Changes in health risks among the participants in the United Auto Workers--General Motors LifeSteps Health Promotion Program

Eight-Year Health Risks Trend Analysis of a Comprehensive Workplace Health Promotion Program

Research has shown that workplace health promotion (WHP) efforts can positively affect employees' health risk accumulation. However, earlier literature has provided insights of health risk changes in the short-term. This prospective longitudinal quasi-experimental study investigated trends in health risks of a comprehensive, eight-year WHP program (n = 523-651). Health risk data were collected from health risk assessments in 2010-2011, 2013-2014, and 2016-2017, applying both a questionnaire and biometric screenings. Health risk changes were investigated for three different time-periods, 2010-2013, 2014-2017, and 2010-2017, using descriptive analyses, t-tests, and the Wilcoxon Signed Rank and McNemar's test, where appropriate. Overall health risk transitions were assessed according to low-, moderate-, and high-risk categories. Trend analyses observed 50-60% prevalence for low-, 30-35% for moderate-, and 9-11% high-risk levels across the eight years. In the overall health risk transitions of the three time-periods, 66-73% of participants stayed at the same risk level, 13-15% of participants improved, and 12-21% had deteriorated risk level across the three intervention periods. Our findings appear to indicate that the multiyear WHP program was effective in maintaining low and moderate risk levels, but fell short of reducing the total number of health risks at the population level.

The implementation and evaluation of health professions students as health coaches within a diabetes self-management education program

BACKGROUND AND PURPOSE

The purpose of this article is to describe how health professions students were trained and incorporated as health coaches into a group diabetes self-management education (DSME) program in an underserved, urban federally qualified health center.

EDUCATIONAL ACTIVITY AND SETTING

Nursing, pharmacy, and physical therapy students from three local colleges were provided health coach training and then integrated into the DSME program with faculty assistance. The students connected with the assigned participants both in person and via weekly telephone calls over a three-month time period, applying concepts learned and providing patient-centered support.

FINDINGS

Students noted self-reported improvement in their own perceived knowledge, skills, and attitudes related to health coaching from both qualitative (weekly and end of experience reflections) and quantitative (pre- and post-survey) measures. Participants were also engaged in assessing the program directly via survey responses and indirectly via attainment of personal health-related behavior change goals based on American Association of Diabetes Educators Seven Self-Care Behaviors.

SUMMARY

With appropriate training and support from faculty, health professions students were successfully incorporated into an existing DSME program in the role of health coach, gaining knowledge, skills, and attitudes needed to help patients make behavior change.

Factors Associated with Work-Related Injury among Hospital Employees

The Central Arkansas Veterans Healthcare System (CAVHS) spends $1 million annually on occupational illnesses and injuries. To address the problem of injuries among hospital employees, a retrospective case-control study was conducted to examine select risk factors for work-related injuries (WRI) among CAVHS employees. Study methods included a review of employee health charts and computer and manual databases from 1997 to 2002 ( N = 2,050). The researchers found that WRI increased with age; WRI occurred more often in women than in men; WRI was greater among maintenance and custodial staff compared to direct caregivers, and less among clerical staff; WRI occurred less often in part-time than full-time staff; and WRI increased with increasing body mass index. Developing standards, guidelines, and policies for preplacement screening, preventive measures, training, and education may help to minimize WRI and associated costs.

Nurse and Physician Involvement in Health Risk Appraisals: An Integrative Review

Unhealthy lifestyle behaviors continue to be a strong contributor to chronic illness and death in the United States. Despite the health care system's efforts to refocus on prevention, primary care visits remain acute care focused. Health risk appraisals are tools that can be used by primary care providers to enhance lifestyle behavior change and prevention efforts. The purpose of this integrative review is to examine nurse and physician use of health risk appraisals in primary care. A total of 26 national and international papers, selected through an electronic database and ancestry search, were reviewed. Identified nurse and physician interventions in addition to other programming included helping participants understand and interpret feedback, behavioral counseling, and development of plans to address unhealthy lifestyle behaviors. The most common intervention was provision of telephonic nurse advice lines. Overall outcomes were positive. The use of these tools could be key to enhancing primary care prevention.

