who test 2
Heart Check
- Developed in 1994 - Usually takes 30-45 minutes to complete - Used in over 1,000 companies to date - Inverse relationship between Heart Check scores and employee risk factors - Demographics may predict Heart Check scores - Larger companies - Industry differences - Presence of unions
Information on Productivity - Newer versions of HRA include questions addressing ______issues - ______ - Inability to concentrate
- Newer versions of HRA include questions addressing productivity issues - "Time off task" - Inability to concentrate
Advantages of Health Risk Appraisal (HRA) instruments - Use previously validated_____ and questions - Provide system to _____ or compile results in a computerized database - Can provide aggregate data summarizing major ____ in different segments of the population - Provide built-in method to provide _____- feedback
- Use previously validated instruments and questions - Provide system to track or compile results in a computerized database - Can provide aggregate data summarizing major risk factors in different segments of the population - Provide built-in method to provide personalized feedback
Calculating Preventable Claims Step 2: Determine % of Employees with Risk Factor: Average Company # Risk Factors Percent 0 _____ 1 _____ 2 to 3 _____ 4 to 5 ______ 6+ ______
15% 28% 43% 12% 2%
Example: Heart Check
226-item survey Tobacco Control Nutrition Physical Activity Stress Screening Administrative Support Organizational Foundation
Calculating Preventable Claims Step 5: Compare to a Healthy Benchmark Company: Benchmark Company - "Healthy Company" A company using PWP and running a wellness program for four years. - Using this company for a benchmark gives a "realistic" estimate of preventable claims or $_____per employee/year
239
MI Tips
Ask Evocative Questions Explore Decisional Balance Good Things/Not-so-good Things Ask for Elaborations/Examples Look Back Look Forward Query Extremes Use Change Rulers Explore Goals and Values Come Alongside
_____ - The true power for change rests within the client - Only ________ can follow through - Responsible for own actions - Develop a "menu" of options
Autonomy: client
Why Conduct Needs Assessment? Baseline evaluation - follow-up study Determine collective ____in the population Identify ______ for targeted programs Identifying participant's _______ Provide means for individualized ______ Provide exposure and _____ of program
Baseline evaluation - follow-up study Determine collective needs in the population Identify high risk population for targeted programs Identifying participant's "readiness to change" Provide means for individualized feedback Provide exposure and margeting of program
Change Talk: Darn Cat
Desire: I want to change Ability: I can change Reason: It is important to change Need: I should change Commitment: I will make changes Activation: I am ready, prepared and willing Taking Steps: I am taking specific actions
Recommendations for Behaviorally-based HRAs: - HRA should provide feedback designed to correct the user's inaccurate _____ of their own risk - HRA should provide feedback that establishes behavior change _____ when multiple risks exist - HRA should provide feedback that enhances the user's ____ to make recommended health behavior change.
HRA should provide feedback designed to correct the user's inaccurate perception of their own risk - HRA should provide feedback that establishes behavior change priorities when multiple risks exist - HRA should provide feedback that enhances the user's ability to make recommended health behavior change.
Common Assessments in Worksite Health Promotion
Health Risk Appraisals Total Worksite Assessment Biomedical Screenings Health Interest Survey
Justification for Programming Longitudinal data from HRA gives you, the health______, evidence for _____d and, hopefully, evidence of _____
Longitudinal data from HRA gives you, the health professional, evidence for need and, hopefully, evidence of efficacy
HRA: Snapshot of Health Status Most helpful when combined with _____ Many employees may not know much about their ____ - Raise awareness Can call attention to ____ habits
Most helpful when combined with biometric screening Many employees may not know much about their health status - Raise awareness Can call attention to unhealthy habits
Sources of Information for Rationale: ____ assessment _______ data Merits _______ to other programs ______ of other successful programs Survey ______ programs _______ with other state/national goals
Needs Epidemiological common Results competitors' Compatibility
Health promotion programs can yield economic benefits for a company (savings are greater than the costs) Can we deliver this kind of program for less cost than we can realisticaly expect to save? To answer this we will first look at a method for determining the preventable cost opportunity for a given population. If you search the literature for evidence of cost benefit from wellness prgorams, you will find stories of a number of different organizations and ROI estimates cited at various levels starting around $3 to $1 and up to as high as $10 to $1 in some examples. The questions raised (but seldom answered) in these anecdotal accounts of cost benefit are a) At what investment level do you begin to receive this ______? and b) At what point do you reach ________s on your wellness investment?
