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1.
Am J Health Promot ; : 890117120906664, 2020 Feb 20.
Artigo em Inglês | MEDLINE | ID: mdl-32077304

RESUMO

Recently, several high-profile randomized clinical trials conducted with employees at the University of Illinois and BJ's Wholesale Club have questioned the value of workplace health and well-being programs. This commentary focuses on the latest research published in The Quarterly Journal of Economics by authors Jones, Molitor, and Reif who evaluated the iThrive wellness program. The commentary challenges the study's main finding that wellness programs (in general) do not work. Several perspectives are explored including whether the evaluated programs are well-designed, sufficiently potent, and appropriate candidates for randomized trials. The article also asks what role employers can or should play in improving the health and well-being of Americans given recent troubling statistics showing a decline in life expectancy and an increase in health risks.

4.
Circulation ; 141(9): e120-e138, 2020 Mar 03.
Artigo em Inglês | MEDLINE | ID: mdl-31992057

RESUMO

Each decade, the American Heart Association (AHA) develops an Impact Goal to guide its overall strategic direction and investments in its research, quality improvement, advocacy, and public health programs. Guided by the AHA's new Mission Statement, to be a relentless force for a world of longer, healthier lives, the 2030 Impact Goal is anchored in an understanding that to achieve cardiovascular health for all, the AHA must include a broader vision of health and well-being and emphasize health equity. In the next decade, by 2030, the AHA will strive to equitably increase healthy life expectancy beyond current projections, with global and local collaborators, from 66 years of age to at least 68 years of age across the United States and from 64 years of age to at least 67 years of age worldwide. The AHA commits to developing additional targets for equity and well-being to accompany this overarching Impact Goal. To attain the 2030 Impact Goal, we recommend a thoughtful evaluation of interventions available to the public, patients, providers, healthcare delivery systems, communities, policy makers, and legislators. This presidential advisory summarizes the task force's main considerations in determining the 2030 Impact Goal and the metrics to monitor progress. It describes the aspiration that these goals will be achieved by working with a diverse community of volunteers, patients, scientists, healthcare professionals, and partner organizations needed to ensure success.

8.
J Occup Environ Med ; 61(9): 767-777, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31306266

RESUMO

OBJECTIVE: The aim of this study was to evaluate the reliability and validity of the updated 2019 CDC Worksite Health ScoreCard (CDC ScoreCard), which includes four new modules. METHODS: We pilot tested the updated instrument at 93 worksites, examining question response concurrence between two representatives from each worksite. We conducted cognitive interviews and site visits to evaluate face validity, and refined the instrument for public distribution. RESULTS: The mean question concurrence rate was 73.4%. Respondents reported the tool to be useful for assessing current workplace programs and planning future initiatives. On average, 43% of possible interventions included in the CDC ScoreCard were in place at the pilot sites. CONCLUSION: The updated CDC ScoreCard is a valid and reliable tool for assessing worksite health promotion policies, educational and lifestyle counseling programs, environmental supports, and health benefits.

9.
Popul Health Manag ; 22(6): 480-487, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-30855210

RESUMO

This case study describes a multistage approach applied to evaluation of an employee wellness program at Northwell Health. The paper describes a framework that other large employers may adopt in their wellness program evaluations. Evaluators worked with Northwell to develop, tailor, and apply a structure-process-outcome framework aligned with the organization's specific goals. Analyses of structural, process, and outcome variables will provide Northwell with valuable information about strengths and weaknesses of its wellness program. The measurement and evaluation framework can serve as a model for businesses aspiring to improve their workplace programs. This framework provides businesses with the opportunity to analyze key elements that need to be addressed collectively to gain a complete picture of program implementation processes and subsequent health and business outcomes.

