Using a Return-On-Investment Estimation Model to Evaluate Outcomes From an Obesity Management Worksite Health Promotion Program

An Enjoyable Workplace Combined Exercise Program for Health Promotion in Trained Employees: Yoga, Pilates, and Circuit Strength Training

Corporate wellness has become an important public health priority through the designing and implementation of different workplace exercise interventions. The objectives of this study were to investigate: (a) the effectiveness of a 4-month workplace combined yoga, Pilates, and circuit strength training program (outside work shift) on health indices, functional capacity, and physical fitness in office employees; and (b) the employees' enjoyment following the program. Fifty physically active office employees (26-55 years old) were equally divided into training (TG) and control groups (CG). The TG followed a 4-month (3 times/week, 50-60 min/training) combined yoga, Pilates, and circuit strength training program. Health indices (body composition, body mass, circumferences, musculoskeletal pains), functional capacity (flexibility, balance), and physical fitness (strength, aerobic capacity) were measured before and after the 4-month time period. After the completion of the program, the TG participants' enjoyment was assessed. The TG significantly improved (p < 0.001) all health, functional capacity (11.3-82.0%), and physical fitness indices (33.9%), except for aerobic capacity, which did not change (p > 0.05). Furthermore, a great percentage of employees (84%) reported high levels of enjoyment. This program could be effectively and safely used in workplace settings as an enjoyable intervention to improve specific health, functional capacity, and physical fitness indices in office employees.

Effectiveness of a worksite lifestyle intervention to reduce body mass index among farmworkers in California: a cluster randomized controlled trial

OBJECTIVE

To evaluate the effectiveness of PASOS SALUDABLES, a culturally tailored lifestyle intervention to prevent obesity and diabetes among Latino farmworkers, when implemented at large scale in the worksite.

DESIGN

This study was a two-arm parallel group, cluster randomized controlled trial (RCT), where participants received either a 12-session lifestyle intervention (intervention) or 6-session leadership training (control) at their worksite. The intervention was delivered by Promotoras in Spanish. All sessions were conducted at the worksites (ranches) during meal breaks. Blinded, trained research assistants collected sociodemographic and outcome data (i.e., body mass index [BMI] as primary outcome, and waist circumference, glycated hemoglobin [HbA1c], cholesterol and blood pressure, as secondary outcomes) at baseline and follow-up assessments (i.e., 3 months, 6 months, 1 year and 1.5 years).

SETTING

Recruitment and intervention delivery occurred at 12 study ranches in Oxnard, California.

PARTICIPANTS

We enrolled farmworkers hired by a large berry grower company, who were ≥18 years old, spoke Spanish and were free of diabetes at screening.

RESULTS

A total of 344 workers were enrolled in the intervention and 271 in the control group. The intervention resulted in attenuated increase of BMI over time; however, the difference in trend between groups was not significant (beta=-0.01 for slope difference, p=0.29). No significantly different trend by group was observed in secondary outcomes (p>0.27).

CONCLUSIONS

The worksite intervention, implemented during meal breaks, did not reduce BMI or other clinical indicators. Nevertheless, this study supports the feasibility of recruiting and engaging the Latino farmworker population in workplace health promotion interventions.

A Scoping Review of Economic Evaluations of Workplace Wellness Programs

OBJECTIVE

Debates about the effectiveness of workplace wellness programs (WWPs) call for a review of the evidence for return on investment (ROI) of WWPs. We examined literature on the heterogeneity in methods used in the ROI of WWPs to show how this heterogeneity may affect conclusions and inferences about ROI.

METHODS

We conducted a scoping review using systematic review methods and adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We reviewed PubMed, EconLit, Proquest Central, and Scopus databases for published articles. We included articles that (1) were published before December 20, 2019, when our last search was conducted, and (2) met our inclusion criteria that were based on target population, target intervention, evaluation method, and ROI as the main outcome.

RESULTS

We identified 47 peer-reviewed articles from the selected databases that met our inclusion criteria. We explored the effect of study characteristics on ROI estimates. Thirty-one articles had ROI measures. Studies with costs of presenteeism had the lowest ROI estimates compared with other cost combinations associated with health care and absenteeism. Studies with components of disease management produced higher ROI than programs with components of wellness. We found a positive relationship between ROI and program length and a negative relationship between ROI and conflict of interest. Evaluations in small companies (≤500 employees) were associated with lower ROI estimates than evaluations in large companies (>500 employees). Studies with lower reporting quality scores, including studies that were missing information on statistical inference, had lower ROI estimates. Higher methodologic quality was associated with lower ROI estimates.

CONCLUSION

This review provides recommendations that can improve the methodologic quality of studies to validate the ROI and public health effects of WWPs.

Transfer and Implementation Process of a Good Practice in Workplace Health Promotion

The procedure developed by the European Joint Action CHRODIS PLUS (JAC+) to transfer and implement good practices from one setting to another was tested in the context of a workplace health promotion good practice identified in the Region of Lombardy (Italy) and transferred and implemented in two organisations in Andalusia (Spain). This article provides a detailed account on how the JAC+ implementation methodology, which included the use of the SQUIRE (Standards for QUality Improvement Reporting Excellence) guidelines, was applied. It offers a practical overview for the uptake of this methodology and of the good practice itself. The account of how this systematic and rigorous implementation reporting model was applied can be of value to those with an interest in workplace health and in the transfer of good practice and implementation sciences.

Health-Promoting Effects of a Concurrent Workplace Training Program in Inactive Office Workers (HealPWorkers): A Randomized Controlled Study

PURPOSE

To the best of our knowledge, no previous study has examined the health-promoting effects of a daily supervised concurrent workplace training program in inactive office workers. The main objective of this study was to examine the effectiveness of a 6-month workplace training program on health indices, musculoskeletal pains, functional capacity, and physical fitness in office workers.

