Implementation of a Worksite Diabetes Intervention Service in a Large US Corporation

Henry Ford Health System, Detroit Michigan

Description | Challenge | Solution | Outcomes | ROI | Additional Info | Time Commitment | Lessons Learned | Future Changes

Description

Henry Ford Health System (HFHS) and Chrysler Corporation, thru a grant provided by Novo Nordisk Inc., cooperated in the development of worksite diabetes intervention services at Chrysler’s corporate headquarters and at one Chrysler assembly plant between August 2005 and December 2008. This service arranged for HFHS Certified Diabetes Educators (CDE’s) to meet with Chrysler employees with diabetes at their workplaces to develop action plans to address patient-specific concerns about their disease. The pilot program was designed to provide each employee at least six one-hour sessions with the CDE within a six month period, and to determine if this interaction had any measurable effect on the employee’s hemoglobin A1c (A1c).

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Challenge

Chronic diseases such as diabetes create an enormous burden for employers in terms of lost productivity (as measured by absenteeism and presenteeism, and in short- and long-term disability) and in medical services claims. Likewise, employees with diabetes cannot afford time off from work to attend multiple appointments with various physician specialists to treat their disease. Additionally, some health insurance plan benefit designs do not include coverage for diabetes education or for CDE consultations. Given the opportunity for mutual benefit for employees with diabetes and their employers from better care of chronic disease, the worksite is an ideal venue to provide medical services for such populations.

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Solution

Employees with diabetes (or pre-diabetes) were invited to voluntarily participate in a confidential health screening which included completion of a health risk questionnaire, a blood draw for A1c and lipid profile, and a blood pressure check. They were also provided with information about the pilot program at that time. Employees with A1c’s >= 7% were invited to enroll in the program. Employees were then scheduled to meet with a CDE for one hour each month for a 6 month period. At each session, the employee’s weight and BP were measured, and records of their blood glucose measurements were reviewed by the CDE. The distinguishing feature of this intervention, however, was to engage the employee in conversations about their major concerns about having diabetes, and what they wanted to achieve in terms of change. This then set the course for an action plan to address these concerns over the time of the intervention. This involved discussion of food choices; exercise; co-morbid medical conditions; family issues; stress management; psychosocial concerns; medication management and adherence; interpretation of blood glucose data, trends, and patterns; and other related matters. Discussion often concluded with a plan of action for the employee to work on before the next session, or planning a structured conversation with the employee’s physician at their next office visit.

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Outcomes

Headquarters Data: A total of 127 employees were enrolled during the pilot program, 84 of whom completed the minimum number of sessions and also obtained a 6 month follow up blood draw. The following table provides a breakdown of enrolled employees by A1c value pre- and post-intervention.

The following table summarizes the impact of the intervention; there was a statistically significant improvement in both A1c and in BMI in this population (p<0.05).

*p < 0.05

Assembly Plant Data: The assembly plant intervention was conducted from February 2007 through April 2008. A total of 70 employees were enrolled during the pilot program out of 179 eligible to participate; 22 completed the minimum number of sessions and also obtained a 6 month follow up blood draw. The following table provides a summary of results pre- and post-intervention:

In addition, we were able to measure the difference in lost hours of work for 18 of the 22 employees who completed all six sessions with a CDE at the assembly plant site. This table summarizes the difference in total lost hours between calendar year 2006 (prior to intervention) and 2007 (during the intervention). Factors other than the intervention that may have affected “lost hours” were not measured.

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Additional Information

Implemented at a US automobile company (Chrysler Corporation) with 10,000 employees at headquarters; 2400 employees at the assembly plant.

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Time Commitment

Planning Cycle: 3 months
Implementation time: 1-2 months

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Lessons Learned

Employees with a chronic condition, particularly diabetes, are often unwilling to reveal their condition at the workplace, which may have negatively affected enrollment in this program; in order to achieve success in such an intervention, employees need to be ready to change their behaviors and to actively engage their disease.

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If you implemented this solution again, what would you do differently?

Increase marketing efforts; do not use incentives to ‘increase enrollment’.