Enhancing Clinical Content and Race/Ethnicity Data in Statewide Hospital Administrative Databases: Obstacles Encountered, Strategies Adopted, and Lessons Learned.

OBJECTIVES: Eight grant teams used Agency for Healthcare Research and Quality infrastructure development research grants to enhance the clinical content of and improve race/ethnicity identifiers in statewide all-payer hospital administrative databases. PRINCIPAL FINDINGS: Grantees faced common challenges, including recruiting data partners and ensuring their continued effective participation, acquiring and validating the accuracy and utility of new data elements, and linking data from multiple sources to create internally consistent enhanced administrative databases. Successful strategies to overcome these challenges included aggressively engaging with providers of critical sources of data, emphasizing potential benefits to participants, revising requirements to lessen burdens associated with participation, maintaining continuous communication with participants, being flexible when responding to participants' difficulties in meeting program requirements, and paying scrupulous attention to preparing data specifications and creating and implementing protocols for data auditing, validation, cleaning, editing, and linking. In addition to common challenges, grantees also had to contend with unique challenges from local environmental factors that shaped the strategies they adopted. CONCLUSIONS: The creation of enhanced administrative databases to support comparative effectiveness research is difficult, particularly in the face of numerous challenges with recruiting data partners such as competing demands on information technology resources. Excellent communication, flexibility, and attention to detail are essential ingredients in accomplishing this task. Additional research is needed to develop strategies for maintaining these databases when initial funding is exhausted.

Six-year cost trends at PPG industries paralleling the introduction of health promotion programs directed at cardiovascular disease prevention.

OBJECTIVE: Over the past several years, PPG Industries (PPG) implemented worksite health promotion programs aimed at improving employees' health and reducing overall medical costs as well as those specific to cardiovascular disease. METHODS: Using medical claims data, we examined trends in these costs among PPG employees for a 6-year period, from 2005 to 2010. RESULTS: Overall medical costs remained relatively flat, increasing by 1.2% compounded annually, unadjusted for inflation, while inflation-adjusted costs declined by 2.9%. Comparing worksites rated "high-high" on both program implementation and leadership support with worksites scoring highly on one or none of those dimensions, the "high-high" group experienced a decreasing cost trend, whereas the "other" group showed an increase. CONCLUSIONS: The analysis suggests that PPG's efforts to reconfigure and intensify its wellness program offerings may have resulted lower health care cost trends.

The Workforce wellness index: a method for valuing US workers' health.

OBJECTIVE: To devise a methodology to create a single health risk-cost score that can be applied to health risk assessment survey data and account for the medical costs associated with modifiable risks. METHODS: We linked person-level health risk assessment data with medical benefit eligibility and claims data for 341,650 workers for the period 2005 to 2010 and performed multivariate analyses to estimate costs associated with high risks. We used the estimated costs and risk prevalence rates to create a composite Workforce Wellness Index (WWI) score. RESULTS: Increasing obesity rates among employees was found to be the most important contributor to increased health care spending and the main reason the WWI score worsened over time. CONCLUSIONS: Employers that address employees' health risk factors may be able to reduce their medical spending and achieve an improvement in their WWI scores.

The relationship between 11 health risks and medical and productivity costs for a large employer.

OBJECTIVE: To evaluate the relationship between modifiable health risks, and health and productivity related expenditures and predict cost savings from improvements in the health risk profile of a large US employer. METHODS: Information was collected on 11 modifiable health risks for active employees who completed a health assessment and enrolled in a noncapitated health plan. These risks were related to employer medical care costs and employee productivity. Multivariate analyses were performed to estimate costs associated with high risk, as well as potential savings from reducing risk prevalence among employees. RESULTS: Health risks with the greatest impact on total medical care costs included obesity, high blood pressure, high blood glucose, high triglycerides, and inadequate exercise. CONCLUSIONS: Modifiable health risks are associated with higher employer costs. Targeted programs that address these risks are expected to yield substantial savings.

The influence of worksite health promotion program management and implementation structure variables on medical care costs at PPG Industries.

OBJECTIVE: To evaluate the relationship between critical factors for successful worksite health promotion programs such as management support and program implementation and health care costs at PPG Industries. METHODS: We analyzed survey data from 37 PPG worksites measuring management support and program implementation. We estimated the relationship between management and implementation scores in 2007 and subsequent health care costs in 2008 using ordinary least squares regression. RESULTS: High program implementation scores were associated with higher health care costs (P < 0.01) as were high management scores (P < 0.05). However, sites with a combination of high management and implementation scores had lower health care costs, while sites with low scores on these dimensions had higher cost trends. CONCLUSIONS: Employers should consider administering worksite health promotion structural assessments to identify gaps in management support and program implementation that may influence program effectiveness.

Measuring changes in lipid and blood glucose values in the health and wellness program of Prudential Financial, Inc.

OBJECTIVE: To determine the effect of health promotion programs of Prudential Financial, Inc on biometric measures of blood lipids and glucose. METHODS: Using actual biometric and self-reported measures of blood lipids and glucose values for the employees of Prudential Financial, Inc, we examined 1) the extent to which self-reported lipid and blood glucose values correlate to laboratory data, 2) whether self-reported and measured lipid values differ for physically active and sedentary employees, and 3) whether participation in a disease management program affects employees' lipid measures. RESULTS: We found significant differences in self-reported and measured total cholesterol and low-density lipoprotein values, although these differences and those for all lipid and blood glucose values were not clinically meaningful. Supporting previous clinical studies, high-density lipoprotein values were significantly higher for fitness center users compared with sedentary employees. Finally, disease management participants showed a significant reduction in total cholesterol and low-density lipoprotein during a 3-year period compared with nonparticipants. CONCLUSIONS: On average, the employees of Prudential Financial, Inc were aware of and accurately reported their lipid and blood glucose levels. Results from this study support the value of evaluating corporate health promotion programs, using measured biometric outcomes.