RESUMO
OBJECTIVES: To identify statistically significant predictors for completing a Personal Health Assessment (PHA) or biometric screening from attributes of incentive designs. METHODS: A cross-sectional study was conducted that included 426,694 members from 56 employer groups who required a PHA or screening as part of their incentive during 2016. RESULTS: Incentive designs that combine high-value with immediate disbursement can relatively increase employee PHA participation by as much as 66% over plans with low-value and delayed disbursement (56.7% vs 34.1%, Pâ<â0.001). Surcharge component was a significant predictor of PHA completion (Pâ<â0.001); similar predictors were found for screening completion. CONCLUSIONS: This study identified several significant predictors of PHA or screening completion, including: monetary value, time to disbursement, disbursement method, and frequency. Our findings are consistent with prior research in human behavior responses to positive reinforcement.
Assuntos
Biometria , Planos para Motivação de Pessoal , Promoção da Saúde/métodos , Programas de Rastreamento , Saúde Ocupacional , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Adolescente , Adulto , Idoso , Estudos Transversais , Feminino , Promoção da Saúde/organização & administração , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Motivação , Saúde Ocupacional/economia , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Estados Unidos , Adulto JovemRESUMO
Medical pain management is in crisis; from the pervasiveness of pain to inadequate pain treatment, from the escalation of prescription opioids to an epidemic in addiction, diversion and overdose deaths. The rising costs of pain care and managing adverse effects of that care have prompted action from state and federal agencies including the DOD, VHA, NIH, FDA and CDC. There is pressure for pain medicine to shift away from reliance on opioids, ineffective procedures and surgeries toward comprehensive pain management that includes evidence-based nonpharmacologic options. This White Paper details the historical context and magnitude of the current pain problem including individual, social and economic impacts as well as the challenges of pain management for patients and a healthcare workforce engaging prevalent strategies not entirely based in current evidence. Detailed here is the evidence-base for nonpharmacologic therapies effective in postsurgical pain with opioid sparing, acute non-surgical pain, cancer pain and chronic pain. Therapies reviewed include acupuncture therapy, massage therapy, osteopathic and chiropractic manipulation, meditative movement therapies Tai chi and yoga, mind body behavioral interventions, dietary components and self-care/self-efficacy strategies. Transforming the system of pain care to a responsive comprehensive model necessitates that options for treatment and collaborative care must be evidence-based and include effective nonpharmacologic strategies that have the advantage of reduced risks of adverse events and addiction liability. The evidence demands a call to action to increase awareness of effective nonpharmacologic treatments for pain, to train healthcare practitioners and administrators in the evidence base of effective nonpharmacologic practice, to advocate for policy initiatives that remedy system and reimbursement barriers to evidence-informed comprehensive pain care, and to promote ongoing research and dissemination of the role of effective nonpharmacologic treatments in pain, focused on the short- and long-term therapeutic and economic impact of comprehensive care practices.
Assuntos
Terapia por Acupuntura , Terapias Mente-Corpo , Manipulações Musculoesqueléticas , Manejo da Dor/métodos , Dor , Modalidades de Fisioterapia , Dor Aguda/terapia , Analgésicos Opioides , Dor do Câncer/terapia , Dor Crônica/terapia , Dieta , Humanos , Dor/etiologia , Dor Pós-Operatória/terapia , Resultado do TratamentoRESUMO
Many large U.S. employers have generally embraced a Health and Productivity Management (HPM) perspective to guide their multiple employee health management efforts. In looking ahead there are a number of emerging trends that are helping to shape these efforts. As health promotion professionals assess the implications of these trends on their respective role and function within the worksite, it may provide a very useful process for refining strategies for programming and professional development. The identified trends also have a variety of implications for health promotion vendors and the growth of the health management marketplace.
Assuntos
Planos de Assistência de Saúde para Empregados/tendências , Promoção da Saúde/tendências , Serviços de Saúde do Trabalhador/tendências , Eficiência Organizacional , Planos para Motivação de Pessoal , Custos de Saúde para o Empregador/tendências , Medicina Baseada em Evidências , Previsões , Pesquisa sobre Serviços de Saúde , Humanos , Sistemas de Informação , Sistemas Computadorizados de Registros Médicos/tendências , Estados UnidosRESUMO
Care management program evaluations bring together constituents from finance, medicine, and social sciences. The differing assumptions and scientific philosophies that these constituents bring to the task often lead to frustrations and even contentions. Given the forms and variations of care management programs, the difficulty associated with program outcomes measurement should not be surprising. It is no wonder then that methods for clinical and economic evaluations of program efficacy continue to be debated and have yet to be standardized. We describe these somewhat hidden processes, examine where the industry stands, and provide recommendations for steps to standardize evaluation methodology.