ROI diminishing return
Gender diversity: • ______ of women and men within organizations, industries and sectors • Relative representations of women and men within the _____ • Differing effects of work requirements by gender Ex: Working overtime has been associated with increased risk of CVD in women but not in men
Relative representations power structures * Women currently hold 5.2% of Fortune 500 CEO positions and 5.4% of Fortune 1000 CEO positions
Example of Benefit Cost Analyses:
Savings from reduced absenteeism (per employee) $303 Savings from medical costs (per employee) $217 Total savings (per employee) $520 Cost of Program Implementation (per employee) $485 Benefit / Cost Ratio = 520 / 485 = 1.07
Average Claims by Number of High Risks Time 1 vs. Time 2
This chart compares the average claims by number of high risk factors from time 1 to time 2 for the subgroup of the population (N=242) who attended a self-care education program and participated in an exercise incentive program. The average claims for participants with 6+ high risks fell from $2,866 at time 1 to $2,713 at time 2. The average claims for participants with 4-5 high risks fell from $2,313 at time 1 to $1,725 at time 2. The average claims for participants with 2-3 high risks fell from $1,188 at time 1 to $1,000 at time 2. The average claims for participants with 1 high risk fell from $861 at time 1 to $705 at time 2. The average claims for participants with 0 high risks remained virtually unchanged at $761 at time 1 and $764 at time 2. This data shows that this group had a reduction in average claims in almost every risk category. This suggests that even when participants did not reduce their risks the programs they participated in may have helped them to make better choices as health care consumers.
Percent of Population by Number of High Risks Time 1 vs. Time 2:
This chart compares the distribution by number of high risk factors from time 1 to time 2 for the subgroup of the population (N=242) who attended a self-care education program and participated in an exercise incentive program. The percent of the group with 6+ high risks fell from 4.55% at time 1 to 2.89% at time 2. The percent of the group with 4-5 high risks remained exactly the same at 7.85%. The percent of the group with 2-3 high risks fell from 45.45% at time 1 to 38.02% at time 2. The percent of the group with 1 high risk went up from 24.79% at time 1 to 30.58% at time 2. The percent of the group with 0 high risks went up from 17.36% at time 1 to 20.66% at time 2. This data shows that there has been a strong improvement in the health profile of participants in the exercise incentive program who received the follow-up education program on self-care.
Average Claims for Participants and Non-Participants Time 1 vs. Time 2
This chart shows the average claims from time 1 to time 2 for the subgroup of the population (N=242) who attended a self-care education program and participated in an exercise incentive program compared to the average claims from time 1 to time 2 of people who did not participate in either follow-up program or the wellness assessment. The average claims for the subgroup of the population (N=242) who attended a self-care education program and participated in an exercise incentive program fell by $229 per person from $1,197 at time 1 to $968 at time 2. People who did not participate in either of the follow-up programs or the wellness assessment experienced an increase in average claims of $97 per person going from $1,193 at time 1 to $1,290 at time 2. With a net difference of more than $300 per person between participants in the wellness assessment and follow-up programs and non-participants it appears that there is significant cost benefit from participation in the wellness activities.
Balancing Cost and Savings:
This slide shows that as elements are added to the wellness program model, costs go up. The cost curve is not meant to show actual program costs but just illustrate a general concept.