DESIGN

Randomized controlled study.

SETTING

Four workplaces in the Region of Thessaly, Greece.

PARTICIPANTS

A total of 36 office workers (≥6 hours/d, 5 days/wk) were randomly assigned to either a training group (TG; n = 18) or a control group (CG; n = 18).

INTERVENTION

The TG participated, every working day, in a 6-month supervised concurrent (flexibility, strength, balance, aerobic) training program (120 training sessions, 2 workouts/d of 15-20 minutes) that was implemented, in small groups, at the workplace during the work shift. The CG did not participate in any training.

MEASURES

Health indices (body composition, blood pressure, respiratory function), musculoskeletal pains, functional capacity (flexibility, balance), and physical fitness (maximal strength, cardiorespiratory fitness) were measured before and after the completion of the program. After the completion of the program, participants' enjoyment was assessed.

ANALYSIS

Two-way analysis of variance (group × time) with repeated measures on the "time" factor.

RESULTS

The statistical power, for all parameters, ranged from 0.85 to 0.94. Training group significantly increased lean body mass (3.81%); respiratory function (4.20%-4.53%); cervical, handgrip, back, and leg maximal strength (8.75%-26.55%); and functional capacity (19.71%-188.20%; P < .001-.01; Cohen's effect size: 0.80-7.21), while significant reductions were observed on body fat (7.58%), blood pressure (4.99%-8.05%), heart rate (12.80%), and musculoskeletal pains (33.33%-100%; P < .001; Cohen's effect size: 0.81-6.21). In CG, all the above variables did not change. Furthermore, a great percentage of workers (94.4%) reported high levels of enjoyment.

CONCLUSION

The program "HealPWorkers" is an enjoyable exercise modality that may be safely and effectively used, to work settings, for the improvement of worker's health, overall fitness, and functional capacity.

Health promotion and the agenda for sustainable development, WHO Region of the Americas

The approaches and tools of health promotion can be useful for civil society groups, local and national governments and multilateral organizations that are working to operationalize the 2030 agenda for sustainable development. Health promotion and sustainable development share several core priorities, such as equity, intersectoral approaches and sustainability, that help maximize their impact across traditional sectoral boundaries. In the Region of the Americas, each of these priorities has strong resonance because of prominent and long-standing health inequities that are proving resistant to interventions driven solely by the health sector. We describe several cases from the World Health Organization's (WHO) Region of the Americas in which the approaches and tools of health promotion, with a focus on cities, healthy settings and multisectoral collaboration, have been used to put the agenda into practice. We highlight areas where such approaches and tools can be applied effectively and provide evidence of the transformative potential of health promotion in efforts to achieve the sustainable development goals.

Cost Effectiveness of a Weight Management Program Implemented in the Worksite: Translation of Fuel Your Life

OBJECTIVE

Conduct a cost-effectiveness analysis of the Fuel Your Life (FYL) program dissemination.

METHODS

Employees were recruited from three workplaces randomly assigned to one of the conditions: telephone coaching, small group coaching, and self-study. Costs were collected prospectively during the efficacy trial. The main outcome measures of interest were weight loss and quality-adjusted life years (QALYs).

RESULTS

The phone condition was most costly ($601 to $589/employee) and the self-study condition was least costly ($145 to $143/employee). For weight loss, delivering FYL through the small group condition was no more effective, yet more expensive, than the self-study delivery. For QALYs, the group delivery of FYL was in an acceptable cost-effectiveness range ($22,400/QALY) relative to self-study (95% confidence interval [CI]: $10,600/QALY-dominated).

CONCLUSIONS

Prevention programs require adaptation at the local level and significantly affect the cost, effectiveness, and cost-effectiveness of the program.

Using the CDC's Worksite Health ScoreCard as a Framework to Examine Worksite Health Promotion and Physical Activity

INTRODUCTION

Worksite health promotion programs are emerging as an effective approach for addressing the adult obesity epidemic and improving the overall health of employees.

METHODS

We conducted a scoping review to identify articles that described a physical activity component (eg, promoted increased physical or reduced sitting time) of a worksite health promotion intervention. Our search specified full-length articles published in English from January 2000 through July 2015. We used the Centers for Disease Control and Prevention's Worksite Health ScoreCard, a validated tool, as a framework to summarize information on organizational supports strategies (18 questions) and physical activity strategies (9 questions) implemented by worksite health promotion programs. We also determined whether or not the included studies reported significant (P < .05) improvements in physical activity.

RESULTS

We identified 18 worksite health promotion programs; 11 produced significant improvements in physical activity. Incentives, health risk assessments, health promotion committees, leadership support, marketing, and subsidies or discounts for use of exercise facilities were the most effective organizational supports strategies cited, and physical activity seminars, classes, and workshops were the most effective physical activity strategies cited.

CONCLUSION

The use of the Health ScoreCard allowed for a practical interpretation of our findings, which can inform next steps for the field. Future research should explore the relationships between components of worksite health promotion programs and their outcomes to further develop best practices that can improve worker health and promote physical activity.

Return on investment of public health interventions: a systematic review

BACKGROUND

Public sector austerity measures in many high-income countries mean that public health budgets are reducing year on year. To help inform the potential impact of these proposed disinvestments in public health, we set out to determine the return on investment (ROI) from a range of existing public health interventions.

METHODS

We conducted systematic searches on all relevant databases (including MEDLINE; EMBASE; CINAHL; AMED; PubMed, Cochrane and Scopus) to identify studies that calculated a ROI or cost-benefit ratio (CBR) for public health interventions in high-income countries.

