Secure LoginLink between workforce health and safety and the health of the bottom line
www.ncbi.nlm.nih.gov/pubmed/24013656
Studies have found that comprehensive efforts to reduce a workforce’s health and safety risks can be associated with a company’s stock market performance. Stock market performance of Corporate Health Achievement Award winners has been tracked under four different scenarios using simulation and past market performance. A portfolio of companies recognized as award winning for their approach to the health and safety of their workforce outperformed the market. Evidence seems to support that building cultures of health and safety provides a competitive advantage in the marketplace. This research may have also identified an association between companies that focus on health and safety and companies that manage other aspects of their business equally well. Companies that build a culture of health by focusing on the well-being and safety of their workforce yield greater value for their investors. (J Occup Environ Med. 2013 Sep;55(9):993-1000. doi: 10.1097/JOM.0b013e3182a6bb75)
Chrysotile as a cause of mesothelioma: an assessment based on epidemiology
www.ncbi.nlm.nih.gov/pubmed/16736942
www.ncbi.nlm.nih.gov/pubmed/17534182
There has been a longstanding debate about the potential contribution of chrysotile asbestos fibers to mesothelioma risk. The failure to resolve this debate has hampered decisive risk communication in the aftermath of the collapse of the World Trade Center towers and has influenced judgments about bans on asbestos use. A firm understanding of any health risks associated with natural chrysotile fibers is crucial for regulatory policy and future risk assessments of synthesized nanomaterials. Although epidemiological studies have confirmed amphibole asbestos fibers as a cause of mesothelioma, the link with chrysotile remains unsettled. An extensive review of the epidemiological cohort studies was undertaken to evaluate the extent of the evidence related to free chrysotile fibers, with particular attention to confounding by other fiber types, job exposure concentrations, and consistency of findings. The review of 71 asbestos cohorts exposed to free asbestos fibers does not support the hypothesis that chrysotile, uncontaminated by amphibolic substances, causes mesothelioma. Today, decisions about risk of chrysotile for mesothelioma in most regulatory contexts reflect public policies, not the application of the scientific method as applied to epidemiological cohort studies. (Crit Rev Toxicol. 2006 Feb;36(2):165-87; Curr Opin Pulm Med. 2007 Jul;13(4):334-8) Note: This extensive epidemiology review by Dr. Yarborough has served as a reference for authors in subsequent peer-reviewed scientific journals, including Bernstein et al. (Crit Rev Toxicol, 2013;43:154-183) and Lippmann (Crit Rev Toxicol, 2014;44:643-695), and at least 1 law firm (see http://www.williamskastner.com/practice-areas/litigation-and-dispute-resolution/asbestos/ ).
Alternative methods for determining the incidence, prevalence, and cost burden of coronary heart disease
www.ncbi.nlm.nih.gov/pubmed/22776806
The most appropriate methods for estimating the prevalence and incidence of coronary heart disease (CHD), the associated risk factors, and health care costs in a corporate setting were uncertain. Using medical insurance claims data for the period of 2005-2009 from 18 companies in the Thomson Reuters MarketScan® database, we evaluated three alternative methods. Prevalence of CHD ranged from 2.1% to 4.0% using a method requiring a second confirmatory claim. Annual incidence of CHD ranged from 1.0% to 1.6% using a method requiring 320 days of benefits enrollment in the previous year, and one claim for a diagnosis of CHD. Alternative methods for determining the epidemiologic and cost burden of CHD using insurance claims data were explored. These methods can inform organizations that want to quantify the health and cost burden of various diseases common among an employed population. (J Occup Environ Med. 2012 Aug;54(8):1026-38. doi: 10.1097/JOM.0b013e318256f636.)