Advancing the Practice of Health Coaching: Differentiation From Wellness Coaching

The increasing demand for health coaches and wellness coaches in worksite health promotion and the marketplace has resulted in a plethora of training programs with wide variations in coaching definitions, content, attributes, and eligibility of those who may train. It is in the interest of public awareness and safety that those in clinical practice take the lead in this discussion and offer a reasonable contrast and comparison focusing on the risks and responsibilities of health coaching in particular. With the endorsement of the American Association of Occupational Health Nurses (AAOHN), the National Society of Health Coaches, whose membership is primarily nurses, discusses the issue and states its position here.

A Systematic Review of the Literature on Health and Wellness Coaching: Defining a Key Behavioral intervention in Healthcare

PRIMARY OBJECTIVE

Review the operational definitions of health and wellness coaching as published in the peer-reviewed medical literature.

BACKGROUND

As global rates of preventable chronic diseases have reached epidemic proportions, there has been an increased focus on strategies to improve health behaviors and associated outcomes. One such strategy, health and wellness coaching, has been inconsistently defined and shown mixed results.

METHODS

A Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)-guided systematic review of the medical literature on health and wellness coaching allowed for compilation of data on specific features of the coaching interventions and background and training of coaches.

RESULTS

Eight hundred abstracts were initially identified through PubMed, with 284 full-text articles ultimately included. The majority (76%) were empirical articles. The literature operationalized health and wellness coaching as a process that is fully or partially patient-centered (86% of articles), included patient-determined goals (71%), incorporated self-discovery and active learning processes (63%) (vs more passive receipt of advice), encouraged accountability for behaviors (86%), and provided some type of education to patients along with using coaching processes (91%). Additionally, 78% of articles indicated that the coaching occurs in the context of a consistent, ongoing relationship with a human coach who is trained in specific behavior change, communication, and motivational skills.

CONCLUSIONS

Despite disparities in how health and wellness coaching have been operationalized previously, this systematic review observes an emerging consensus in what is referred to as health and wellness coaching; namely, a patient-centered process that is based upon behavior change theory and is delivered by health professionals with diverse backgrounds. The actual coaching process entails goal-setting determined by the patient, encourages self-discovery in addition to content education, and incorporates mechanisms for developing accountability in health behaviors. With a clear definition for health and wellness coaching, robust research can more accurately assess the effectiveness of the approach in bringing about changes in health behaviors, health outcomes and associated costs that are targeted to reduce the global burden of chronic disease.

Health coaching to improve healthy lifestyle behaviors: an integrative review

OBJECTIVE

Chronic diseases account for 70% of U.S. deaths. Health coaching may help patients adopt healthy lifestyle behaviors that prevent and control diseases. This integrative review analyzed health coaching studies for evidence of effectiveness and to identify key program features.

DATA SOURCE

Multiple electronic databases were utilized, yielding a final sample of 15 documents.

STUDY INCLUSION AND EXCLUSION CRITERIA

The search was limited to peer-reviewed research articles published between 1999 and 2008. Studies were further analyzed if they (1) specifically cited coaching as a program intervention, and (2) applied the intervention to research.

DATA EXTRACTION

Articles describing various quantitative and qualitative methodologies were critically analyzed using a systematic method.

DATA SYNTHESIS

Data were synthesized using a matrix format according to purpose, method, intervention, findings, critique, and quality rating.

RESULTS

All 15 studies utilized nonprobability sampling, 7 (47%) with randomized intervention and control groups. Significant improvements in one or more of the behaviors of nutrition, physical activity, weight management, or medication adherence were identified in six (40%) of the studies. Common features of effective programs were goal setting (73%), motivational interviewing (27%), and collaboration with health care providers (20%).

CONCLUSIONS

Health coaching studies with well-specified methodologies and more rigorous designs are needed to strengthen findings; however, this behavioral change intervention suggests promise.

A systematic review of selected interventions for worksite health promotion. The assessment of health risks with feedback

BACKGROUND

Many health behaviors and physiologic indicators can be used to estimate one's likelihood of illness or premature death. Methods have been developed to assess this risk, most notably the use of a health-risk assessment or biometric screening tool. This report provides recommendations on the effectiveness of interventions that use an Assessment of Health Risks with Feedback (AHRF) when used alone or as part of a broader worksite health promotion program to improve the health of employees.

