reduction in type 2 respiratory failure errors (61.3% versus 44.0%, p = 0.49). In conclusion, significant and quick improvements in oxygen prescribing behaviour are achievable through a nurse-facilitated reminder strategy with reduction in inappropriate oxygen prescribing. These strategies are relevant to other ward settings and aspects of patient care.

Women veterans and outcomes after acute myocardial infarction.

BACKGROUND: Previous studies have shown that women have decreased survival and receive fewer cardiac procedures after acute myocardial infarction (AMI) compared with men, raising concerns for sexual bias in provision of care. The objective of this study is to describe clinical characteristics, treatment, and survival in women veterans compared with men after admission to VA hospitals for AMI. METHODS: This is a retrospective inception cohort study using data drawn from the VA Cardiac Care Follow-up Clinical Study, describing patients admitted for AMI to VA hospitals from October 1, 2003 to March 31, 2005. Subjects were followed for 1 year. RESULTS: There were 236 women and 13,259 men admitted during the study period to VA hospitals with AMI. Women were less likely to have a history of heart failure compared with men (18.2% of women vs. 27.2% of men, p = 0.002) and previous coronary artery bypass grafting (CABG) (11.4% of women vs. 19.6% of men, p = 0.002). Diagnostic cardiac catheterization was similar in women and men (36.9% and 34.9%, p = 0.539). Crude in-hospital mortality was 4.2% for women and 7.6% for men (p = 0.051). After adjusting for comorbidities and treatment variables, in-hospital mortality was not significantly different for women compared with men (hazard ratio [HR] 0.82, 95% confidence interval [CI] 0.60-1.12). CONCLUSIONS: Women veterans receive a level of care similar to men veterans for MI treated in VA hospitals. Differences in mortality between women and men were not significant and do not suggest that women fare worse.

Using a personal health care cost calculator to estimate future expenditures based on individual health risks.

OBJECTIVE: To describe the development and application of an innovative Health Improvement Cost Calculator tool designed to help individuals recognize the link between their current health risks, future medical costs, and productivity. METHODS: We describe how the Calculator was developed using data from studies that tie health care costs and productivity to population health risks, and how changes in risks are projected to reduce future spending for individual workers. RESULTS: Two simulations of the model illustrate how individuals may realize future economic costs or benefits depending on whether they maintain or change their health-risk profile. CONCLUSIONS: The Calculator has the potential to be a powerful motivational tool for individuals, especially those heading toward retirement, who are looking to understand the relationships between their health risks, future medical spending, and impacts on productivity.

First-year results of an obesity prevention program at The Dow Chemical Company.

OBJECTIVE: To examine first-year results from a workplace environmental obesity prevention program at The Dow Chemical Company. METHODS: A quasi-experimental cohort study was conducted among employees at nine treatment worksites (n = 8013) who received environmental weight management interventions and three control worksites (n = 2269). Changes in employees' weight, body mass index (BMI), and other health risks were examined using chi2 and t-tests. RESULTS: After 1 year, a modest treatment effect was observed for weight and BMI largely because the control group subjects gained weight; however, no effect was observed for overweight and obesity prevalence. Other risk factors (tobacco use, high blood pressure, and systolic and diastolic blood pressure values) decreased significantly, although blood glucose (high risk prevalence and values) increased. CONCLUSIONS: Environmental changes to the workplace can achieve modest improvements in employees' health risks, including weight and BMI measures, in 1 year.

Using a return-on-investment estimation model to evaluate outcomes from an obesity management worksite health promotion program.

OBJECTIVE: Certain modifiable risk factors lead to higher health care costs and reduced worker productivity. A predictive return-on-investment (ROI) model was applied to an obesity management intervention to demonstrate the use of econometric modeling in establishing financial justification for worksite health promotion. METHODS: Self-reported risk factors (n = 890) were analyzed using chi2 and t test methods. Changes in risk factors, demographics, and financial measures comprised the model inputs that determined medical and productivity savings. RESULTS: Over 1 year, 7 of 10 health risks decreased. Of total projected savings ($311,755), 59% were attributed to reduced health care expenditures ($184,582) and 41% resulted from productivity improvements ($127,173), a $1.17 to $1.00 ROI. CONCLUSIONS: Using an ROI model to project program savings is a practical way to provide financial justification for investment in worksite health promotion when risk reduction data are available.

Differences in safety climate between hospital personnel and naval aviators.

We compared results of safety climate survey questions from health care respondents with those from naval aviation, a high-reliability organization. Separate surveys containing a subset of 23 similar questions were conducted among employees from 15 hospitals and from naval aviators from 226 squadrons. For each question a "problematic response" was defined that suggested an absence of a safety climate. Overall, the problematic response rate was 5.6% for naval aviators versus 17.5% for hospital personnel (p < .0001). The problematic response was 20.9% in high-hazard hospital domains such as emergency departments and operating rooms. Problematic response among hospital workers was up to 12 times greater than that among aviators on certain questions. Although further research on safety climate in health care is warranted, hospitals may need to make substantial changes to achieve a safety climate consistent with the status of high-reliability organizations.