Employer-Based Outreach Program for Prediabetes Screening

San Francisco—An employer-based outreach program significantly increased prediabetes screening rates among a group of at-risk employees compared with a control group of people who did not receive any outreach, according to results of a partnership between Kaiser Permanente and an unidentified University and county agency in California. However, two-thirds of the people were not screened even though the program was low-intensity and was meant to reach as wide of an audience as possible.

Sara R. Adams, MPH, the study’s lead author and a senior consulting data analyst at the Kaiser Permanente Northern California division of research, discussed the results during an oral presentation at the American Diabetes Association’s Scientific Sessions on Friday.

“Health plans, employers, clinicians, and policy makers should continue to develop and refine appropriate methods to improve prediabetes screening and care,” Ms. Adams said.

The Kaiser Permanente division of research is participating in the NEXT-D [Natural Experiments in Diabetes Translation] study, a research network studying natural experiments and diabetes prevention and control. In this pilot program, the researchers identified and treated 684 at-risk patients at a University and county agency and compared them with a control group of 1050 at-risk patients at a University and 2 county agencies that did not receive any interventions. The patient characteristics between the intervention and control groups were similar, according to Ms. Adams.

Within 6 months of the interventions, 33% of patients at-risk for prediabetes went in for FPG screening compared with 11% of patients in the control group (P<.001). Approximately one-third of people in each group who received screening had prediabetes. Further 49% of patients in the intervention group and 58% of patients in the control group who had a prediabetes lab value received a clinical response within 6 months.

The authors examined patient characteristics associated with people coming in for screening. They found that people 60 years of age or older were significantly more likely to respond to the outreach than people from 18 to 39 years of age (P=.008). Asian people were also significantly more likely to get screened compared with other races, according to Ms. Adams, as were people who had undergone a fasting plasma glucose (FPG) or hemoglobin A1c (HbA1c) test within the past 5 years or had an office visit within the previous year. The non-significant predictors included gender, geocoded education, geocoded median household income, body mass index, tobacco use, hypertension diagnosis, systolic blood pressure of 140 mg/dL or higher, hyperlipidemia diagnosis, and abnormal cholesterol value.

The authors also evaluated patient characteristics associated with an elevated lab value. The significant predictors were people who were obese, currently smoked, and had hypertension or hyperlipidemia. People who had undergone an FPG or HbA1c test within the past 5 years had a significant reduction in lab value, as did people who had 4 or more office visits within the past 12 months. The non-significant predictors included age, gender, race/ethnicity, geocoded education, geocoded median household income, systolic blood pressure of 140 mg/dL or higher, and abnormal cholesterol value.

Although wellness and prevention programs are more common than they were in the past, their efficacy has not been widely studied. At Kaiser Permanente, the partnerships with employers are facilitated through the HealthWorks wellness program. The companies and HealthWorks collaborate and identify the most pressing health issues and provide relevant activities at the company or online such as biometric screenings, health promotion classes, and rewards programs.

In 2012, after companies expressed concern about diabetes and prediabetes, HealthWorks developed a new program to identify employees at risk of prediabetes and invited them for screening. Employees were considered at-risk if they had hypertension and had not had an FPG test within a year; if they had a body mass index >25 kg/m² and had not had an FPG test within 5 years; or if they were 45 years of age or older and had not had an FPG test within 5 years. Employees with diabetes were excluded.

Based on this criteria, 20% of employees were at risk for prediabetes. In September 2012, the at-risk employees received a letter that identified the risks of high blood sugar levels and requested them to voluntarily come to a Kaiser Permanente lab for an FPG test. People who used their electronic medical record had messages sent through their online accounts. In December 2012, people who did not respond to the initial inquiry were sent a reminder letter and received an automated voicemail message.

—Tim Casey