Assuntos
Administração dos Cuidados ao Paciente , Análise Atuarial , Gerenciamento Clínico , Humanos , Administração dos Cuidados ao Paciente/economia , Administração dos Cuidados ao Paciente/normas , Administração dos Cuidados ao Paciente/tendências , Ciências Sociais , Estados UnidosRESUMO
OBJECTIVE: To explore the link between companies investing in the health and well-being programs of their employees and stock market performance. METHODS: Stock performance of C. Everett Koop National Health Award winners (n = 26) was measured over time and compared with the average performance of companies comprising the Standard and Poor's (S&P) 500 Index. RESULTS: The Koop Award portfolio outperformed the S&P 500 Index. In the 14-year period tracked (2000-2014), Koop Award winners' stock values appreciated by 325% compared with the market average appreciation of 105%. CONCLUSIONS: This study supports prior and ongoing research demonstrating a higher market valuation--an affirmation of business success by Wall Street investors--of socially responsible companies that invest in the health and well-being of their workers when compared with other publicly traded firms.
Assuntos
Promoção da Saúde/economia , Indústrias/economia , Investimentos em Saúde , Saúde Ocupacional/economia , Cultura Organizacional , Responsabilidade Social , Distinções e Prêmios , Competição Econômica , Promoção da Saúde/normas , Humanos , Indústrias/organização & administração , Indústrias/normas , Saúde Ocupacional/normasRESUMO
This critical review focuses on the 12 new studies focused on the clinical and cost outcomes research focused on worksites and published between 2000 and 2004. Although these new studies indicate further evidence of positive clinical and cost outcomes, the quantity and quality of such research continue to decline. When corporations and health plans are demanding more evidence-based outcomes, this decline in rigorous research marks a serious challenge to the field of health promotion and disease management.
Assuntos
Gerenciamento Clínico , Promoção da Saúde , Serviços de Saúde do Trabalhador , Análise Custo-Benefício , Promoção da Saúde/economia , Pesquisa sobre Serviços de Saúde , Humanos , Serviços de Saúde do Trabalhador/economia , Avaliação de Resultados em Cuidados de Saúde , Ensaios Clínicos Controlados Aleatórios como Assunto , Local de TrabalhoRESUMO
For more than 25 years, health promotion and disease management interventions have been conducted by large employers in the United States. Today there are more than 100 studies of such multifactorial, comprehensive interventions that all demonstrate positive clinical outcomes. For those interventions that have also been evaluated for return on investment, all but one have demonstrated cost-effectiveness. This article is an evidence-based overview of the clinical and cost outcomes research to elaborate on the insights gained from this research in the areas of implementation and evaluation of such programs; integration of health promotion and disease management programs into conventional, occupational medicine; accessing difficult to reach populations, such as mobile workers, retirees, and/or dependents; areas of potential conflict of interest and privacy/confidentiality issues; health consequences of downsizing and job strain; and, finally, recommendations for improved integration and evaluation of such programs for both clinical and cost outcomes. With medical costs rapidly escalating again on a global scale, these interventions with evidence of both clinical and cost outcomes can provide the foundation to improve the health, performance, and productivity of both individuals and their corporations.
Assuntos
Gerenciamento Clínico , Implementação de Plano de Saúde/organização & administração , Promoção da Saúde/organização & administração , Cooperação Internacional , Serviços de Saúde do Trabalhador/organização & administração , Análise Custo-Benefício , Custos de Cuidados de Saúde , Pesquisa sobre Serviços de Saúde , Humanos , Japão , Estados UnidosRESUMO
OBJECTIVE: The aim of this study is to measure the selection effects of the inclusion of a chiropractic benefit on a managed care health plan. DESIGN: An analysis of enrollment data from a managed care health plan over a 4-year period was conducted. Employers could select the managed care plan with or without a chiropractic care benefit. Comparisons of demographic and comorbid characteristics were made between employees who had the chiropractic benefit and those who did not, and between individuals who self-selected chiropractic care and those who self-selected medical care. RESULTS: The cohort with chiropractic coverage was younger with fewer subjects in the older age group (>65 years; 6.5% vs 9.6%) and more subjects in the younger age group (0-17 years; 31.9% vs 26.2%). The mean age of the group with coverage was 32.9 compared with 35.5 in the group without coverage. Comparing self-selected chiropractic patients to self-selected medical patients, there were fewer subjects older than 65 years in the chiropractic group (4.9% vs 9.2%) and fewer subjects aged 0 to 17 years (9.4% vs 19.4%). In 6 of the 8 comorbid conditions studied, the rates were lower in the cohort with chiropractic coverage compared with the group without coverage. The rates of comorbid conditions in self-selected chiropractic patients were lower in all 8 categories compared with self-selected medical patients. CONCLUSION: The inclusion of a chiropractic benefit in a health plan produces a modest favorable selection processes resulting in a slightly younger patient population with fewer comorbidities. At the level of patient self-selection, chiropractic patients are considerably younger and healthier than comparable medical patients.