RESULTS

We identified 2957 titles, and included 52 studies. The median ROI for public health interventions was 14.3 to 1, and median CBR was 8.3. The median ROI for all 29 local public health interventions was 4.1 to 1, and median CBR was 10.3. Even larger benefits were reported in 28 studies analysing nationwide public health interventions; the median ROI was 27.2, and median CBR was 17.5.

CONCLUSIONS

This systematic review suggests that local and national public health interventions are highly cost-saving. Cuts to public health budgets in high income countries therefore represent a false economy, and are likely to generate billions of pounds of additional costs to health services and the wider economy.

The well-being valuation model: a method for monetizing the nonmarket good of individual well-being

The objective of this research is to advance the evaluation and monetization of well-being improvement programs, offered by population health management companies, by presenting a novel method that robustly monetizes the entirety of well-being improvement within a population. This was achieved by utilizing two employers' well-being assessments with medical and pharmacy administrative claims (2010-2011) across a large national employer (n = 50,647) and regional employer (n = 6170) data sets. This retrospective study sought to monetize both direct and indirect value of well-being improvement across a population whose medical costs are covered by an employer, insurer, and/or government entity. Logistic regression models were employed to estimate disease incidence rates and input-output modelling was used to measure indirect effects of well-being improvement. These methodological components removed the burden of specifying an exhaustive number of regression models, which would be difficult in small populations. Members who improved their well-being were less likely to become diseased. This reduction saved, per avoided occurrence, US$3060 of total annual health care costs. Of the members who were diseased, improvement in well-being equated to annual savings of US$62 while non-diseased members saved US$26. The method established here demonstrates the linkage between improved well-being and improved outcomes while maintaining applicability in varying populations.

Pasos Saludables: A Pilot Randomized Intervention Study to Reduce Obesity in an Immigrant Farmworker Population

OBJECTIVE

To evaluate a workplace-based diet and physical activity intervention to reduce obesity in a Latino farmworker population.

METHODS

254 Latino farmworkers were allocated in a 1:2 control:intervention ratio to parallel groups in this randomized controlled study, [Clinical Trial ID# NCT01855282]. Intervention participants attended 10 weekly educational sessions led by promotoras. All participants had anthropometry and lifestyle habits recorded before randomization and at follow-up after 12-14 weeks.

RESULTS

Seventy percent (n = 112 intervention and 66 control) completed the study. Intervention females (not controls) decreased the primary outcome measures of weight, BMI, and waist circumference (mean [95% CI]) of -0.7 [-1.3 to -0.1] kg, -0.3 [-0.4 to -0.2] and -0.9 [-1.7 to -0.1] cm, respectively. Intervention participants increased water consumption, fruit and vegetable servings, and moderate physical activity in a dose-dependent fashion.

CONCLUSIONS

The successful pilot workplace intervention offers a model to reach otherwise difficult-to-access Latino farmworkers.

The Value of a Well-Being Improvement Strategy: Longitudinal Success across Subjective and Objective Measures Observed in a Firm Adopting a Consumer-Driven Health Plan

Objective:

The objective of this study is to evaluate effectiveness of a firm's 5-year strategy toward improving well-being while lowering health care costs amidst adoption of a Consumer-Driven Health Plan.

Methods:

Repeated measures statistical models were employed to test and quantify association between key demographic factors, employment type, year, individual well-being, and outcomes of health care costs, obesity, smoking, absence, and performance.

Results:

Average individual well-being trended upward by 13.5% over 5 years, monthly allowed amount health care costs declined 5.2% on average per person per year, and obesity and smoking rates declined by 4.8 and 9.7%, respectively, on average each year. The results show that individual well-being was significantly associated with each outcome and in the expected direction.

Conclusions:

The firm's strategy was successful in driving statistically significant, longitudinal well-being, biometric and productivity improvements, and health care cost reduction.

The relationship between return on investment and quality of study methodology in workplace health promotion programs

OBJECTIVE

To determine the relationship between return on investment (ROI) and quality of study methodology in workplace health promotion programs.

DATA SOURCE

Data were obtained through a systematic literature search of National Health Service Economic Evaluation Database (NHS EED), Database of Abstracts of Reviews of Effects (DARE), Health Technology Database (HTA), Cost Effectiveness Analysis (CEA) Registry, EconLit, PubMed, Embase, Wiley, and Scopus.

STUDY INCLUSION AND EXCLUSION CRITERIA

Included were articles written in English or German reporting cost(s) and benefit(s) and single or multicomponent health promotion programs on working adults. Return-to-work and workplace injury prevention studies were excluded.

DATA EXTRACTION

Methodological quality was graded using British Medical Journal Economic Evaluation Working Party checklist. Economic outcomes were presented as ROI.

DATA SYNTHESIS

ROI was calculated as ROI = (benefits - costs of program)/costs of program. Results were weighted by study size and combined using meta-analysis techniques. Sensitivity analysis was performed using two additional methodological quality checklists. The influences of quality score and important study characteristics on ROI were explored.

RESULTS

Fifty-one studies (61 intervention arms) published between 1984 and 2012 included 261,901 participants and 122,242 controls from nine industry types across 12 countries. Methodological quality scores were highly correlated between checklists (r = .84-.93). Methodological quality improved over time. Overall weighted ROI [mean ± standard deviation (confidence interval)] was 1.38 ± 1.97 (1.38-1.39), which indicated a 138% return on investment. When accounting for methodological quality, an inverse relationship to ROI was found. High-quality studies (n = 18) had a smaller mean ROI, 0.26 ± 1.74 (.23-.30), compared to moderate (n = 16) 0.90 ± 1.25 (.90-.91) and low-quality (n = 27) 2.32 ± 2.14 (2.30-2.33) studies. Randomized control trials (RCTs) (n = 12) exhibited negative ROI, -0.22 ± 2.41(-.27 to -.16). Financial returns become increasingly positive across quasi-experimental, nonexperimental, and modeled studies: 1.12 ± 2.16 (1.11-1.14), 1.61 ± 0.91 (1.56-1.65), and 2.05 ± 0.88 (2.04-2.06), respectively.

