Worksite Public-Private Partnership: Improving The Health And Well Being Of New Yorkers By Supporting New York City Employers In Health Promotion Efforts

Project Team:
Cornell University Institute for Health & Productivity Studies
New York City Department of Health & Mental Hygiene
Thomson Medstat
Wellness Councils of America

(image: Worksite Wellness: Worksite wellness is good business, Cornell University, NYC Health and Thomson Medstat logos)

• To identify strategies by which a public sector agency can effectively support employer efforts to design, implement, and evaluate evidence-based health promotion and disease prevention programs.
• To measure the incremental effects of high-intensity, comprehensive worksite health promotion interventions developed and implemented by the New York City Department of Health and Mental Hygiene (NYC DOHMH).
• To assess program impact on improvement in health behavior, biometric measures, health risks, productivity, health care utilization and cost; and return on investment.

• Relative moderate intensity interventions, high intensity interventions will show reductions in:
  • Behavioral risk factors
  • Self-reported biometrics
  • Presenteeism
  • Absenteeism
  • Health care utilization and expenditures
• Relative to all employed individuals in New York City (as assessed by the Community Health Survey administered by the NYC Epidemiology Division), all intervention sites will achieve reductions in the above categories.

• Con Edison – Gas Operations
• Columbia University Medical Center
• Coney Island Hospital
• North Bronx Healthcare Network
  • Jacobi Hospital
  • North Central Bronx Hospital
• South Manhattan Healthcare Network –
  • Gouverneur Hospital
  • Belleview Hospital
  • Coler Goldwater - Hospital
• Pace University
• Transport Workers Union -- NYCTA

• Quasi-experimental:
  • moderate vs. high intensity treatments
  • pre-post design
    • 3 data points: baseline, year 1,year 2)
• Intervention sites – matched then randomly assigned to moderate or high intensity
• Number of eligible employees = 31,535
• Number of participants in baseline HRA = 5,539

• To recruit NYC employers into the study and gain commitment from the senior leadership at each site.
• To design effective data collection tools and procedures, and develop individual and group feedback reports.
• To use these tools to collect and analyze baseline data concerning:
  • Employees' health risks, medical care and absenteeism
  • Leadership and environmental supports for health promotion
  • Health promotion plans already instituted at each site.
• To develop appropriate intervention programs using:
  • Analysis of baseline data
  • Assessment of the work environment and culture at each site
  • Insight from site leaders and employees regarding effective programming.

• Ten employers agreed to provide access to their worksites and internally promote programs.
• Recruitment efforts involved engaging key influencers at these organizations in informal discussions followed by formal presentations to senior leadership.
• Incentives to participate:
  • NYCDOHMH provided multiple health promotion programs and resources to worksites free of charge.
  • Measurement and evaluation is built into project.
  • Employers are provided their organization's study data at key milestones.

• Health and Productivity Management tool (HPM)
  • Healthcare utilization & cost; absenteeism, productivity, etc.
• Environmental Assessment Tool (EAT)
  • Size of workforce, employee characteristics, current health promotion programs & policies, stair/elevator assessments, etc.
• Leading by Example Questionnaire (LBE)*
  • Site leadership attitude, commitment, support for health promotion
• Health Risk Assessment (HRA)*
  • Self-reported health behaviors, biometrics, health status, etc.
  • 18% Participation Rate (n = 5,539)

* Due to space limitation, only the data collected using these tools is presented here.

• Of 31,535 eligible employees, 5,539 responded to the HRA survey (18 percent response rate).
• The average age was 43.3 years.
• Eighty-five percent of respondents were covered by their employer's healthcare insurance plan.