Assuntos
Quiroprática , Benefícios do Seguro , Programas de Assistência Gerenciada , Pacientes/estatística & dados numéricos , Adolescente , Adulto , Distribuição por Idade , Idoso , Criança , Pré-Escolar , Estudos de Coortes , Feminino , Nível de Saúde , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-IdadeRESUMO
An analysis of claims data from a managed care health plan was performed to evaluate whether patients use chiropractic care as a substitution for medical care or in addition to medical care. Rates of neuromusculoskeletal complaints in 9e diagnostic categories were compared between groups with and without chiropractic coverage. For the 4-year study period, there were 3,129,752 insured member years in the groups with chiropractic coverage and 5,197,686 insured member years in the groups without chiropractic coverage. Expressed in terms of unique patients with neuromusculoskeletal complaints, the cohort with chiropractic coverage experienced a rate of 162.0 complaints per 1000 member years compared with 171.3 complaints in the cohort without chiropractic coverage. These results indicate that patients use chiropractic care as a direct substitution for medical care.
Assuntos
Quiroprática/economia , Cobertura do Seguro , Seguro Saúde , Programas de Assistência Gerenciada/estatística & dados numéricos , Doenças Neuromusculares/epidemiologia , Adulto , Idoso , California , Criança , Feminino , Humanos , Cobertura do Seguro/estatística & dados numéricos , Masculino , Programas de Assistência Gerenciada/economia , Pessoa de Meia-Idade , Saúde OcupacionalRESUMO
Workforce productivity has become a critical factor in the strength and sustainability of a company's overall business performance. Absenteeism affects productivity; however, even when employees are physically present at their jobs, they may experience decreased productivity and below-normal work quality--a concept known as decreased presenteeism. This article describes the creation and testing of a presenteeism scale evaluating the impact of health problems on individual performance and productivity. A total of 175 county health employees completed the 34-item Stanford Presenteeism Scale (SPS-34). Using these results, we identified six key items to describe presenteeism, resulting in the SPS-6. The SPS-6 has excellent psychometric characteristics, supporting the feasibility of its use in measuring health and productivity. Further validation of the SPS-6 on actual presenteeism (work loss data) or health status (health risk assessment or utilization data) is needed.
Assuntos
Absenteísmo , Avaliação de Desempenho Profissional/métodos , Indicadores Básicos de Saúde , Adulto , California , Feminino , Humanos , Satisfação no Emprego , Reprodutibilidade dos Testes , Estresse Psicológico/psicologiaRESUMO
Ambulatory medicine is a frequent clinical setting where practitioners can effectively apply Mind-body interventions ranging from basic stress management therapies to the sophisticated biomedical instrumentation of clinical biofeedback. Given the rather extensive and growing body of clinical research in this area, the intent of this article is to provide an evidence-based assessment of the evidence underlying the clinical efficiency of such interventions. Such an evidence-based approach can help ambulatory care providers to identify those Mind-body interventions with specific clinical indication so that they can be utilized both safely and effectively in ambulatory medicine.