Preventable Claims Analyses: Preventable Claims Progress Profile Time 1 vs. Time 2 Comparison for PWP Participants (N = 242)
We now have a sound theoretical basis for expecting cost benefit. The big question of course is - Does it actually happen in the real world? The following slides profile a specific subgroup of participants identified by their participation in an exercise incentive program and a follow-up education program on self-care from an employee population in an agricultural company. Each individual's initial wellness assessment data is matched with their medical claims data from the preceding year. The following year's assessment data for these same participants are then matched with that year's medical claims data for analysis of the impact of the group's participation in health promotion activities. Charts Include Time 1 vs. Time 2 Comparisons of - Percent of Population by Number of Risk Factors Average Claims by Number of Risk Factors Average Claims of Target Group vs. Non-participants
How Much of a "Dose" of Health Promotion is Needed to Produce a Benefit?: 5. counseling and support 4. treatments for high risk populations 3. incentive program 2. information/ classes 1. screening and feedback
Wellness programs that achieve the desired outcomes of both health improvement and cost benefit almost always share five key elements. These five elements represent the core components of a comprehensive wellness and prevention system. These elements appear to be essential if we expect a positive return on our investment in wellness. Most wellness programs launched with the hope of cost benefit fall well short of having the following essential elements: 1) A wellness assessment to identify the needs for both the individual and the group as well as provide a prevention database for targeting the best opportunities for success in the population 2) Personal and Aggregate Goal Setting to give the individual and group direction 3) A variety of different opportunities for participation in health improvement programs 4) A means of monitoring progress, and providing feedback to keep individuals on track with their goals and for use in evaluating what works and what doesn't 5) An outcomes analysis strategy to measure results, justify the program, and provide marketing ammunition for expanding the service.
Non-Experimental Design One Group Posttest: Typically used for satisfaction or behavior surveys Survey is administered ________ the program/intervention Participants report satisfaction with program and self-reported behavior change Lack of baseline for comparison limits conclusion intervention-> post test
after
Monitor Population Health Status: ______________ report to employer Assess collective health trends _________________ - Demographics - Risk level - Interest trends - Behaviors, attitudes and perceptions - Readiness level
aggregate over time
partnership______________ is between therapist and client Not: Confrontation, Expert Build rapport and trust - Does not mean you always agree
collaboration
Definitions of MI Lay: Collaborative_____ to strengthen a person's own motivation for and commitment to change Technical Therapeutic: Collaborative, goal-oriented method of communication with particular attention to the ____ of change. Designed to strengthen an individual's motivation for and movement toward a specific goal by eliciting and exploring the person's own _____ for change
conversation language arguments
Health Risk Appraisals: - Originally developed to estimate probability of ___________ - Recently used as systematic method of gathering information about a population - Can serve as a ___________________ - Can provide aggregate data summarizing major risk factors
death marketing tool
Ex 3: Environmental Assessment Tool 100-item - Physical Activity - Nutrition and Weight Management - Organizational Characteristics and Support Research has shown that high EAT scores correspond with ____________________________ and emergency room payments
decreases in paid absenteeism
What information is needed? ______ information Health ____ Health _____ Health ____ readiness for _____ behaviors _____ and interests - Preferred ways to receive information - Level of interest in specific health topics - Where and when to hold activities - Likelihood of participating
demographic staus history behaviors changing preferences
Quasi-Experimental Design Ex Post Facto (Posttest only w/ Control): - Compare characteristics of participants after they complete a program with a similar group of people who ________________in program. - A major limitation is that the "matched" control group may not be equivalent treatment-post test control-post test
didn't enroll
Health Risks and Medical Claims : - Relationships verified in different populations - Relationship exhibits "_____-_______" characteristics - Relationships found to be more extreme for individuals with _____________ risk factors - Relationship is inverse when costs are related to "wellness scores"
dose response multiple
Track Over Time: - _________ identification; not surprised by sudden adverse health events - Similar to tracking an investment portfolio - Annual health assessment can help identify __________ changes Ex: May not notice if weight increases 1-2 pounds per year. Probably will notice 10-20 pounds over 10 years. Ex: May not notice systolic blood pressure increase of 2-4 mmHg per year. Probably will notice 20-40 mmHg over 10 years.