10.
Am J Prev Med ; 56(3): e95-e106, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30777167

RESUMO

CONTEXT: Cardiovascular disease in the U.S. accounted for healthcare cost and productivity losses of $330 billion in 2013-2014 and diabetes accounted for $327 billion in 2017. The impact is disproportionate on minority and low-SES populations. This paper examines the available evidence on cost, economic benefit, and cost effectiveness of interventions that engage community health workers to prevent cardiovascular disease, prevent type 2 diabetes, and manage type 2 diabetes. EVIDENCE ACQUISITION: Literature from the inception of databases through July 2016 was searched for studies with economic information, yielding nine studies in cardiovascular disease prevention, seven studies in type 2 diabetes prevention, and 13 studies in type 2 diabetes management. Analyses were done in 2017. Monetary values are reported in 2016 U.S. dollars. EVIDENCE SYNTHESIS: The median intervention cost per patient per year was $329 for cardiovascular disease prevention, $600 for type 2 diabetes prevention, and $571 for type 2 diabetes management. The median change in healthcare cost per patient per year was -$82 for cardiovascular disease prevention and -$72 for type 2 diabetes management. For type 2 diabetes prevention, one study saw no change and another reported -$1,242 for healthcare cost. One study reported a favorable 1.8 return on investment from engaging community health workers for cardiovascular disease prevention. Median cost per quality-adjusted life year gained was $17,670 for cardiovascular disease prevention, $17,138 (mean) for type 2 diabetes prevention, and $35,837 for type 2 diabetes management. CONCLUSIONS: Interventions engaging community health workers are cost effective for cardiovascular disease prevention and type 2 diabetes management, based on a conservative $50,000 benchmark for cost per quality-adjusted life year gained. Two cost per quality-adjusted life year estimates for type 2 diabetes prevention were far below the $50,000 benchmark.

11.
Am J Health Promot ; 33(3): 439-447, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30700099

RESUMO

PURPOSE: We investigated the relationship between companies' efforts to build internal (COH-INT) and external cultures of health (COH-EXT) and their stock performance. DESIGN: We administered 2 surveys, which measure companies' programs, policies, and supports for improving the health of their employees and communities. We then compared the companies' stock performance to the Standard and Poor's (S&P) 500 Index from January 2013 through August 2017. SETTING: United States. PARTICIPANTS: Representatives from 17 publicly traded companies who completed the COH-INT survey, of whom 14 also completed the COH-EXT. MEASURES: Culture of health scores were dichotomized into high versus low for both surveys. Stock price data for all companies were gathered from public sources. ANALYSIS: We constructed 5 stock portfolios: all 17 companies, high COH-INT, low COH-INT, high COH-EXT, and low COH-EXT companies. We examined total returns for each portfolio compared to the S&P 500. RESULTS: High COH-INT companies' stock price appreciated by 115% compared to the S&P benchmark (+69%), while low COH-INT companies appreciated only 43%. In contrast, high COH-EXT companies underperformed (+44%) when compared to the S&P 500 (+69%) and low COH-EXT companies (+89%). CONCLUSION: This study supports the view that employers' efforts to build an internal culture of health is a sound business strategy. More research is needed, however, to establish whether a link exists between supporting healthy community initiatives and company stock performance.

12.
J Occup Environ Med ; 61(2): 96-101, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30358659

RESUMO

OBJECTIVE: To examine changes in internal and external cultures of health scores and relate those changes to employees' health risks, health care utilization, and costs for 21 large employers (N = 641,901). METHODS: We measured the relationship between changes in internal and external culture of health scores and changes in employee health risks, health care utilization, and costs. RESULTS: Improvements in a company's internal culture of health predicted lower levels of obesity, poor diet, and tobacco use but higher stress for employees reporting high baseline risk. For those not at high baseline risk, health improved for depression, alcohol consumption, and diet. Improvements in internal culture of health also led to lower prescription drug utilization. CONCLUSION: Investments in internal culture of health predict improvements in some employee health risks and health care utilization.

14.
J Occup Environ Med ; 60(12): 1087-1097, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30188490

RESUMO

OBJECTIVE: The aim of the study was to develop tools that quantify employers' investment in building cultures of health (COH)-inside and outside company walls. METHODS: Two COH instruments were developed through literature reviews and expert consultation. The first focused on internal culture of health (COH-INT), that is, programs, policies, and attributes of the physical and social environments that support employees' health and well-being. The second focused on external culture of health (COH-EXT), that is, programs, policies, and environmental supports that promote communities' health. We administered these tools to 32 employers and examined instrument reliability, distribution of scores, and correlation between the two instruments. RESULTS: Both tools demonstrated adequate reliability. COH-EXT scores changed minimally over the 3-year study timeframe. There was little correlation between the COH-INT and COH-EXT scores. CONCLUSIONS: More research is needed to further develop and validate COH-EXT instruments.


