1. The Cost Savings and Enhancements of a District’s Wellness Program A Case Study from Broward Presented by: Kay Blake, Training Supervisor Tina Severance-Fonte, Wellness Coordinator

2. 1 Partnerships Broward County District Schools - Pupil Transportation Department - Benefits Department / Wellness Unit

3. 2 Creating Partnerships Identify key partner in Transportation Dept. (Facilitator) Identify key partner in Benefits Department (Facilitator) Solicit approval from Directors (Champions) Identify staff member(s) at each work-site to coordinate activities Dialogue

4. 3 Benefits of a Wellness Program Decreased Absenteeism and Tardiness Increased Employee Engagement Boost Morale Positive Publicity National Recognition

5. 4 Wellness Case Study 1 Organize local gym to conduct bi-weekly classes Develop core group Add gym work-out to weekly program Develop strategies to facilitate engagement

6. 5 Primary Study Objectives Evaluate the impact of a hypertension educational initiative, the Blood Pressure (BP) DownShift Program, for the CDL employee study population with respect to hypertension (HTN) awareness and control Measure the prevalence of hypertension in a sample of the study employee population (as diagnosed by a health care professional) Measure the prevalence of high BP among drivers not diagnosed with hypertension Characterize hypertension control in a sample of the employed CDL population (based on both DOT and JNC 7 Guidelines) Wellness Case Study 2

7. 6 Objectives Secondary Study Objectives Describe the CDL population enrolled in the BP DownShift Program (BPDS) at baseline and 6-month follow-up  Over time: Baseline (August, 2007) vs. Follow-up (May, 2008)  Age categories  Body Mass Index (BMI) categories  BP measurement  Cardiovascular risk factors  Self-management behaviors Understand study participants’ behavioral practices to manage their blood pressure Evaluate participant awareness of hypertension management Assess employee satisfaction with the BP DownShift Program

8. 7 SystolicDOTJNC 7 < 120 Normal 120 – 129 Pre-hypertension 130 – 139 140 – 159Stage 1 160 – 179Stage 2 > 179Stage 3 DiastolicDOTJNC 7 < 80 Normal 80 – 84 Pre-hypertension 85 – 89 90 – 99Stage 1 100 – 104 Stage 2 105 – 109 > 109Stage 3 Hypertension Guideline Definitions – Summary The table below shows how each Guideline (DOT and JNC 7) classified CDL employees based on systolic and diastolic blood pressure levels.  If a blood pressure score corresponded to two different categories based on the systolic and diastolic measures, then it would be classified as the riskier category. Although the DOT Guidelines are used as criteria on the CDL medical exam, JNC 7 provides BP classifications based on clinical guidelines relevant in a managed care setting. JNC 7 provides more specific BP information by sub- dividing the large “Normal” category under DOT into “Normal and “Pre- hypertension”. This classification provides more information to employers, who can then potentially target employees who fall within this category.

9. 8 Profile of Screened Study Population: Baseline vs. Follow-Up The table below provides a profile for the sample of Broward School District bus drivers at study baseline (N=208, August 2007) compared to the follow-up sample screened in May 2008 (N=120) Baseline mean BP for the follow-up study sample (n=120), at 145/87 mmHg, was similar to that of the entire baseline population (n=208) Risk Factors Baseline Population (N=208) Follow-Up Population (N=120) Systolic (mean)144 mmHg135 mmHg Diastolic, (mean)86 mmHg82 mmHg Female73% Age (mean)49 years50 years BMI (mean)32 kg/m 2 African-American 76%72% Prior HTN Diagnosis 1 54%58% AHY Medication Use among diagnosed HTN drivers 2 61.3%62.5% 1 Among persons who participated in the baseline BP DownShift survey (n=138) or the follow-up survey (n=96). 2 Based on self-report among persons who indicated a prior physician diagnosis of hypertension (n=75, baseline, and n=56, follow-up)

10. 9 DOT Classification of BP Among Screened Population: Baseline vs Follow-Up While 40% of drivers were classified as having normal BP based on DOT classification at baseline, 58% were classified as normal at follow-up Fewer drivers were classified as Stage 2 HTN at follow-up, and no drivers were classified as Stage 3 HTN at follow-up % of CDL Employees Stage 3, 0%

11. 10 BP Control: Baseline vs Follow-Up BP control (<140/90 mmHg) improved from 40% at baseline, to 58% at follow-up