early gradual
Factors to Consider When Selecting an HRA instrument: - Does it fulfill needs - Immediate feedback? Online access? - Adequacy of scientific basis - ______ of participation - Appropriate and complete questionnaires - Use of _____________________ - Availability of aggregate and group data - System considerations (upgrades etc...) - Customer service
ease individual reports
Socioeconomic diversity: • Representations of persons from all _____ and ______ backgrounds - Particularly marginalized groups, including social class
economic sociodemographic
Principles of MI Express ______ Support self _____ Roll with _____ Develop ______
empathy efficiency Resistance Discrepancy
Engage Employee AND Employer: What's in it for me?" ____________: - Information about personal health - Ideas for change - Validation of behavior improvements ____________: - Information about health of company - Ideas for programming - Support for programming
employees employers
Evaluation is Critical for Evaluating Savings and Determining Cost Effectiveness: failure to _____ failure to _____ outcomes inadequate use of ____
evaluate track data
- Therapist helps to draw out client's own ideas - Draw out motivation and skills for change
evocation
Calculating Preventable Claims Step 4: Calculate Excess Medical Claims: Potential preventable claims equals any _______ ______ (costs above that of persons with 0 risk factors) For example: If you have 2,500 employees and average claims = $1,104 and cost for employees with 0 risks = $408 then excess claims are $____ per employee
excess costs 618
Summary of Research Design Issues: True _____designs are the best approach but they require money, time and expertise. Quasi experimental designs can be effective if efforts are made to control for alternative explanations. - Using a control group controls for _____ - Blinding of research staff and participants prevents ____ When using non-experimental methods, be aware of the limitations for _____you use
experimental self-selection bias methods
Total Worksite Assessment: Assesses not only individual employee health status, but other ________________________that may help or inhibit healthy behaviors
factors in the organization
Individual Approaches for Worksite HP: - Employer sponsored _____________ - Fitness and ______________for employees - Individualized health risk appraisals - Educational programming for employees - Individual _____________ on healthy lifestyles - Group courses on healthy lifestyles
fitness center health screening counseling
Tips for Gaining Support: - Use _______and open-ended surveys to query for interests of target population - Involve ______ in the planning process - Propose initial ____ phase to allow program to start small - Build success into programs by including short term ______ in evaluation
focus groups "decision makers" pilot outcomes
What is a Needs Assessment? "The process by which the program planner identifies and measures ____ between what is and what ought to be" "A planned process that identifies the reported _____ of an individual or a group."
gaps needs
Four types of diversity: - ____ -race and ethnic - ____- - cultural
gender socioeconomic
Poor Generalizability of Program Effects: Results of program effectiveness may not __________ from one study to another and one population to another.
generalize
Rationale for Worksite Health Promotion Programs: 1. Preventable health risks are associated with higher corporate ______________costs. 2. The prevalence of preventable health risk factors can be ____________ through a comprehensive worksite health promotion program. 3. Health promotion programs can yield economic benefits for a company (savings are greater than the costs)
health care reduced
Gaining Support from Management: 1. Become familiar with the potential values and benefits associated with HP. 2. Determine which potential values and benefits are _________________________. 3. Be aware of the ___________________for the values and benefits you have decided to focus on. 4. Document and present rationale for program to decision makers. 5. Evaluate the results in terms of the level of resources and support provided for HP programs.
important to management quality of evidence
Organizational Approaches for WHP: - Providing _________ for employees to adopt healthy lifestyles - Implementing changes in _________ and regulations - Creating changes in structure of work - Making environment more conducive to healthy living - Management support that creates a healthy subculture
incentives rules
Heart Check Lite(s): - Heart Check's length may be prohibitive in some situations - Developed two shorter versions - 55-item - 27-item - Results showed strong relationships of the two new versions to the original - While the full HC is preferred, the shorter versions may be useful in ____________________situations
large scale surveillance
Threats to Internal Validity: - Regression toward the _______ - Extreme values tend to move toward the average. - Diffusion of treatments - Spillover effects from treatment group to control group. - Testing - The act of testing may affect the outcome of interest ("Hawthorne Effect"- just by measuring will affect outcome)
mean
Why Programs Should be Evaluated: Program evaluations support a business case for the program (preventable claims) Program evaluations provide ongoing ______________ and measurement to improve program performance Program evaluations offer ________ of whether program is achieving objectives Program evaluations contribute to the science of organizational and individual change
monitoring evidence
Types of Needs
needs of company vs needs of individual
Research Designs in Intervention Research: ____-Experimental - Do not have a control group ______-Experimental - Non-randomized or non-equivalent control group Experimental - _____________ control group
non quasi randomized
Advantages of Screening: - Provides ________________________of health parameters rather than self-reported information - May provide greater "alarm" for individuals at risk since the information is more concrete
objective indicators
OARS
open ended questions affirmations reflections summaries
In what type of industries, settings, or work ____________ does a particular intervention work? What is the expected __________ of effect? Does the effect differ by gender, age, job classification, ethnic or racial group? _____________are effects likely to last?