Assuntos
Assistência Ambulatorial/métodos , Medicina Baseada em Evidências/métodos , Terapias Mente-Corpo/métodos , Atitude Frente a Saúde , Pesquisa sobre Serviços de Saúde , Humanos , Terapias Mente-Corpo/efeitos adversos , Terapias Mente-Corpo/economia , Avaliação de Processos e Resultados em Cuidados de Saúde/economia , Estados UnidosRESUMO
OBJECTIVE: To assess the status of managed care and insurance coverage of complementary and alternative medicine (CAM) and the integration of such services into managed care. DATA SOURCES: A literature review and information search were conducted to determine which new insurers had special policies for CAM from 1999 to 2000. Telephone interviews were conducted with a sample of 6 new managed care organizations (MCOs) or insurers identified in 2000 and a nonrepresentative cohort of 4 of the original 18 MCOs and insurers who responded both to the original survey in 1997 and again in 1998 to determine trends. STUDY SELECTION: This study constitutes the results of the third year of an ongoing annual survey. For the year 2000, a total of 14 new companies were identified as offering some CAM coverage. Survey results were analyzed for 6 of these who responded to the current survey as well as the results of the cohort mentioned above. DATA EXTRACTION AND SYNTHESIS: Most of the insurers interviewed offer some coverage for the following: nutrition counseling, biofeedback psychotherapy, acupuncture, preventive medicine, chiropractic, osteopathy, and physical therapy. All new companies indicated that market demand was a primary motivator for covering CAM. Factors determining whether insurers would offer coverage for additional therapies included potential cost-effectiveness, consumer interest, and demonstrable clinical efficacy. Among the most common obstacles listed for incorporating CAM into mainstream healthcare were lack of research on clinical or cost-effectiveness, economics, ignorance about CAM, provider competition, and lack of standards of practice. CONCLUSION: Consumer demand for CAM is motivating more MCOs and insurance companies to assess the clinical and cost benefits of incorporating CAM. Outcomes studies for both conventional and CAM therapies are needed to help create a healthcare system based on treatments that work, whether they are conventional, complementary, alternative, or integrative medicine.
Assuntos
Terapias Complementares/economia , Necessidades e Demandas de Serviços de Saúde , Reembolso de Seguro de Saúde/estatística & dados numéricos , Programas de Assistência Gerenciada/economia , Prestação Integrada de Cuidados de Saúde , Custos de Cuidados de Saúde , Inquéritos Epidemiológicos , Humanos , Satisfação do Paciente , Inquéritos e Questionários , Telefone , Estados UnidosRESUMO
This paper provides an (OHE) overview of a population health management (PHM) approach to the creation of optimal healing environments (OHEs) in worksite and corporate settings. It presents a framework for consideration as the context for potential research projects to examine the health, well-being, and economic effects of a set of newer "virtual" prevention interventions operating in an integrated manner in worksite settings. The main topics discussed are the fundamentals of PHM with basic terminology and core principles, a description of PHM core technology and implications of a PHM approach to creating OHEs.
Assuntos
Educação em Saúde/normas , Promoção da Saúde/normas , Saúde Holística , Doenças Profissionais/prevenção & controle , Serviços de Saúde do Trabalhador/normas , Saúde Ocupacional , Local de Trabalho/normas , Comportamento de Ajuda , Humanos , Cultura Organizacional , Inovação Organizacional , Estados UnidosRESUMO
OBJECTIVE: The objective of this study was to determine whether a mindfulness program, created for the workplace, was both practical and efficacious in decreasing employee stress while enhancing resiliency and well-being. METHODS: Participants (89) recruited from The Dow Chemical Company were selected and randomly assigned to an online mindfulness intervention (n = 44) or wait-list control (n = 45). Participants completed the Perceived Stress Scale, the Five Facets of Mindfulness Questionnaire, the Connor-Davidson Resiliency Scale, and the Shirom Vigor Scale at pre- and postintervention and 6-month follow-up. RESULTS: The results indicated that the mindfulness intervention group had significant decreases in perceived stress as well as increased mindfulness, resiliency, and vigor. CONCLUSIONS: This online mindfulness intervention seems to be both practical and effective in decreasing employee stress, while improving resiliency, vigor, and work engagement, thereby enhancing overall employee well-being.
Assuntos
Atenção Plena , Estresse Psicológico/epidemiologia , Local de Trabalho/psicologia , Adulto , Feminino , Humanos , Masculino , Inquéritos e Questionários , Resultado do Tratamento , Listas de EsperaRESUMO
OBJECTIVE: To respond to the question, "Do workplace health promotion programs work?" METHODS: A compilation of the evidence on workplace programs' effectiveness coupled with recommendations for critical review of outcome studies. Also, reviewed are recent studies questioning the value of workplace programs. RESULTS: Evidence accumulated over the past three decades shows that well-designed and well-executed programs that are founded on evidence-based principles can achieve positive health and financial outcomes. CONCLUSIONS: Employers seeking a program that "works" are urged to consider their goals and whether they have an organizational culture that can facilitate success. Employers who choose to adopt a health promotion program should use best and promising practices to maximize the likelihood of achieving positive results.