Health care delivery by integrating workplaces, homes, and communities
www.ncbi.nlm.nih.gov/pubmed/22453809
In recent years, the health care reform discussion in the United States has focused increasingly on the dual goals of cost-effective delivery and better patient outcomes. A number of new conceptual models for health care have been advanced to achieve these goals, including two that are well along in terms of practical development and implementation-the patient-centered medical home (PCMH) and accountable care organizations (ACOs). At the core of these two emerging concepts is a new emphasis on encouraging physicians, hospitals, and other health care stakeholders to work more closely together to better coordinate patient care through integrated goals and data sharing and to create team-based approaches that give a greater role to patients in health care decision-making. This approach aims to achieve better health outcomes at lower cost. The PCMH model emphasizes the central role of primary care and facilitation of partnerships between patient, physician, family, and other caregivers, and integrates this care along a spectrum that includes hospitals, specialty care, and nursing homes. Accountable care organizations make physicians and hospitals more accountable in the care system, emphasizing organizational integration and efficiencies coupled with outcome-oriented, performance-based medical strategies to improve the health of populations. The ACO model is meant to improve the value of health care services, controlling costs while improving quality as defined by outcomes, safety, and patient experience. This document urges adoption of the PCMH model and ACOs, but argues that in order for these new paradigms to succeed in the long term, all sectors with a stake in health care will need to become better aligned with them-including the employer community, which remains heavily invested in the health outcomes of millions of Americans. At present, ACOs are largely being developed as a part of the Medicare and Medicaid systems, and the PCMH model is still gathering momentum and evolving among physicians. But, the potential exists for implementation of both of these concepts across a much broader community of patients. By extending the well-conceived integrative concepts of the PCMH model and ACOs into the workforce via occupational and environmental medicine (OEM) physicians, the power of these concepts would be significantly enhanced. Occupational and environmental medicine provides a well-established infrastructure and parallel strategies that could serve as a force multiplier in achieving the fundamental goals of the PCMH model and ACOs. In this paradigm, the workplace-where millions of Americans spend a major portion of their daily lives-becomes an essential element, next to communities and homes, in an integrated system of health anchored by the PCMH and ACO concepts. To be successful, OEM physicians will need to think and work innovatively about how they can provide today’s employer health services-ranging from primary care and preventive care to workers’ compensation and disability management-within tomorrow’s PCMH and ACO models. (J Occup Environ Med. 2012 Apr;54(4):504-12. doi: 10.1097/JOM.0b013e31824fe0aa)
Strategic quality planning
www.ncbi.nlm.nih.gov/pubmed/8014712
Instilling the principles of total quality management (TQM) into organizations is a difficult undertaking. Despite this , many leaders of health care organizations are making this paradigmatic change with encouraging results. In this paper, we describe a practical approach that has been successfully deployed within an occupational and environmental health setting. The vehicle for this transformation is called the Strategic Quality Plan. Once the purpose was clearly stated firmly by the leadership, we developed a basic design of the plan that melded two interrelated goals: achieving strategic business objectives by applying quality principles. The combination of objectives became the basis for a detailed mission plan that show the steps, inputs, decision points, deadlines, and continuous improvement loops for each strategic objective. A deployment plan was developed to aid implementation. (J Occup Med. 1994 Apr;36(4):414-8) This work was foundational for setting the assessment framework for the annual Corporate Health Achievement Award that Dr. Yarborough chaired for 7 years (see www.chaa.org ).
Study to assess occupational risk factors following a workplace colorectal cancer cluster
To assess potential etiologic factors among a population of Texas polypropylene workers previously found to have an excess of colorectal cancer (concentrated among mechanical and process workers), the authors conducted an adenomatous polyp case-control study. Cases (n = 24) were workers found to have adenomatous polyps during a company-sponsored colorectal cancer screening program, while controls (n = 72) were workers found to be free of polyps. Exposure assessment utilized a thorough industrial hygiene and toxicologic review of operations in conjunction with work activity interviews of cases and controls to develop chemical-specific exposure scores weighted by time, exposure level, and frequency of exposure. Stratified analyses and logistic regression found that cases tended to have higher exposure to pre-extrusion polymer plus additives (odds ratio (OR) = 2.6, 90% confidence interval (CI) 1.1-6.3) and higher exposure to certain finishing additives (OR = 4.8, 90% CI 1.5-15.3). Analyses by job category or area of the plant did not indicate additional risk factors. The exposures identified in this study are discussed in light of the available toxicologic data on these and related compounds. (Am J Epidemiol. 1991 Feb 15;133(4):357-67. PMID: 1994699)
Agent Orange Case-Control Study
Dr. Yarborough was one of two main diagnosticians in a ground-breaking case-control epidemiology study by Lathrop G, et al., entitled, “The Air Force Health Study. An Epidemiologic Investigation of Health Effects in Air Force Personnel Following Exposure to Herbicides.” In this role he performed complete medical assessments for approximately 800 Vietnam veterans to document valid health outcomes for the data set for statistical analyses. The report was published: First Follow-up Examination Results. Final Report. USAF School of Aerospace Medicine. (NTIS AD A 188 262), 1987 Air Force Health Study, NTIS document no. AD A 188 262)