EVIDENCE ACQUISITION

The Guide to Community Preventive Services' methods for systematic reviews were used to evaluate the effectiveness of AHRF when used alone and when used in combination with other intervention components. Effectiveness was assessed on the basis of changes in health behaviors and physiologic estimates, but was also informed by changes in risk estimates, healthcare service use, and worker productivity.

EVIDENCE SYNTHESIS

The review team identified strong evidence of effectiveness of AHRF when used with health education with or without other intervention components for five outcomes. There is sufficient evidence of effectiveness for four additional outcomes assessed. There is insufficient evidence to determine effectiveness for others such as changes in body composition and fruit and vegetable intake. The team also found insufficient evidence to determine the effectiveness of AHRF when implemented alone.

CONCLUSIONS

The results of these reviews indicate that AHRF is useful as a gateway intervention to a broader worksite health promotion program that includes health education lasting > or =1 hour or repeating multiple times during 1 year, and that may include an array of health promotion activities. These reviews form the basis of the recommendations by the Task Force on Community Preventive Services presented elsewhere in this supplement.

Structuring successful interventions in employee health programs

This literature review explored common characteristics of successful health promotion interventions that have produced positive outcomes for the diverse populations studied. Health education interventions delivered in structured environments with quarterly monitoring produced the most positive outcomes. Interventions delivered to employees in a "team" format were as successful as interventions delivered one on one. Single disease- or health behavior-focused interventions were more successful than multifocused interventions. Review findings indicate that academic or consultant researchers may lend expertise to research methods and informed consent as employers create health promotion programs they wish to evaluate. Employers may find benefits in conducting health-related studies developed through partnerships or collaborations with academic researchers.

Use of preventive care by the working poor in the United States

OBJECTIVE

Examine the association between poverty and preventive care use among older working adults.

METHOD

Cross-sectional analysis of the pooled 1996, 1998 and 2000 waves of the Health and Retirement Study, a nationally representative sample of older community-dwelling adults, studying self-reported use of cervical, breast, and prostate cancer screening, as well as serum cholesterol screening and influenza vaccination. Adults with incomes within 200% of the federal poverty level were defined as poor.

RESULTS

Among 10,088 older working adults, overall preventive care use ranged from 38% (influenza vaccination) to 76% (breast cancer screening). In unadjusted analyses, the working poor were significantly less likely to receive preventive care. After adjustment for insurance coverage, education, and other socio-demographic characteristics, the working poor remained significantly less likely to receive breast cancer (RR 0.92, 95% CI, 0.86-0.96), prostate cancer (RR 0.89, 95% CI, 0.81-0.97), and cholesterol screening (RR 0.91, 95% CI, 0.86-0.96) than the working non-poor, but were not significantly less likely to receive cervical cancer screening (RR 0.96, 95% CI, 0.90-1.01) or influenza vaccination (RR 0.92, 95% CI, 0.84-1.01).

CONCLUSION

The older working poor are at modestly increased risk for not receiving preventive care.

Promising Practices in Employer Health and Productivity Management Efforts: Findings From a Benchmarking Study

OBJECTIVE

To identify key success factors related to employer-based health and productivity management (HPM) programs.

METHODS

Data regarding promising practices in HPM were gathered via literature review, discussions with subject matter experts, online inventory, and site visits.

RESULTS

Promising practices in HPM include 1) integrating HPM programs into the organization's operations; 2) simultaneously addressing individual, environmental, policy, and cultural factors affecting health and productivity; 3) targeting several health issues; 4) tailoring programs to address specific needs; 5) attaining high participation; 6) rigorously evaluating programs; and 7) communicating successful outcomes to key stakeholders.

CONCLUSION

Increased efforts should be directed at disseminating the experiences of promising practices. However, more research is needed in this area, so that additional public and private funding is made available for applied research in "real-life" business settings. Finally, employers should be provided effective tools and resources to support their HPM efforts.