Assuntos
Atitude Frente a Saúde , Promoção da Saúde , Cultura Organizacional , Inquéritos e Questionários , Humanos , Saúde do Trabalhador , Política Organizacional , Reprodutibilidade dos Testes , Local de Trabalho
15.
Ann Work Expo Health ; 62(suppl_1): S42-S54, 2018 09 13.
Artigo em Inglês | MEDLINE | ID: mdl-30212884

RESUMO

Objective: Worksite wellness programs (WWP) may positively impact employee health, medical expenditures, absenteeism, and presenteeism. However, there has been little research to assess the benefits of WWP in small businesses. The purpose of this study is to prospectively evaluate changes in health, absenteeism, and presenteeism for employees who participated in a WWP. Methods: We conducted an observational, 3-year cohort study of 5766 employees from 314 businesses of differing sizes. We followed two cohorts of employees, who completed at least two annual health risk assessments (HRA) between May 2010 and December 2014. Changes from baseline to the first and second follow-up periods were assessed for chronic and non-chronic health conditions, absenteeism, and presenteeism. Results: Small business employees were more likely to participate in the WWP than were employees from large businesses. Changes in chronic and non-chronic health conditions varied by size of business, with small business employees showing improvements in stress, overall health, depression, smoking status, vegetable and fruit consumption, and physical activity, and in their perceptions of job health culture. In contrast, large business employees experienced improvements in stress, vegetable consumption, and alcohol use. No changes in absenteeism or presenteeism were observed. Conclusions: Small businesses achieve higher employee participation rates and more health improvements when compared to employees from large employers. Findings suggest that small businesses may gain the most from a WWP.


Assuntos
Absenteísmo , Promoção da Saúde , Saúde do Trabalhador/normas , Presenteísmo/estatística & dados numéricos , Local de Trabalho/estatística & dados numéricos , Adulto , Nível de Saúde , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Medição de Risco , Empresa de Pequeno Porte , Estados Unidos , Adulto Jovem
16.
J Occup Environ Med ; 60(8): 710-716, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-29438153

RESUMO

OBJECTIVE: The aim of this study was o examine how work and nonwork health-related factors contribute to workers' compensation (WC) claims by gender. METHODS: Workers (N = 16,926) were enrolled in the Pinnacol Assurance Health Risk Management study, a multiyear, longitudinal research program assessing small and medium-sized enterprises in Colorado. Hypotheses were tested using gender-stratified logistic regression models. RESULTS: For both women and men, having incurred a prior WC claim increased the odds of a future claim. The combination of incurring a prior claim and having metabolic health conditions resulted in lower odds of a future claim. Behavioral health risk factors increased the odds of having a claim more so among women than among men. CONCLUSION: This study provides data to support multifactorial injury theories, and the need for injury prevention efforts that consider workplace conditions as well as worker health.


Assuntos
Comportamentos Relacionados com a Saúde , Transtornos Mentais/epidemiologia , Doenças Metabólicas/epidemiologia , Traumatismos Ocupacionais/epidemiologia , Indenização aos Trabalhadores/estatística & dados numéricos , Adolescente , Adulto , Idoso , Artrite/epidemiologia , Doença Crônica , Colorado/epidemiologia , Doenças do Sistema Digestório/epidemiologia , Feminino , Transtornos da Cefaleia/epidemiologia , Inquéritos Epidemiológicos , Cardiopatias/epidemiologia , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Dor Musculoesquelética/epidemiologia , Neoplasias/epidemiologia , Recidiva , Doenças Respiratórias/epidemiologia , Fatores Sexuais , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Doenças Urológicas/epidemiologia , Adulto Jovem
17.
J Occup Environ Med ; 60(3): 241-247, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-29370010

RESUMO

OBJECTIVE: A large employer partnered with local health care providers to pilot test an intensive nurse care manager program for employees and retirees. We evaluated its impact on health care utilization and costs. METHODS: A database was developed containing 2011 to 2015 health care enrollment and claims data for 2914 patients linked to their nurse care manager data. We used a difference-in-difference design to compare health care costs and utilization of members recruited for the pilot program and a propensity-score-matched comparison group. RESULTS: We found statistically significant reductions in doctors' office visits and prescription drug costs. A return-on-investment analysis determined that the program saved $0.83 for every dollar spent over the 2-year pilot study period. CONCLUSIONS: Employer-driven care management programs can succeed at reducing utilization, although they may not achieve cost neutrality in the short run.