CONCLUSION

Overall, mean weighted ROI in workplace health promotion demonstrated a positive ROI. Higher methodological quality studies provided evidence of smaller financial returns. Methodological quality and study design are important determinants.

Economic Analysis of the Return-on-Investment of a Worksite Wellness Program for a Large Multistate Retail Grocery Organization

OBJECTIVE

The objective of this study is to measure the return on investment (ROI) of the Price Chopper/Golub Corporation employee population who participate in wellness programs available to them.

METHODS

Medical claims data, risk level, and presence of comorbidities such as diabetes and heart disease were compared in a matched retrospective cohort of participants and nonparticipants, with 2008, 2009, and 2010 serving as measurement years. Program costs and estimated savings were used to calculate an ROI of $4.33 for every dollar invested in wellness programs.

RESULTS

Reductions in medical costs were observed at several risk and participation levels, with an average savings of $133 per participant and a 3-year savings estimate of $285,706.

CONCLUSIONS

The positive ROI and savings estimate indicate that wellness interventions added economic value to Price Chopper/Golub Corporation.

The Productivity Dilemma in Workplace Health Promotion

BACKGROUND

Worksite-based programs to improve workforce health and well-being (Workplace Health Promotion (WHP)) have been advanced as conduits for improved worker productivity and decreased health care costs. There has been a countervailing health economics contention that return on investment (ROI) does not merit preventive health investment. METHODS/PROCEDURES: Pertinent studies were reviewed and results reconsidered. A simple economic model is presented based on conventional and alternate assumptions used in cost benefit analysis (CBA), such as discounting and negative value. The issues are presented in the format of 3 conceptual dilemmas.

PRINCIPAL FINDINGS

In some occupations such as nursing, the utility of patient survival and staff health is undervalued. WHP may miss important components of work related health risk. Altering assumptions on discounting and eliminating the drag of negative value radically change the CBA value.

SIGNIFICANCE

Simple monetization of a work life and calculation of return on workforce health investment as a simple alternate opportunity involve highly selective interpretations of productivity and utility.

Reducing Health Risk Factors in Workplaces of Low and Middle-Income Countries

OBJECTIVE

To reduce risk factors in workplace settings in low- and middle-income countries.

DESIGN AND SAMPLE

Workplace interventions were utilized as part of the Community Interventions for Health program, a nonrandomized, controlled study undertaken in three communities in China, India, and Mexico. Exactly, 45 industrial, 82 health and 101 school workplace settings with a target population of 15,726. Two independent cross-sectional surveys of workers were conducted at baseline and follow-up, after 18-24 months of intervention activities.

MEASURES

Culturally appropriate interventions to reduce tobacco use, increase physical activity, and improve dietary intake were delivered in the intervention areas.

RESULTS

Exactly, 12,136 adults completed surveys at baseline, and 9,786 at follow-up. In the intervention group, the prevalence of tobacco use reduced significantly in men (-6.0%, p < .001) and the proportion eating five portions of fruit and vegetables daily increased (+6.9%, p < .001) compared with the control group. There were no significant differences between the groups for changes in physical activity or prevalence of overweight.

CONCLUSIONS

Workplace interventions improved risk factors in China, India, and Mexico.

Estimating the return on investment from a health risk management program offered to small Colorado-based employers

OBJECTIVE

To determine whether changes in health risks for workers in small businesses can produce medical and productivity cost savings.

METHODS

A 1-year pre- and posttest study tracked changes in 10 modifiable health risks for 2458 workers at 121 Colorado businesses that participated in a comprehensive worksite health promotion program. Risk reductions were entered into a return-on-investment (ROI) simulation model.

RESULTS

Reductions were recorded in 10 risk factors examined, including obesity (-2.0%), poor eating habits (-5.8%), poor physical activity (-6.5%), tobacco use (-1.3%), high alcohol consumption (-1.7%), high stress (-3.5%), depression (-2.3%), high blood pressure (-0.3%), high total cholesterol (-0.9%), and high blood glucose (-0.2%). The ROI model estimated medical and productivity savings of $2.03 for every $1.00 invested.

CONCLUSIONS

Pooled data suggest that small businesses can realize a positive ROI from effective risk reduction programs.

Health and performance: science or advocacy?

Purpose

– The purpose of this paper is to examine the literature assessing the return-on-investment (ROI) of healthy workplace programs.

Design/methodology/approach

– Used a narrative review to summarize and evaluate findings.

Findings

– Although substantial ROI data now exist, methodological and logical weaknesses limit the conclusions that can be drawn.

Practical implications

– A strategy for monetizing the benefits of healthy workplaces that draws on both human resource accounting and strategic human resource management is described.

Social implications

– The promotion of healthy workplaces is an important goal in its own right. To the extent that ROI estimates are important in advancing this goal, these estimates should be based on clear logic and strong methodology.

Originality/value

– The paper suggests the need for stronger research designs but also note the difficulties in monetizing outcomes of the healthy workplace.

Investigating the association between obesity and asthma in 6- to 8-year-old Saudi children: a matched case-control study

BACKGROUND

Previous studies have demonstrated an association between obesity and asthma, but there remains considerable uncertainty about whether this reflects an underlying causal relationship.

