What causes chronic disease? Doctors have long known that stress can trigger disease, make medical conditions worse, and create barriers to obtaining appropriate health care. Now UNM employees who have UNM health providers might get the chance to manage that stress in a way that can reduce the cost of their healthcare.
"There is a relationship between adverse events and health in people's lives," said Deborah Helitzer, director of the UNM School of Medicine Office of Evaluation. Helitzer is Assistant Dean for Research at the SOM and Vice Chair for Research within the Department of Family and Community Medicine. Helitzer is leading a team of researchers at the Health Sciences Center to investigate whether UNM employees and their health providers can work together to discover the underlying basis for some chronic diseases and increase their well-being in the process. Healthcare providers in the departments of Pediatrics, Psychiatry, Family and Community Medicine, and Internal Medicine are participating in the project.
"We know that stress definitely affects a person's physical health as well as their mental health," said Helitzer. "For example, stress and depression are both conditions that can make a patient more prone to being distracted and more prone to being involved in accidents."
Helitzer has received one of 17 grants awarded by the Centers for Disease Control as part of the $21.7 million, "Health Protection Research Initiative," a program designed to develop workplace strategies to increase physical activity, improve diets and nutrition, and reduce obesity.
Her project, "Computerized Risk Assessment in an Employee Population," is a three-year grant that will test the effectiveness of an interactive behavioral and health risk assessment system to be used by UNM employees who have UNM health providers.
"We're hoping that by talking to your health provider about what is really going on in your life - for instance, if you have a family member in jail or think you may be facing an imminent divorce then the employee and provider, as a team, may be able to map out a plan for facing that stress and its impact throughout the year," she said.
Employees participating in the study will be randomized into two groups, an intervention group and a control group. Patients in both groups will complete an eight-part 40 minute health and behavior risk assessment of their medical and mental history; current and prior life situation, and prior health system use. The patients and providers in the intervention group will review a profile of the patient's response together during an annual physical appointment and negotiate a treatment plan that takes the identified health risks into account The patients in the control group will also have an annual physical appointment but the results of the risk assessment will not be available for the patients and physicians to discuss.
Primary care providers participating in the study will also be randomized into two groups. The intervention group providers will be specially trained in communication techniques and topics that are contained in the risk assessment. Providers in the control group will receive the training at the end of the study. Both groups of providers will be given local resources for referral and additional information to share with their patients on the risk assessment topics.
"There are lots of risk assessments out there. But what makes ours so different is that its purpose is primarily to provide information to improve the communication between a patient and their health provider. We believe that the risk assessment results will help to focus the conversation and help the patients talk about what's really going on in their lives things that they are not used to discussing with their providers. In this way they can sit down together and make a game plan to address these issues for the coming year," said Helitzer.
"There are things people can do if they have the resources to counteract chronic disease. We see this as an opportunity for employees to really work together with their health provider to reduce the risk of complications from chronic diseases," she said.
"And, we should be able to quantify this by tracking changes in health outcomes and changes in employees' utilization of health services.
Part of the study is to test a hypothesis that such a game plan will result in fewer trips to the emergency room. Another assumption is that addressing underlying reasons for poor health over the long term will increase employee management of their health, decrease absenteeism or sick leave days, and decrease "presenteeism" or being on the job and feeling sick and therefore unable to do your job effectively. In both cases, as the employer, the university could potentially save money The department has just completed a pilot study on the risk assessment tool to test the questions and make sure that they are easy to answer. The study showed that people believed the questions are very important and that they would want their providers to have this kind of information. The risk assessment is now being computerized by a team of experts at the Health Sciences Library and Informatics Center.
One of the CDC's goals is to fund research that could produce science-based recommendations that could be adopted by health departments, health care providers, employers and policy makers. "We are also collaborating with the New Mexico Department of Health which means that if this study shows an impact, the potential is that every employee work place in the state would have access to this system," Helitzer said.
"It is exciting to us that we have the opportunity to contribute to the ways that individuals can control their own health as well as possibly shape the way health care will be provided nationally in the future," she said. "We're in the big leagues with this, research institutions such as Harvard, Washington, University of Michigan and Cornell competed with us for this grant. We have a unique population here and therefore a special opportunity to contribute to the understanding of how we can improve health care utilization for special populations.
"We don't know what will happen," Helitzer stressed. "It might be that costs will go up in the short-term if a person is getting more regular health care, yet three to five years later the overall costs to the system might be reduced."
The research project is something apart from Lobo Care which is administered by the UNM Human Resources Department, but is designed to have an impact on the way that UNM thinks about health care for its employees.
Only UNM employees who have UNM health providers are eligible to participate in the study. Only UNM employees who have UNM health providers are eligible to participate in the study. Recruitment should begin in the fall. Employees should look for a letter from their UNM primary care provider inviting them to participate in the study.
Contact: Cindy Foster, 272-3322