Assuntos
Custos de Medicamentos/estatística & dados numéricos , Visita a Consultório Médico/estatística & dados numéricos , Administração dos Cuidados ao Paciente/economia , Medicamentos sob Prescrição/economia , Automóveis , Redução de Custos , Feminino , Humanos , Masculino , Indústria Manufatureira , Pessoa de Meia-Idade , Papel do Profissional de Enfermagem , Administração dos Cuidados ao Paciente/organização & administração , Projetos Piloto , Avaliação de Programas e Projetos de Saúde , Aposentadoria
18.
J Occup Environ Med ; 60(4): 322-330, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-29280775

RESUMO

OBJECTIVE: The aim of the study was to declare a call to action to improve mental health in the workplace. METHODS: We convened a public health summit and assembled an Advisory Council consisting of experts in the field of occupational health and safety, workplace wellness, and public policy to offer recommendations for action steps to improve health and well-being of workers. RESULTS: The Advisory Council narrowed the list of ideas to four priority projects. CONCLUSIONS: The recommendations for action include developing a mental health in the workplace (1) "how to" guide, (2) scorecard, (3) recognition program, and (4) executive training.


Assuntos
Promoção da Saúde , Transtornos Mentais/economia , Transtornos Mentais/prevenção & controle , Saúde Mental , Saúde do Trabalhador , Local de Trabalho/psicologia , Eficiência , Promoção da Saúde/métodos , Humanos , Transtornos Mentais/complicações , Estudos de Casos Organizacionais , Cultura Organizacional , Desenvolvimento de Programas , Fatores de Risco
19.
Am J Prev Med ; 53(3): e105-e113, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-28818277

RESUMO

CONTEXT: The health and economic burden of hypertension, a major risk factor for cardiovascular disease, is substantial. This systematic review evaluated the economic evidence of self-measured blood pressure (SMBP) monitoring interventions to control hypertension. EVIDENCE ACQUISITION: The literature search from database inception to March 2015 identified 22 studies for inclusion with three types of interventions: SMBP used alone, SMBP with additional support, and SMBP within team-based care (TBC). Two formulae were used to convert reductions in systolic BP (SBP) to quality-adjusted life years (QALYs) to produce cost per QALY saved. All analyses were conducted in 2015, with estimates adjusted to 2014 U.S. dollars. EVIDENCE SYNTHESIS: Median costs of intervention were $60 and $174 per person for SMBP alone and SMBP with additional support, respectively, and $732 per person per year for SMBP within TBC. SMBP alone and SMBP with additional support reduced healthcare cost per person per year from outpatient visits and medication (medians $148 and $3, respectively; median follow-up, 12-13 months). SMBP within TBC exhibited an increase in healthcare cost (median, $369 per person per year; median follow-up, 18 months). SMBP alone varied from cost saving to a maximum cost of $144,000 per QALY saved, with two studies reporting an increase in SBP. The two translated median costs per QALY saved were $2,800 and $4,000 for SMBP with additional support and $7,500 and $10,800 for SMBP within TBC. CONCLUSIONS: SMBP monitoring interventions with additional support or within TBC are cost effective. Cost effectiveness of SMBP used alone could not be determined.


Assuntos
Monitorização Ambulatorial da Pressão Arterial/economia , Efeitos Psicossociais da Doença , Análise Custo-Benefício , Custos de Cuidados de Saúde/estatística & dados numéricos , Hipertensão/economia , Monitorização Ambulatorial da Pressão Arterial/instrumentação , Humanos , Hipertensão/complicações , Hipertensão/diagnóstico , Modelos Econômicos , Equipe de Assistência ao Paciente/economia , Anos de Vida Ajustados por Qualidade de Vida , Acidente Vascular Cerebral/prevenção & controle
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