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.

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.

Hospital readmission among medicaid patients with an index hospitalization for mental and/or substance use disorder.

Hospital readmission rates are increasingly used as a performance indicator. Whether they are a valid, reliable, and actionable measure for behavioral health is unknown. Using the MarketScan Multistate Medicaid Claims Database, this study examined hospital- and patient-level predictors of behavioral health readmission rates.

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.

Ten modifiable health risk factors are linked to more than one-fifth of employer-employee health care spending.

An underlying premise of the Affordable Care Act provisions that encourage employers to adopt health promotion programs is an association between workers' modifiable health risks and increased health care costs. Employers, consultants, and vendors have cited risk-cost estimates developed in the 1990s and wondered whether they still hold true. Examining ten of these common health risk factors in a working population, we found that similar relationships between such risks and total medical costs documented in a widely cited study published in 1998 still hold.

Seven-year trends in employee health habits from a comprehensive workplace health promotion program at Vanderbilt University.

Objective: To assess long-term changes in health risks for employees participating in Vanderbilt University's incentive-based worksite wellness program.

Methods: Descriptive longitudinal trends were examined for employees' health risk profiles for the period of 2003 to 2009.

Results: The majority of risk factors improved over time with the most consistent change occurring in physical activity.

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.

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.

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.