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February 8, 2007

Assembly endorses fitness for life proposal

Faculty Assembly last week endorsed a proposal to expand Pitt’s fledgling “fitness for life” initiative, a program designed to encourage individuals to create and maintain a healthy lifestyle.

Launched in 2005, fitness for life awarded Pitt’s UPMC Health Plan subscribers one month’s free health care premium for completing a health screening that measured blood pressure and blood sugar and cholesterol levels.

The success of the incentive — about 40 percent of Pitt health plan subscribers had the screening — led to the formation of the University Senate fitness for life ad hoc committee, which was charged to recommend ways to expand and enhance the program.

Senate Vice President Michael Pinsky, who chairs the ad hoc committee, reported Jan. 30 that the current proposal was designed primarily to promote disease prevention by matching those who exhibit risk factors, particularly for cardiovascular disease (CVD) and type 2 diabetes, with established Pitt and area health treatment and wellness programs.

“There are still a lot of unknowns in this program, but what is known is that most cardiovascular disease is preventable,” Pinsky said. “However, merely identifying those with high risk doesn’t do anybody any good, unless they modify their behavior and enroll in programs associated with addressing the risks.”

A wellness subcommittee is working to identify such programs, Pinsky said.

Strategies recommended by the proposal would encompass:

• Educating the Pitt population through web-based tutorials, small conferences and group therapy sessions designed to lead to healthy living, as well as educating primary care providers with web-based referral services and health-themed conferences.

• Promoting health screening to be overseen by a risk evaluation committee created by the UPMC Health Plan. The screenings would be designed to stratify health plan participants into high-risk and moderate-risk populations.

• Providing lipid consultation services.

• Establishing behavioral interventions for reducing CVD risk factors.

• Establishing CVD and diabetes type 2 prevention mechanisms including dietary interventions, exercise programs, stress reduction programs, lipid-lowering therapies, anti-hypertension therapies, pre-diabetes management and smoking cessation.

• Establishing incentives such as the elimination of co-payments for individuals who participate in risk-reduction plans.

• Monitoring outcomes in preparation for future recommendations.

Under the proposal, health plan members also could take advantage of Pitt’s state-of-the-art electron beam computed tomography (EBCT) scanning device, a non-invasive tool that can predict heart problems even in moderate-risk individuals by measuring intra-coronary artery calcium density, Pinsky said. Calcium in the arteries indicates the presence of atherosclerosis, Pitt researchers have shown.

“EBCT is better than a CT scan with much lower radiation exposure risks,” said Pinsky, who is a professor of critical care medicine. The test now costs about $300 but in cooperation with the health plan that cost could be lowered considerably or even eliminated, he added.

Senate benefits and welfare chairperson Patricia Weiss told the Assembly that her committee “strongly endorses” the fitness for life proposals generally, but had concerns about two recommendations that potentially could entail substantial costs.

“The proposal posits that using EBCT as an adjunct to conventional assessment measures in people at intermediate risk for CVD can improve [identification of] those who will and will not benefit from use of lipid-lowering drugs, thus avoiding the expense and risk associated with their unnecessary use,” said Weiss. It also would increase appropriate use of such drugs, which would lower long-term treatment costs, she said. “However, recent evidence-based guidelines are at best cautiously positive about EBCT for asymptomatic individuals at intermediate risk.”

In addition, Weiss said, UPMC Health Plan’s technology assessment committee as recently as last July reviewed information and literature on EBCT’s effectiveness as a screening tool for healthy and moderate-risk patients and recommended that the health plan not offer reimbursement. The health plan committee also pointed out that EBCT is not being covered by any other health insurance plan nationally, she said.

Weiss said there were two reservations regarding EBCT: the lack of outcomes data available to demonstrate expected cost or safety benefits, and the assumption that all EBCT procedures would be performed at the UPMC Cardiovascular Institute in Oakland.

The latter reservation raises the issue of equity for University community members working or living elsewhere, she said.

Weiss said her committee agrees with the proposal’s attention to prevention therapies and screening follow-ups. That strategy led to the creation of the wellness subcommittee, she noted.

“The [budget and welfare] committee concurs with the emphasis on behavioral intervention and wellness follow-up, since long-term success of fitness for life will hinge on them,” Weiss said. “We see this as an occasion to expand availability and to encourage and potentially subsidize lifelong use of quality resources by the entire University community, not just those at risk for CVD.”

Benefits and welfare recommended that the wellness subcommittee take the following actions:

• Systematize access to behaviorally focused local programs and facilities by creating an online directory with information on these facilities.

• Include on-campus resources of all types that meet criteria of demonstrated effectiveness in achieving desired wellness goals, such as sustained weight loss or exercise programs.

• Create financial incentives for healthy behavior for all University employees, such as reduced membership fees at fitness centers. This would be in addition to incentives for adherence by high-risk people that are mentioned in the proposal.

Pinsky said that the next step was a review of his proposal by Human Resources benefits staff in preparation for negotiations with UPMC Health Plan officials. Pinsky also summarized the proposal at this week’s Senate Council meeting.

In other Faculty Assembly developments:

• Assembly members voted to increase the number of School of Medicine faculty elected to serve as representatives on Faculty Assembly from three to nine. The vote, 22 in favor and six against with one abstention, followed a lengthy debate that included several alternate proposals and a dissenting opinion from Ted Rice, a member of the bylaws and procedures committee.

The proposal was introduced by Thomas Smitherman, chair of the bylaws and procedures committee, which has studied the issue since 2005.

Smitherman also reviewed the background and rationale for the bylaws changes at this week’s meeting of Senate Council, a group that includes senior administrators and staff and student leaders, in addition to faculty members. That group also voted to approve the changes, which will go into effect for the 2008 election season.

• Irene Frieze, chair of the newly formed ad hoc committee for the promotion of gender equity, reported that the group’s mission statement had been formulated and that four issues had been selected for the committee’s initial consideration: enhancement of child care facilities; enhancement of career planning and mentoring programs for staff; recommendations on increasing the number of women in senior administrative positions, and improved opportunities for employment for partners of faculty recruited to Pitt. Subcommittees are being formed to address each issue, she said.

• Frieze has been named as chair of the Senate elections committee.

• John Close, co-chair of the computer usage committee, reported that the recently approved electronic voting process, which will be run through the Pitt portal, complies with the Americans With Disabilities Act, according to officials at Computing Services and Systems Development. (See Dec. 7 University Times.)

Beginning this spring, faculty will vote for their representatives on Faculty Assembly and for officers of the University Senate via electronic ballot for the first time.

Close also reported that a request by the Student Government Board to extend Pitt computer accounts to students beyond graduation was denied by the Provost’s office. “However, students should be aware that graduates can have their email forwarded to another account for up to two years after graduation,” Close said.

• Senate President John Baker reported that, beginning in January 2008, Senate Council meetings will be held the second Wednesday of each month to accommodate the travel schedules of the chancellor and the provost. Currently, Council meetings are held on the Monday following the Tuesday Faculty Assembly meetings.

• Assembly passed a resolution unanimously calling on Senate officers and the University’s administration to work with civic and political leaders in securing funding for the Port Authority, which faces a fiscal crisis.

—Peter Hart

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