Association of Healthcare Costs With Per Unit Body Mass Index Increase

OBJECTIVE

The objective of this study was to quantify the healthcare costs per unit increase in body mass index (BMI).

METHODS

This cross-sectional study included 35,932 employees and spouses in a manufacturing company who participated in an indemnity/PPO plan and one health risk appraisal during 2001 and 2002.

RESULTS

Within the BMI range of 25 to 45 kg/m, medical costs and pharmaceutical costs increased dollar 119.7 (4%) and dollar 82.6 (7%) per BMI unit, respectively, adjusted for age and gender. The adjusted medical costs related to diabetes and heart disease increased by dollar 6.2 and dollar 20.3 per BMI unit. The likelihood of having any medical claim increased 11.6% per BMI unit for diabetes and 5.2% for heart disease.

CONCLUSIONS

Each unit increase in BMI is associated with higher healthcare costs and increased likelihood of having claims for most major diagnostic codes and for diabetes and heart diseases.

BMI, physical activity, and health care utilization/costs among Medicare retirees

OBJECTIVE

To examine the influence of physical activity (PA) and BMI on health care utilization and costs among Medicare retirees.

RESEARCH METHODS AND PROCEDURES

This cross-sectional study was based on 42,520 Medicare retirees in a U.S.-wide manufacturing corporation who participated in indemnity/preferred provider and one health risk appraisal during the years 2001 and 2002. Participants were assigned into one of the three weight groups: normal weight, overweight, and obese. PA behavior was classified into three levels: sedentary (0 time/wk), moderately active (1 to 3 times/wk), and very active (4+ times/wk).

RESULTS

Generalized linear models revealed that the moderately active retirees had US 1456 dollars, US 1731 dollars, and US 1177 dollars lower total health care charges than their sedentary counterparts in the normal-weight, overweight, and obese groups, respectively (p < 0.01). The very active retirees had US 1823 dollars, US 581 dollars, and US 1379 dollars lower costs than the moderately active retirees. Health care utilization and specific costs showed similar trends with PA levels for all BMI groups. The total health care charges were lower with higher PA level for all age groups (p < 0.01).

DISCUSSION

Regular PA has strong dose-response effects on both health care utilization and costs for overweight/obese as well as normal-weight people. Promoting active lifestyle in this Medicare population, especially overweight and obese groups, could potentially improve their well-being and save a substantial amount of health care expenditures. Because those Medicare retirees are hard to reach in general, more creative approaches should be launched to address their needs and interests as well as help reduce the usage of health care system.

The Association of Health Risks With On-the-Job Productivity

OBJECTIVE

Decreased on-the-job productivity represents a large yet poorly characterized indirect cost to employers. We studied the impact of employee health risk factors on self-reported worker productivity (presenteeism).

METHODS

Using a brief version of the Work Limitation Questionnaire incorporated into a Health Risk Appraisal, 28,375 employees of a national company responded to the survey. The association between health risks and work limitation and each of the four domains was examined. Percentage of lost productivity also was estimated.

RESULTS

Ten of 12 health risk factors studied were significantly associated with self-reported work limitations. The strength of the associations varied between risks and the four domains of work limitation. Perception-related risk factors such as life dissatisfaction, job dissatisfaction, poor health, and stress showed the greatest association with presenteeism. As the number of self-reported health risk factors increased, so did the percentage of employees reporting work limitations. Each additional risk factor was associated with 2.4% excess productivity reduction. Medium and high-risk individuals were 6.2% and 12.2% less productive than low-risk individuals, respectively. The annual cost of lost productivity in this corporation was estimated at between 99Mdollars and 185Mdollars or between 1392dollars and 2592dollars per employee.

CONCLUSIONS

Health risk factors represent additional causes of lost productivity.