Table 2: HRA Risk Profile of Participants

Risk Factor	Percent of Respondents at High Risk (N = 5,539)
Poor nutrition Obese Poor emotional health Poor safety behaviors Poor physical activity/exercise Smoking and tobacco use Lack of preventative screenings (Age 50+) High cholesterol High blood pressure High stress High blood glucose (sugar) High alcohol use	94.8% 26.9% 21.5% 21.7% 19.6% 13.6% 38.8% 5.0% 4.6% 4.1% 3.0% 2.8%

Table 3: Baseline HRA Healthcare Utilization and Absenteeism Data (n=5,539)

Medical Care and Absenteeism	Percent or Average Number of Times
Percent who have a regular doctor	87.9
Percent who had a physical checkup within the last two years	92.0
Average number of visits to a physician:
In the past year	3.1
In the past month	0.8
Average number of times in the past year:
Admitted to the hospital	0.1
Visited the emergency room	0.3
Average number of days of missed work due to illness/injury	4.8

Table 4: Baseline HRA Health Effects on Workplace Performance

(image: bar graph titled "Work Limitations Questionnaire")

• LBE administered to:
  • Site coordinator/leadership
  • Site wellness team
  • Site health services staff
• 76 questionnaires distributed, 50 returned (66 percent response rate)
• Participants responded to 15 statements regarding leadership/organizational support for health promotion:
  • 5 Strongly agree
  • 4 Agree
  • 3 Neither agree nor disagree
  • 2 Disagree
  • 1 Strongly disagree
• Average response score: 3.23

Table 5: LBE Questionnaire Baseline Data

Example Statements	Avg. Response
Site leadership is committed to health promotion as an important investment in human capital.	4.14
Organizational goals and plans advocate for improved employee health.	3.72
Organization provides support for participation in health programs.	3.70
Work teams provide support for participation in health programs.	3.70
Employees are educated about the cost of healthcare and its effects on success.	2.44
Organization provides training for site leadership on the importance of employee health.	2.68
Site leadership provides adequate financial support for health promotion.	2.72

• Common deficits:
  • Education and training on employee health and healthcare costs
  • Financial support for health promotion
• Key success factors:
  • Incentives
  • Ease of participation (time/accessibility/convenience)
  • Encouragement/support of colleagues and management
  • Multilevel communication strategies
• Interventions that need focus:
  • Educating/training employees and management about the effect of employee health on healthcare costs and productivity
  • Strategies to increase and secure financial support from leadership
  • Incentives to reinforce healthy behavior among employees

• Establishment of a practical model for public-private collaboration in work site health promotion initiatives
• Development of effective evaluation tools
• Acquisition and analysis of baseline data
  • HRA illustrated pressing need for multicomponent interventions.
  • LBE and work site culture analyses revealed need for key support factors for successful programming.
• Construction of intervention programs tailored to the unique makeup of each employer site and establishment of health improvement goals

Results from formative research were used to tailor interventions:

• Moderate-intensity intervention (control condition)
  • Administer HRA to employees and provide individual and group feedback reports.
  • Offer awareness-building programs on ways to improve health.
  • Distribute signs prompting stairwell usage.
  • Give employees Internet access to "wellness challenge" programs.
• High-intensity intervention
  Includes all moderate-intensity interventions, plus:
  • Provide self-management workshops and counseling to individuals at high risk.
  • Provide assistance in designing and implementing social environmental policy changes.
  • Provide professional management consulting, training, and coaching to business leaders on ways to establish a healthy work site culture.
  • Aggressively promote all intervention measures.

• Intervention Implementation
• Collecting Year 2 – HRA, LBE, EAT and HPM data
• Data analysis- baseline vs. year 2 data points
• Site Coordinator training and support
• Process Evaluation
  • Score "dose delivered" and "dose received" data
  • Analyze results of site visits and interviews with site coordinators
  • Use process evaluation results to improve interventions, program delivery and participation rates
• Site specific presentations on key findings

For more information, contact: Ron Z. Goetzel, Ph.D., Director
Institute for Health and Productivity Studies, Cornell University
e-mail: ron.goetzel@thomson.com

Project Team
Daria Luisi, MPH, PhD
Ronald J. Ozminkowski, PhD
Enid Chung Roemer, Ph.D.
Sabira Taher, MPH
Kristin Quitoni, MPH
Angelika Sutton, MPH
Maryam Tabrizi, MS
Shannon Mitchell, Ph.D.
David Hunnicutt, Ph.D.

(image: Worksite Wellness logo)