Online Program

Diabetes and work force productivity: An assessment of diabetes-related productivity losses among type II diabetes patients in central Texas

Sunday, November 3, 2013

Omolola Adepoju, MPH, Department of Health Policy & Management, School of Rural Public Health, Texas A&M Health Science Center, College Station, TX
Robert Ohsfeldt, PhD, Department of Health Policy and Management, TAMHSC, COLLEGE STATION, TX
Hongwei Zhao, ScD, Epidemiology and Biostatistics, Texas A&M School of Rural Public Health, College Station, TX
Charles Phillips, PhD, Department of Health Policy and Management, Texas A&M Health Science Center, College Station, TX
Samuel N. Forjuoh, MD, DrPH, FGCP, Department of Family & Community Medicine, Scott and White, Texas A&M HSC College of Medicine, Temple, TX
Jane N. Bolin, PhD, JD, RN, School of Rural Public Health - Health Policy & Mgmt. Dept., Texas A&M Health Science Center, College Station, TX
Study Objective: This study estimates: 1) the productivity-related costs associated with employee absence on the job due to a diabetes-related hospitalization, 2)the productivity losses associated with diabetes-related disability, and 3) the productivity losses associated with employee presence on the job (reduced productivity while on the job and/or reduced time at work due to diabetes-related ambulatory care visits). We model total productivity loss (sum of 1,2,3) as a function of identified demographic and clinical characteristics.

Methods: Data were obtained from electronic medical records (EMR) and survey responses of 376 adults aged 18 or older who consented to participate in a randomized trial of Type 2 diabetes self-management programs in Central Texas. All study participants had uncontrolled diabetes and were randomized into one of four study arms: personal digital assistant diabetes software(PDA), Chronic Disease Self-Management Program(CDSMP), combined PDA and CDSMP (COM), and controls. The study lasted two years. EMR were used to estimate 1) employee absence on the job due to a diabetes-related hospitalization using length of stay over a one-year period. A multiplication factor from the literature was used to estimate 2) employee absence on the job due to diabetes-related disability. 3) Reduced productivity and time on the job are estimated using survey responses on impairments that limit work and EMR on the number of diabetes-related ambulatory care visits. The human-capital approach to estimate lost productivity is used to cost components 1, 2 and 3, which are summed to obtain total productivity loss. Using robust regression, we model total productivity loss as a function of different diabetes self-management programs, as well as other identified demographic and clinical characteristics.

Results:Compared to the controls, there were no statistically significant differences in productivity losses among persons undergoing any of the three diabetes-management interventions. Males were associated with higher productivity losses (+$708/year;p<0.001). Persons with greater than high school education were also associated with additional productivity losses (+$758/year;p<0.001). Persons with more than 1 comorbid condition were marginally associated with lesser productivity losses (-$326/year; p=0.055). Compared to non-Hispanic whites, there were no statistically significant differences among persons of Hispanic or African-American descent. Neither higher baseline HbA1c values nor longer diabetes duration were significantly associated with productivity losses.

Conclusions: We are unable to find evidence the chronic disease management programs examined in this trial control indirect productivity losses. Persons with chronic conditions such as diabetes may continue to work despite their illnesses, until they are unable to work.

Learning Areas:

Biostatistics, economics
Chronic disease management and prevention
Conduct evaluation related to programs, research, and other areas of practice
Implementation of health education strategies, interventions and programs
Public health or related research

Learning Objectives:
Assess the impacts of chronic disease management programs for patients with type 2 diabetes on productivity-related indirect costs of the disease

Keyword(s): Diabetes, Economic Analysis

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I a doctoral student in Health Services Research, with a focus on health economics. My research areas include chronic disease management and research methods to address health disparities.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.