Relationship of body mass index and physical activity to health care costs among employees

This study examined the relationship between physical activity and health care costs by different weight groups. The study sample consisted of 23,490 active employees grouped into normal weight, overweight, and obese categories. After adjustment for covariates, physically moderately active (1 to 2 times/week) and very active (3 + times/week) employees had approximately $250 less paid health care costs annually than sedentary employees (0 time/week) across all weight categories. The difference was approximately $450 in the obese subpopulation. The maximum possible savings was estimated to be 1.5% of the total health care costs if all obese sedentary employees would adapt a physically active lifestyle. As a strategy to control escalating health care costs, wellness programs should facilitate engagement in moderate physical activity of at least 1 to 2 times a week among sedentary obese people and help them to maintain this more active lifestyle.)

Association Between Wellness Score from a Health Risk Appraisal and Prospective Medical Claims Costs

This study examines how wellness scores generated from the Health Risk Appraisal are associated with prospective medical claims costs, controlling for age, gender, and disease status. The study was conducted among 19,861 active employees who participated in the Health Risk Appraisal and selected indemnity or PPO medical plans from 1996 to 1998. A multiple regression model based on group averages of age, gender, disease status, and wellness score levels was developed among a randomly selected screening subsample (n=10,172) from the study sample. Total medical claim costs of -$56, $88, and $3574 were estimated for one additional point on the wellness score, 1 year of additional age, and an existing major disease, respectively. No significant differences were found between the model predicted and actual medical claims costs for the individuals in both screening and calibration (n=9689) subsamples.

The relationship between National Heart, Lung, and Blood Institute Weight Guidelines and concurrent medical costs in a manufacturing population

PURPOSE

To explore the relationship between the 1998 National Heart, Lung, and Blood Institute (NHLBI) weight guidelines and concurrent medical costs.

DESIGN

Cross-sectional study.

SETTING

In a nationwide manufacturing corporation (General Motors Corporation).

SUBJECTS

A total of 177,971 employees, retirees, and their adult dependents who were enrolled in Indemnity/PPO health insurance plan during the years 1996 and 1997 and completed one health risk appraisal (HRA) in the same period.

MEASURES

The participants were categorized into six weight groups according to the NHLBI 1998 guidelines (body mass index [BMI] < 18.5, 18.5-24.9, 25-29.9, 30-34.9, 35-39.9, > or = 40 kg/m2). The height and weight data were collected by self-reported values on an HRA or biometric screening completed during 1996 to 1997. To represent the typical medical costs in a given group, the median, instead of mean, medical charges were used in this article. The annual median medical charges (including drug charges) for years 1996 and 1997 were compared among the six weight groups by using Wilcoxon rank sum tests. The differences in median charges were also tested between the normal weight group and the other five groups for each of the 10 gender-age subgroups (five age groups: 19-44, 45-54, 55-64, 65-74, 75+).

RESULTS

Overall median medical costs were consistent with the NHLBI weight guidelines. The normal-weight group costs the least and both underweight and overweight-obesity groups cost more. The median medical costs of the six weight groups were $3184, $2225, $2388, $2801, $3182, and $3753, respectively, with statistical differences existing between any two groups of the last five categories. The underweight groups, especially in females, were not consistent with the guidelines in the two young groups (ages 19-44 and 45-54). An inconsistent relationship between medical costs and BMI groups was seen in the oldest males (age 75+).

CONCLUSIONS

The six weight groups defined by the 1998 NHLBI guidelines are consistent with concurrent medical costs. Except for the underweight group (BMI < 18.5 kg/m2), medical costs gradually increased with BMI. Given that the prevalence of obesity continues to increase in western countries, effective weight control programs would help avoid a substantial amount of medical costs associated with overweight/obesity and related diseases.

Influence of participation in a worksite health-promotion program on disability days

This study assessed the impact of health-promotion program participation on short-term and long-term disability absence days during a 6-year period in a manufacturing company. Male, hourly, active employees (n = 4189) were analyzed from 1995 to 2000. Disability absences were compared for program participants and nonparticipants from baseline (1995) through 5 years of the program. The percentage of nonparticipants absent on any given day was greater than that of participants. Moreover, the average number of disability absence days incurred by nonparticipants significantly increased from baseline to program year 5 compared with participants. The total amount saved each year in disability absence days for the 2596 program participants was $623,040, which resulted in a savings-to-cost ratio of 2.3 per year. Participation in worksite health-promotion programs may lead to reduced disability days in a manufacturing worksite population.