12. 11 DOT Classification of BP Among Diagnosed and Treated Participants: Baseline vs Follow-Up Among participants with a prior diagnosis of hypertension who reported current use of AHY (antihypertensive) medication, 57% were controlled to ‘normal’ levels according to DOT at follow-up, compared to 24% at baseline. Stage 3, 0%

13. 12 Difference in systolic and diastolic BP among participants: Baseline vs Follow-Up  Among drivers with BP measured at baseline and follow-up (n=120), 42% had a reduction in systolic BP >10mmHg, while 44% had a diastolic BP reduction >5 mmHg Decrease from Baseline (mmHg) Decrease from Baseline (mmHg) Increase from Baseline (mmHg) Increase from Baseline (mmHg)

14. 13 Hypertension Self-Management Behaviors: Baseline vs Follow-Up In the subset of drivers who reported a prior diagnosis of hypertension (n=75, baseline, and n=56, follow-up), an improvement in the proportion reporting all self-management behaviors was evident at follow-up *Question was not included on the baseline survey.

15. 14 Hypertension Self-Management Behaviors: Baseline vs Follow-Up (cont’d) While among diagnosed hypertensive drivers, the rate of anti- hypertensive medication usage remained the same, drivers indicated more diet or exercise at follow-up as a means to control BP

16. 15 Key FindingsKey Finding Study results indicate a positive impact of the BP DownShift Program on the Broward County school bus driver population At baseline, the mean BP of the study sample (n=208) was 144/86 mmHg, compared to 135/82 mmHg at follow-up (n=120) 58% of all participants were controlled to BP <140/90 mmHg at follow- up, compared to only 40% at baseline Among diagnosed hypertensive participants, 57% were controlled to <140/90 mmHg at follow-up, compared to 25% at baseline Participants with baseline and follow-up BP measurements (n=120) had a mean decrease of 10.2 mmHg systolic and 4.7 mmHg diastolic 42% had a reduction in systolic BP >10mmHg, while 44% had a diastolic BP reduction >5 mmHg At follow-up, over half (52%) of participants were classified as obese based on self-reported height/weight Overall, participant self-reported weight did not change from baseline to follow-up

17. 16 Key FindingsKey Finding Compared to baseline, the proportion of drivers with a hypertension diagnosis who practiced self-management behaviors (such as BP monitoring, exercise, and diet) increased An increase in exercise frequency since BPDS enrollment was observed among participants who report exercising to control BP The proportion of diagnosed hypertensive drivers using AHY medication remained the same at follow-up 58% report a high level of medication compliance Initiatives targeting increased antihypertensive medication use may improve BP control in this population Survey results at follow-up indicated a high level of participant satisfaction with the BP DownShift Program and the health and wellness program

18. 17 BP DownShift Survey Results at Follow-Up (n=96) 93% of drivers who responded to the survey indicated that they had made changes in their blood pressure management based on BPDS 82% said that they suggested that a family member with hypertension make changes in their BP management based on BPDS 77% of survey respondents who exercise to control their BP said that they exercise more often since BPDS enrollment 37% of respondents who take antihypertensive medication reported a change in BP medication regimen during the past 6 months 81% of survey respondents indicate that they monitored their BP, compared to 56% of the baseline study sample At follow-up, 40% indicated daily BP monitoring, while 42% measure BP at least once a week 73% monitor BP at home, and 44% monitor BP at work 26% of BPDS participants indicated that they visited the BPDS website 15% of participants registered to receive additional materials from the website

19. 18 BP DownShift Satisfaction Survey Results at Follow-Up (n=96) BP DownShift Program Percent responding ‘Agree’ or ‘Strongly Agree’ I am satisfied with the quality of the BP DownShift Program. 97% The content of the educational material was easy to follow and understand. 96% The materials were interesting and informative. 94% I feel that the number of mailings was satisfactory. 89% I took my enrollment in the BP DownShift Program seriously and made every effort to fully participate. 94%

20. 19 BP DownShift Satisfaction Survey Results at Follow-Up (n=96) BP DownShift- Employer/Other Percent responding ‘Agree’ or ‘Strongly Agree’ I feel that the BP DownShift Program was a good benefit offered by my employer. 94% I feel that the health and wellness program offered by my employer will help me to live a healthier life. 93% I would recommend this program, or one like it, to a co-worker or a family member. 92% I feel that the BP DownShift Program offered by my employer will help me to live a healthier life. 96% Overall, I am satisfied with the quality of the BP DownShift Program & the benefits it provided me. 93% I recognize the importance of living my life in a healthier manner. I will continue to strive for better health. 94%

21. 20 Questions ????????????