population magnitude how long
Choices of Outcome Measures: - Select ______ outcome measures based on the goals and needs of the organization (and decision makers). - Align health promotion goals with the company mission. - ___________ outcome measures into easily understood metrics to enhance understanding
primary translate
Quasi-Experimental Design Pre- and post-test w/ comparison group : - Compare effect of program at 2 time points - Lack of ________ assignment to study and control groups can bias results pretest- treatment; control-post test; post test
random
Experimental Design: - ______________________subjects into control and experimental groups - Pretest and posttest observations made Example: - Compare sites with and without health promotion programs randomization -> pre test-> treatment; control-> post test; post test
randomly assigned
An overall improvement in health will result from the combination of these events within the workforce: A _______________________behaviors - smoking, binge drinking An ________________ in behaviors that promote health - regular exercise, better nutrition An improvement in the ____________ of modifiable or treatable health conditions - high blood pressure An improvement in _________________ workers' existing health conditions - diabetes
reduction in unhealthy increase detection managing
Levels/Types of Evidence for WHP: Type 1: Helps to identify and explain _______________ among the cause of disease, the development of disease, and the effect of disease on the population - Ex: Studies on the link between Tobacco and Health Type 2: Informs the decision maker as to the effectiveness of a ___________________in improving health Type 3: Provides information regarding the ________________ of a policy or intervention - - The how-to
relationships specific intervention implementation
ROI Analyses: - _____________________________are used to determine if WHP programs actually save the company money - How is this determined? - Compare program savings (benefits) are compared against program expenses (costs)
return on investment analyses
Readiness to Change Assessment: - Often include Stage of Change questions. - Useful for health coaches and for program planning - Timing: The right message at the ______________
right time
Non-Experimental Design One Group Study (Pre-test / Post-test): - Compares before and after program in ___ group - Lack of a control group limits conclusions Example: - Collect health measures at baseline - Conduct intervention program - Collect follow-up measure at end of program pre test-> intervention-> post test
same
Threats to Internal Validity: - ________ Bias - Control and Treatment groups are different at baseline. - Attrition - Subject Drop-out - History - Outside factors (environment) change during study period. - Instrumentation - Changes in the way data are recorded.
selection
Non-Experimental Design Longitudinal or Time Series Analysis: - Series of measures taken for a baseline - Measures are taken at _____________________ intervention is completed to see time course of changes - Deviation from baseline may be due to intervention but other explanations are also possible. pre test-> intervention-> post test-> follow ups
several points after
What Should be Evaluated?: Program ___________ - Components of the program Program ____________ - Extent to which program was delivered Program _____________ - Extent to which program achieved objectives
structure process outcomes
Origin of Motivational Interviewing (MI): - ______________________ - Address ambivalence to change
substance abuse
Foundation for Change: - Risks are presented in black and white - Reports often __________________ - May link HRA to contact with a health coach or advisor who can plant seeds for change - ________: "If there is a concern or a significant health risk, please have a health professional contact me." - HIPPA
suggest changes opt-in
Factors Influencing Financial Success of WHP programs: - _____________ of population - Participation rates - ___________________ of program at changing risks
susceptibility effectiveness
Justifying WHP Programs: - Link program to overall mission or objectives of the organization - Balance _________ outcomes with more subjective or _____________ ones (morale, image) - Build program into overall health cost containment efforts of the company - Encourage management to invest savings from program back into more initiatives
tangible, intangible
Why do Health Promotion Programs Fail?: Inappropriate or inadequate application of_______ - _____approach to behavior change - Inadequate dose of _____ Poor _____ Bad design or poor ____
theory Flawed intervention implementation measurement
Calculating Preventable Claims Step 1: Determine Average Claims: Divide __________________from your company by the number of eligible __________ Example: If you have 2,500 employees and total claims = $2,760,850 then average claims = $_____________
total health claims employees 1,104.34
Underserved populations: - _______- Minority groups that are or have been systematically denied full access to equal opportunity because of discrimination, marginalization or exclusion - ______- Any group for whom a small fraction of their representation in the general population is found among physicians, health administration executives, university professors, research investigators and other positions of power in the public health establishment • Subset of Underserved • African Americans, American Indians and Alaska Natives, Latinos and Hispanics and Pacific Islanders
underserved under-represented