AIMS

To investigate the association between obesity and asthma in pre-pubertal children and to investigate the roles of airway obstruction and atopy as possible causal mechanisms.

METHODS

We conducted an age- and sex-matched case-control study of 1,264 6- to 8-year-old schoolchildren with and without asthma recruited from 37 randomly selected schools in Madinah, Saudi Arabia. The body mass index (BMI), waist circumference and skin fold thickness of the 632 children with asthma were compared with those of the 632 control children without asthma. Associations between obesity and asthma, adjusted for other potential risk factors, were assessed separately in boys and girls using conditional logistic regression analysis. The possible mediating roles of atopy and airway obstruction were studied by investigating the impact of incorporating data on sensitisation to common aeroallergens and measurements of lung function.

RESULTS

BMI was associated with asthma in boys (odds ratio (OR)=1.14, 95% confidence interval (CI), 1.08-1.20; adjusted OR=1.11, 95% CI, 1.03-1.19) and girls (OR=1.37, 95% CI, 1.26-1.50; adjusted OR=1.38, 95% CI, 1.23-1.56). Adjusting for forced expiratory volume in 1 s had a negligible impact on these associations, but these were attenuated following adjustment for allergic sensitisation, particularly in girls (girls: OR=1.25; 95% CI, 0.96-1.60; boys: OR=1.09, 95% CI, 0.99-1.19).

CONCLUSIONS

BMI is associated with asthma in pre-pubertal Saudi boys and girls; this effect does not appear to be mediated through respiratory obstruction, but in girls this may at least partially be mediated through increased risk of allergic sensitisation.

Worksite primary care clinics: a systematic review

Despite levels of health spending that are higher per capita and as share of gross domestic product than any country worldwide, the US health care system is fragmented, technology and administration heavy, and primary care deficient. Studies of regional variations in US health care show similar "disconnects" between higher spending and better health outcomes. Faced with rising health benefit costs and suboptimal workforce health amid economic downturn, concerned US employers have implemented innovative payment and health care delivery strategies such as consumer-driven health plans and targeted prevention programs. The former may impose undue cost shifting, prohibitive out-of-pocket expenses, and health literacy challenges, while the latter have shown inconsistent near-term economic returns and long-term clinical efficacy. Employers have begun exploring more comprehensive health delivery platforms such as integrated worksite primary care clinics that have potential to cost-effectively address several pressing problems with current US health care: the growing primary care physician shortage, poor access to routine care, lack of coordinated and patient-centered treatment models, low rates of childhood immunizations, and "quality-blind" fee-for-service payment mechanisms. Such on-site medical clinics exploit one of the rare comparative strengths of the US health care system-its plentiful supply of highly skilled registered nurses-to offer workers and their dependents convenient, high-quality, affordable care. A relatively recent health care paradigm, worksite clinics must yet develop consistent reporting strategies and credible demonstration of outcomes. This review explores available evidence regarding worksite primary care clinics, including current rationale, historical trends, prevalence and projected growth, expected health and financial benefits, challenges, and future research directions.

The impact of a worksite weight management program on obesity: a retrospective analysis

The objective of this study was to examine the efficacy of a worksite weight management program on the reduction of weight and lipid levels in employees and their dependents. This retrospective study examined the impact of a one-on-one worksite weight management program. Patients with a body mass index (BMI)>30, or a BMI>25 and 2 or more risk factors were eligible for inclusion. Laboratory and biometric readings at study end were compared to those at baseline. In addition, the percentage change of patients reaching recommended guideline levels was reported. Of the 310 employees enrolled, 157 completed the program (50.6%) with an average weight loss of 5.6%. Improvement was realized for pre-post weight (-6.0 lbs.; P≤.0001), BMI (-0.9; P≤.0001), blood pressure (systolic: -2.6; P≤.0001; diastolic: -1.9; P≤.0001), total cholesterol (-5.9; P=.0485), low-density lipoprotein cholesterol (LDL; -4.7; P=.0004), and triglycerides (-7.6; P=.0060). The proportion moving to within guideline levels increased for the following metrics: normal BMI category (2.6%; P=.0060),<30 BMI (10%; P≤.0001), systolic and diastolic blood pressure readings (7.7%; P=.0011 and 6.1; P=.0056, respectively), total cholesterol (6.5%; P=.0020), LDL (3.9%; P=.0396), and triglycerides (4.8; P=.0137). Retention in the worksite program was almost twice that seen in some commercial weight loss programs and significant improvements in laboratory and biometric readings were achieved. This study suggests that employer worksite-based programs may have an important role in improving the health of an employee population, which is of particular interest given the high prevalence of obesity and its attendant costs.

Do work relationships matter? Characteristics of workplace interactions that enhance or detract from employee perceptions of well-being and health behaviors

This qualitative case study adopted the position that health and health behaviors are complex social constructs influenced by multiple factors. Framed by the social ecological model, the study explored how work interactions enhanced or detracted from the perceptions of well-being and health behaviors. Despite the fact that previous studies indicated that the social workplace environment contributed to employee health, there was little information regarding the characteristics. Specifically, little was known about how employees perceived the connections between workplace interactions and health, or how social interactions enhanced or detracted from well-being and health behaviors. The participants included 19 volunteers recruited from four companies, who shared their experiences of workplace interactions through interviews and journaling assignments. The findings indicated that feelings of well-being were enhanced by work interactions, which were trusting, collaborative, and positive, as well as when participants felt valued and respected. The study also found that interactions detracted from well-being and health behaviors when interactions lacked the aforementioned characteristics, and also included lack of justice and empathy. The enhancing and detracting relationships generated physical symptoms, and influenced sleeping and eating patterns, socializing, exercise, personal relations, careers, and energy. Surprisingly, the study found that regardless of how broadly participants defined health, when they were asked to rate their health, participants uniformly rated theirs on physical attributes alone. The exclusive consideration of physical attributes suggests that participants may have unconsciously adopted the typical western medical view of health - an individually determined and physiologic characteristic. Despite research suggesting health is more than biology, and despite defining health broadly, participants uniformly adopted this traditional view. The study also offers human resource development professionals with evidence supporting interventions aimed at minimizing workplace incivility. Interventions designed to improve employee engagement could minimize financial and human costs of negative interactions. The bottom line is that workplaces should be physically, emotionally, and psychologically safe for well-being and healthy behaviors to flourish.

The Workforce wellness index: a method for valuing US workers' health

OBJECTIVE

To devise a methodology to create a single health risk-cost score that can be applied to health risk assessment survey data and account for the medical costs associated with modifiable risks.

METHODS

We linked person-level health risk assessment data with medical benefit eligibility and claims data for 341,650 workers for the period 2005 to 2010 and performed multivariate analyses to estimate costs associated with high risks. We used the estimated costs and risk prevalence rates to create a composite Workforce Wellness Index (WWI) score.

RESULTS

Increasing obesity rates among employees was found to be the most important contributor to increased health care spending and the main reason the WWI score worsened over time.

CONCLUSIONS

Employers that address employees' health risk factors may be able to reduce their medical spending and achieve an improvement in their WWI scores.

Prevalence of and intention to change dietary and physical activity health risk behaviours

Poor nutrition and insufficient physical activity contribute to high rates of obesity. Prevalence, intention to change and co-occurrence of four health risk behaviours (inadequate fruit and vegetables, excessive dietary fat, excessive sugary beverages and inadequate physical activity in comparison to public health recommendations) were investigated in an Australian population of working adults. Participants (n=105) completed sociodemographic and stage of change questionnaires. A subsample (n=40) were assessed twice to estimate test-retest repeatability. In the full sample, 73% were female, mean age was 33.8 years and mean BMI was 23.8 kg/m(2). Eighty-seven percent of participants consumed inadequate fruit and vegetables, 43% had excessive dietary fat, 42% had excessive sugary beverages and 29% had inadequate physical activity. The proportions intending to change each behaviour were 57%, 25%, 18% and 24%, respectively. Two-thirds exhibited multiple risk behaviours and 38% intended to change multiple risk behaviours. Fruit and vegetables and dietary fat were the most commonly paired risk behaviours (39%) and the pair most intended to change (19%). Occurrence of multiple risk behaviours was associated with being male (OR 3.10, 95% CI 1.06-9.03) or overweight/obese (OR 2.66, 95% CI 1.02-6.93). Targeting two risk behaviours, particularly fruit and vegetables and dietary fat, may be appropriate when designing health promotion programs in working populations.

Metabolic risk factor reduction through a worksite health campaign: a case study design

The purpose of this intervention study was to measure the impact of an onsite and online 12-week worksite heart-health campaign designed to reduce metabolic risk factors for employees at BMW of North America, LLC. All participants received three coaching sessions by a registered dietitian (RD), participated in eight educational sessions led by an RD, viewed their pre, midpoint and final biometric data online, and had access to other web-based tools and educational booklets. The program used team-based competition. At baseline and week 12, blood pressure, anthropometric and hematologic parameters were measured, including changes in weight, blood pressure, fasting blood glucose, waist circumference, total cholesterol, LDL cholesterol, HDL cholesterol, triglycerides, and smoking habits. Of the 100 individuals that enrolled, 95 completed the program, and 87 met criteria to be eligible for data analysis. Paired t tests demonstrated significant reductions in weight (p<.0001), body mass index (p=.0047), waist circumference (p <.0001), diastolic blood pressure (p=.0018), and systolic blood pressure (p=.0012). Paired t tests for total cholesterol, LDL cholesterol, HDL cholesterol, triglycerides, and fasting blood glucose did not indicate any significant improvements. There was an improvement in body mass index and blood pressure classifications after completion of the program. A Friedman’s test of blood pressure classification demonstrated significant improvements in participants’ blood pressure classification from pre-program to midpoint, midpoint to end, and pre-program to end. These results support the effectiveness of a dietitian-led, team-based, worksite heart-health campaign with web-based education to reduce risk factors for metabolic syndrome.

Cost-effectiveness of a workplace-based incentivized weight loss program

OBJECTIVE

To evaluate the cost-effectiveness ratios of a nursing home-based incentivized Behavioral Weight Management Program (BWMP) from the employer's perspective.

METHODS

Seventy-two overweight and obese health care workers completed the BWMP (n = 35 incentivized; n = 37 nonincentivized). Weight change outcomes were compared for the pre- (0) and postintervention (28 weeks) follow-up periods within and between sites. Comprehensive estimates of BWMP direct program costs and avoided costs of absenteeism and productivity improvements were estimated to evaluate a business case.

RESULTS

There was a significant difference (P = 0.01) between the average per-participant weight change between incentivized sites (-7.4 lb) and nonincentivized sites (-2.2 lb). The cost-effectiveness ratios per pound of weight loss were $25.5 and $58.1, respectively.

CONCLUSIONS

In general, incentivized BWMPs were more cost effective. To generate a business case, enhancement in productivity becomes a critical factor and future research needs to investigate it further.

Interest and use of mental health and specialty behavioral medicine counseling in US primary care patients

BACKGROUND

Counseling interventions have the potential to improve health and quality of life for primary care patients, but there are few studies describing the interest in and utilization of counseling among this patient population in the USA.

PURPOSE

The purpose of the study was to evaluate interest in mental health and specialty behavioral medicine counseling and predictors of utilization over 1 year among US primary care patients.

METHOD

Participants in this two-survey longitudinal study included 658 primary care patients in an urban US academic medical center (461 females, age M = 51.05, SD = 15.46 years). Retention rate was 61.2% at survey 2. Patient demographics, depression, anxiety, and interest in counseling services were assessed through a survey mailed 1 week following an outpatient appointment. Respondents to survey 1 were re-contacted 1 year later to assess. Interest and use of the following counseling services were evaluated in the relevant subgroups: mental health (the entire sample and patients with elevated anxiety and/or depression), health/lifestyle (overweight and obese participants), smoking cessation (current and occasional smokers), and pain management (participants with elevated daily pain ratings).

RESULTS

At survey 1, 45.7% of the sample reported interest in mental health counseling, and 58.9% of the sample reported interest in behavioral medicine counseling. Among overweight or obese participants, 59.9% were interested in health/lifestyle counseling. Among smokers, 55.3% were interested in smoking cessation, and among participants with chronic pain, 33.8% were interest in pain management. Rates of utilization of services at survey 2 were 21.3% for mental health, 7.7% for health/lifestyle, 6.7% for smoking cessation, and 6.6% for pain management. Interest in receiving services at survey 1 was the strongest predictor of utilization.

CONCLUSION

Results demonstrate high interest but low utilization over 1 year among US primary care patients. Identifying patients interested in counseling services and reducing barriers may help facilitate receipt of services for those with interest and need for behavioral treatments.

Systematic review on the financial return of worksite health promotion programmes aimed at improving nutrition and/or increasing physical activity

This systematic review summarizes the current evidence on the financial return of worksite health promotion programmes aimed at improving nutrition and/or increasing physical activity. Data on study characteristics and results were extracted from 18 studies published up to 14 January 2011. Two reviewers independently assessed the risk of bias of included studies. Three metrics were (re-)calculated per study: the net benefits, benefit cost ratio (BCR) and return on investment (ROI). Metrics were averaged, and a post hoc subgroup analysis was performed to compare financial return estimates between study designs. Four randomized controlled trials (RCTs), 13 non-randomized studies (NRSs) and one modelling study were included. Average financial return estimates in terms of absenteeism benefits (NRS: ROI 325%, BCR 4.25; RCT: ROI -49%, BCR 0.51), medical benefits (NRS: ROI 95%, BCR 1.95; RCT: ROI -112%, BCR -0.12) or both (NRS: ROI 387%, BCR 4.87; RCT: ROI -92%, BCR 0.08) were positive in NRSs, but negative in RCTs. Worksite health promotion programmes aimed at improving nutrition and/or increasing physical activity generate financial savings in terms of reduced absenteeism costs, medical costs or both according to NRSs, whereas they do not according to RCTs. Since these programmes are associated with additional types of benefits, conclusions about their overall profitability cannot be made.

Value of primordial and primary prevention for cardiovascular disease: a policy statement from the American Heart Association

The process of atherosclerosis may begin in youth and continue for decades, leading to both nonfatal and fatal cardiovascular events, including myocardial infarction, stroke, and sudden death. With primordial and primary prevention, cardiovascular disease is largely preventable. Clinical trial evidence has shown convincingly that pharmacological treatment of risk factors can prevent events. The data are less definitive but also highly suggestive that appropriate public policy and lifestyle interventions aimed at eliminating tobacco use, limiting salt consumption, encouraging physical exercise, and improving diet can prevent events. There has been concern about whether efforts aimed at primordial and primary prevention provide value (ie, whether such interventions are worth what we pay for them). Although questions about the value of therapeutics for acute disease may be addressed by cost-effectiveness analysis, the long time frames involved in evaluating preventive interventions make cost-effectiveness analysis difficult and necessarily flawed. Nonetheless, cost-effectiveness analyses reviewed in this policy statement largely suggest that public policy, community efforts, and pharmacological intervention are all likely to be cost-effective and often cost saving compared with common benchmarks. The high direct medical care and indirect costs of cardiovascular disease-approaching $450 billion a year in 2010 and projected to rise to over $1 trillion a year by 2030-make this a critical medical and societal issue. Prevention of cardiovascular disease will also provide great value in developing a healthier, more productive society.

Assessment of a Worksite Health Promotion Readiness Checklist

OBJECTIVE

To assess the utility of a Worksite Health Promotion Readiness Checklist (WRCL) designed to evaluate the worksite's readiness for implementing health promotion and health protection programs.

METHODS

The WRCL was pilot tested in worksites with (WHPy) and without (WHPn) health promotion programs. The two parts of WRCL scores (observational and administrative) for WHPy and WHPn sites were compared within and between the worksites to establish WRCL utility and sensitivity.

RESULTS

Observational WRCL (completed by two observers per site) demonstrated high interrater reliability (P < 0.05) for most items. Administrative WRCL (completed by three administrators per site) showed some discrepant responses between administrators. Overall, both sections of WRCL produced higher scores for WHPy sites.

CONCLUSIONS

WRCL could be a valid and reliable instrument to measure readiness of a worksite toward health promotion and health protection programs.

Adoption of health promotion practices in a cohort of U.S. physician organizations

BACKGROUND

Physician organizations such as medical groups and independent practice associations can play a vital role in health promotion through the adoption of effective health promotion practices such as health risk assessments, patient reminder systems, and health promotion education programs.

PURPOSE

To examine organizational changes in a cohort of physician organizations and changing health promotion practices.

METHODS

Data for a cohort of 369 physician organizations in the U.S. with 20 or more physicians were collected between September 2000 and September 2001 and subsequently from March 2006 to March 2007. Paired-sample t tests were used to identify changes in physician organization characteristics and the use of nine health promotion practices between 2000-2001 and 2006-2007.

RESULTS

Compared to 2000-2001, the cohort of physician organizations in 2006-2007 was larger, more likely to be owned by physicians; less likely to be owned by a hospital, health system, or HMO; more profitable; and more likely to use electronic information technology. Between 2000-2001 and 2006-2007, physician organizations increased the use of health risk appraisals to contact high-risk patients and increased the use of reminders for eye exams for diabetic patients. During the same time period, physician organizations decreased the use of nutrition and weight-loss health promotion programs.

CONCLUSIONS

The adding and dropping of programs among physician organizations is due to many factors, including changing regulatory environments, market conditions, populations, and new health promotion technologies. In the coming years, incentives and regulatory policy should encourage the adoption of effective health promotion practices by physician organizations.

A successful occupational health nurse-driven health promotion program to support corporate sustainability

Health promotion programs offer an opportunity to support the health of employees, their families, and the communities in which they reside. By integrating health promotion programs with a company's sustainability efforts, the occupational health nurse can directly impact the company's bottom line by ensuring the benefits from a healthy, safe, and fully productive employee who is able to remain in the workplace for some time. This article discusses a successful health promotion program developed and implemented by an occupational health nurse in support of a company's sustainability effort.

Obesity-related costs and the economic impact of laparoscopic adjustable gastric banding procedures: benefits in the Texas Employees Retirement System

OBJECTIVE

To assess the return on investment (ROI) and economic impact of providing insurance coverage for the laparoscopic adjustable gastric banding (LAGB) procedure in classes II and III obese members of the Texas Employees Retirement System (ERS) and their dependents from payer, employer, and societal perspectives.

METHODS

Classes II and III obese employee members and their adult dependents were identified in a Texas ERS database using self-reported health risk assessment (HRA) data. Direct health costs and related absenteeism and mortality losses were estimated using data from previous research. A dynamic input-output model was then used to calculate overall economic effects by incorporating direct, indirect, and induced impacts. Direct health costs were inflation-adjusted to 2008 US dollars using the Consumer Price Index for Medical Care and other spending categories were similarly adjusted using relevant consumer and industrial indices. The future cost savings and other monetary benefits were discounted to present value using a real rate of 4.00%.

RESULTS

From the payer perspective (ERS), the payback period for direct health costs associated with the LAGB procedure was 23-24 months and the annual return (over 5 years) was 28.8%. From the employer perspective (State of Texas), the costs associated with the LAGB procedure were recouped within 17-19 months (in terms of direct, indirect, and induced gains as they translated into State revenue) and the annual return (over 5 years) was 45.5%. From a societal perspective, the impact on total business activity for Texas (over 5 years) included gains of $195.3 million in total expenditures, $93.8 million in gross product, and 1354 person-years of employment.

LIMITATIONS

The analysis was limited by the following: reliance on other studies for methodology and use of a control sample; restriction of cost savings to 2.5 years which required out-of-sample forecasting; conservative assumptions related to the cost of the procedure; exclusion of presenteeism; and no sensitivity analyses performed.

CONCLUSION

This analysis indicates that providing benefits for the LAGB procedure to eligible members of the Texas ERS and their dependents is worthy of support from payer, employer, and societal perspectives.

A Successful Occupational Health Nurse-Driven Health Promotion Program to Support Corporate Sustainability

Health promotion programs offer an opportunity to support the health of employees, their families, and the communities in which they reside. By integrating health promotion programs with a company's sustainability efforts, the occupational health nurse can directly impact the company's bottom line by ensuring the benefits from a healthy, safe, and fully productive employee who is able to remain in the workplace for some time. This article discusses a successful health promotion program developed and implemented by an occupational health nurse in support of a company's sustainability effort.

A review and analysis of the clinical and cost-effectiveness studies of comprehensive health promotion and disease management programs at the worksite: update VII 2004-2008

OBJECTIVE

To conduct the seventh periodic review and analysis of the clinical and cost-effectiveness research conducted in worksite/corporate environments between 2004 and 2008.

METHODS

A literature search of US-based research was conducted using a multistage process including MEDLINE, ADI, EDGAR, CARL, Inform, Lexis-Nexis, as well as direct inquiries to key researchers in this area of expertise.

RESULTS

From 2004 to 2008, there were 16 new studies that met the Inclusion/Exclusion criteria. These studies are critiqued and entered into a data table consisting of 13 variables and citations of the 16 new studies.

CONCLUSIONS

Clinical and cost-effectiveness research in the worksite/corporate environment continues to evolve although there was only one randomized clinical trial conducted during the most recent interval. There are innovations in pilot studies, quasi-experimental methodologies, and econometric modeling as indicative of future trends.

Health risk reduction programs in employer-sponsored health plans: Part I-efficacy

OBJECTIVE

We sought to determine whether workplace health risk reduction programs (HRRPs) using health risk assessments (HRAs), individually focused risk reduction, and financial incentives succeeded in improving employee health and reducing employer health benefit costs.

METHODS

We reviewed the proprietary HRA available to us and conducted a literature review to determine the efficacy of HRRPs using HRAs, individualized employee interventions, and financial incentives for employee participation.

RESULTS

There is some evidence that HRRPs in employer-sponsored programs improve measures of employee health, but the results of these studies are somewhat equivocal.

CONCLUSION

Employer-sponsored HRRPs may have some benefits, but problems in plan design and in the studies assessing their efficacy complicate drawing conclusions.