Assuntos
Promoção da Saúde/normas , Serviços de Saúde do Trabalhador , Objetivos , Humanos , Avaliação de Programas e Projetos de Saúde/métodosRESUMO
Back pain consists of a spectrum of conditions, with no common etiology and therefore no dominant method of treatment. The purpose of this study is to describe the complexity of a collection of 8000 back pain patients who appeared in an integrative medicine clinic, as a prelude to conducing comparative effectiveness research on CAM alternatives to conventional therapy. Approximately 23% of all clinic patients were diagnosed at some time with back pain. Nearly half had treatment periods of less than one month, while more than 25% were treated for back pain for more than two years. Women were represented more than twice as often as men. The initial diagnosis categories that occurred most frequently were lumbar symptoms, cervical symptoms, and a general category, with smaller numbers having lumbar anatomic, thoracic symptom, brachial neuritis, or sciatica diagnoses. There were few strong relationships between initial diagnosis pattern and length of back pain treatment period. While 77% of back pain patients presented with diagnoses in only a single category, there were many composite categories each of which was sparsely represented. Between 50% and 75% of patients used some CAM service, depending on their initial diagnosis pattern. Patients with complex initial diagnosis patterns strongly tended to chose CAM, and among CAM-users those with complex diagnoses tended toward chiropractic, as opposed to acupuncture or bodywork. The CAM usage patterns of men and women were highly similar. Again among CAM users, 82% used only a single type of CAM service, and multiple service uses tend to be combined at random. Between two-thirds and three-quarters of multiple CAM service users had very simple temporal patterns of use, dominated by use of one type of CAM at a time.
Assuntos
Dor nas Costas/terapia , Terapias Complementares/estatística & dados numéricos , Registros Eletrônicos de Saúde , Aceitação pelo Paciente de Cuidados de Saúde , Projetos de Pesquisa , Adulto , Idoso , Idoso de 80 Anos ou mais , Instituições de Assistência Ambulatorial , Dor nas Costas/diagnóstico , Feminino , Humanos , Medicina Integrativa , Masculino , Manipulação Quiroprática/estatística & dados numéricos , Pessoa de Meia-Idade , Adulto JovemAssuntos
Prestação Integrada de Cuidados de Saúde/métodos , Medicina Baseada em Evidências/métodos , Medicina Clínica/métodos , Medicina Clínica/tendências , Terapias Complementares/métodos , Terapias Complementares/tendências , Prestação Integrada de Cuidados de Saúde/tendências , Medicina Baseada em Evidências/tendências , Previsões , Humanos , Sensibilidade e Especificidade , Estados UnidosRESUMO
OBJECTIVE: This critical review focuses on the 27 new studies focused on the clinical and cost outcomes research focused on worksites and published between 2008 to 2010. METHODS: A comprehensive search was conducted using a multi-stage process that included a MEDLINE, ERIC, ADI, EDGAR, CARL, Inform, Lexis-Nexis databases, and direct inquires to worksite researchers and corporate medical directors. RESULTS: Clearly, these new studies indicate further evidence of positive outcomes since, the quantity and quality of such research continues to improve. CONCLUSIONS: When corporations, government, and health plans are demanding more evidence based outcomes, this increase in rigorous research.
Assuntos
Gerenciamento Clínico , Promoção da Saúde/economia , Local de Trabalho , Análise Custo-Benefício , Humanos , Estados UnidosRESUMO
OBJECTIVE: This research was aimed at developing a self-completed questionnaire for use in the assessment of stress-related factors at a US government high-tech worksite. METHODS: A literature review was performed to identify existing scales of workplace stress and strain. An initial pool of potential items was developed and assessed for content validity by using focus groups. This item pool was reduced to 38 items covering eight domains based on focus group results. A pilot study was conducted to examine the measurement properties of selected items and scales. RESULTS: Findings from the pilot study led to the 22-item Workplace Stressors Assessment Questionnaire, which includes six domains/scales that exhibited satisfactory measurement properties. CONCLUSIONS: The Workplace Stressors Assessment Questionnaire is a relatively short and psychometrically sound measure that can be used to systematically monitor employees' perceptions of workplace-related stressors.