The Rural Hospital as a Provider of Health Promotion Programs

Although patient education has always been recognized as an essential function of a hospital, it was not until the health concerns of the nation focused on prevention that hospitals began to develop activities aimed at primarily healthy individuals. Hospital health promotion evolved from patient education about specific diseases to programs focused on modifying of lifestyle practices to prevent future debilitating conditions. Studies conducted in the early 1980s show hospital-based health promotion programs increasing in number and including such target populations as senior citizens, children, business people, and hospital employees. However, the extent of involvement of the rural hospital in offering health promotion programs has not been clearly established. The current study was conducted to determine the status of health promotion programs in rural North Carolina hospitals. Elements considered were types of programs, target audiences, methods of financing, staff use, and availability of specialized facilities for health promotion programs. The results indicate rural hospitals do offer health promotion programs, but their primary focus is on hospital employees. