Thomas Golaszewski

The Effect of Self-care Interventions on the Use of Medical Service Within a Medicare Population

To determine the effect of a self-care communication-based health education program on ambulatory care utilization, a prospective, randomized, controlled trial was conducted with a Medicare population within a health maintenance organization. A statistically significant decrease of 15% in total medical visits was found in the experimental group as compared with a control. Although not evident in the control, a statistically significant decrease in the ratio of follow-up visits from pre-entry to postentry was realized in the experimental group. Medical-visit decreases resulted in a savings of

Impact of a facility-based corporate fitness program on the number of absences from work due to illness

36.65 per household in the experimental group for a benefit-cost ratio of 2.19 saved for every dollar spent on intervention. These results demonstrate that a health education program can reduce utilization while having no known negative impact on the quality of health.

Shining Lights: Studies That Have Most Influenced the Understanding of Health Promotion's Financial Impact

This study examined the relationship between participation in a facility-based fitness program and the number of reported absences from work due to illness. Employees who became members had a history of fewer absences before the program began in 1987 than employees who did not become members. Comparing 1988 with 1986, members experienced a significant decrease in absences, whereas nonmembers did not. Male and female members experienced 0.42 and 1.0 fewer days absent in 1988 than in 1986, respectively. Controlling for gender and previous absences, members could be expected to have 1.2 fewer absences in 1988 than nonmembers. On average, those who participated most frequently experienced the greatest improvement in attendance. A significant interaction between participation and 1986 absences indicated that a members decrease in absences depended both on how many absences the member had to begin with, and how much he or she participated. Members having a high number of absences in 1986 could expect the greatest benefit from frequent participation.

Heart check: the development and evolution of an organizational heart health assessment.

Purpose. To examine the literature from the past 20 years and identify those studies that support the economic merit of health promotion. Data Source. A panel of experts was used to identify the top studies supporting the purpose of this article. Study Inclusion and Exclusion Criteria. Studies were chosen based on the following criteria: the study (1) examined the relationship between health risks and financial outcomes, or health promotion programs and financial outcomes; (2) provided strong and compelling financial data supporting the worth of health promotion; (3) had a high-quality methodology; (4) answered an important question or replicated important findings with superior methodology; and (5) represented U.S.-based initiatives published since 1980. After initially nominating a group of studies for consideration, panelists rated each on a scale from 1 to 3 representing their opinion of importance. Studies rating the highest were included for this discussion. Data Extraction Methods. Studies were analyzed by population characteristics, design, statistical tests, limitations, and results. This information was summarized for each identified article. Major Conclusions. A relationship between modifiable health risk factors and health care costs is supported by research. Health promotion interventions appear to provide positive financial returns, most notably for health care costs and absenteeism reduction. Private sector initiatives seem to be driving economic-based research. Overall, health promotion shows promising results for providing financial advantages for its sponsors; however, if this discipline is to show its true worth, considerable funding is needed from government or philanthropic sources to cover the substantial costs of quality research.

Development of assessment tools to measure organizational support for employee health.

Purpose. The purpose of this article is to document the development, testing, and application of an organizational assessment tool used to measure employer support for heart health. Additional information is presented on its future research and applications plan. Design. This article represents the pooling of results from multiple studies using a variety of designs, including pilot tests, cross-sectional analyses, and quasi-experiments. Setting. Worksites covering the spectrum of employers across industry types and size, and throughout all of New York State. Subjects. Over 10,000 New York employees and 1000 New York employers are represented in the multiple phases of this research. Measures. Heart Check is a 226-item inventory designed to measure such features in the worksite as organizational foundations, administrative supports, tobacco control, nutrition support, physical activity support, stress management, screening services, and company demographics. Additional side studies used professional judgments and behavioral surveys. Results. As an assessment tool Heart Check shows evidence for reliability and validity. Applications of the instrument show characteristics that define high-scoring companies, quasi standards for New York employers, and, when applied during interventions, positive changes in organizational support levels. Conclusions. A relatively inexpensive, easy-to-use, and metrically tested instrument exists for measuring the construct of organizational support for employee heart health. The instrument shows promise as part of a system to enhance heart health through public health-based interventions in the workplace.

Organizationally Based Stress: What Bothers Teachers.

OBJECTIVE To develop systems that measure and effect organizational support for employee health. METHODS Multiple studies and developmental projects were reviewed that show the process of instrument development, metric quality testing, utilization within intervention studies, and prediction modeling efforts. RESULTS Demographic patterns indicate high support levels and relationships of subsections to various employee health risks. Successes with the initial version have given rise to 2 additional evaluation tools. CONCLUSIONS The availability of these systems illustrates how ecological models can be practically applied. Such efforts contribute to the paradigm shift in worksite health promotion that focuses on the organization as the target of intervention.

Effects of Organizationally-Based and Individually-Based Stress Management Efforts in Elementary School Settings.

AbstractData are presented that establish the level of respondent teachers’ perceived stress. Through use of surveys, urban elementary school teachers’ responses to the organizationally based stressors that can potentially lead to manifestations of stress were examined. Results indicate that these teachers are moderately stressed and that stressors that center on classroom life are more problematic than stressors that are organizationally focused.

The relationship between retrospective health insurance claims and a health risk appraisal-generated measure of health status

Organizational intervention as well as intervention with individuals reduces teacher stress.

Measuring worksite resources for employee heart health.

This research examined the relationship between a measure of health status (defined as the health index--the difference between actual and appraised ages) derived from a health risk appraisal and retrospective health insurance claims taken from one cooperating work organization. A model was defined consisting of 3-year retrospective medical claims as the criterion and age and the health index as predictors. Using a cube-root transformation of medical claims, a significant inverse relationship for age and the health index was identified for men. No relationships were found for women. It was concluded that, for men when age is held constant, a negative relationship exists between retrospective medical claims and a health risk appraisal-generated health status indicator, the health index.

Demographic Characteristics of Users of Worksite Health Promotion Written Materials

Purpose. Intervention at the organizational rather than the individual level is gaining greater attention in worksite health promotion efforts. However, little research has been done on instruments to measure this domain. Therefore, the purpose of this study was to further test the utility of an existing organizational heart health support instrument by examining relationships among worksite structural characteristics and comparing these results to other survey findings. Design. One-time cross-sectional. Setting. New York State. Subjects. One hundred fifteen volunteer worksites in the New York State Healthy Heart Program, representing manufacturing, government, education, health care, and other industries. Measures. A survey was conducted using HeartCheck, an organizational assessment of employee support for heart health. HeartCheck contains 175 items measuring organizational support for tobacco control, nutrition, physical activity, stress, screening, and administrative support structure. Results. On average, only 22% of all worksite resources assessed were present in the sample. Having a workforce greater than 250 provided a 12% increase in predicted overall worksite resources. A predominantly female workforce (>75%) provided 10% higher levels of worksite stress resources. Worksites with unions had higher levels of resources for physical activity (10%), screening (13%), and general supportive structures (10%). The presence of manual labor diminished support for tobacco control resources (−13%). Finally, manufacturing worksites demonstrated a clear advantage for all types of worksite resources, except for stress. Conclusion. A number of trends found in this study are consistent with earlier work. Industry type and size both predict worksite supports similar to previous studies. Other findings that appear to contradict previous work, including the relatively low level of support observed in this sample, can be explained by the comprehensive nature of the instrument. Overall, these findings demonstrate the utility of HeartCheck.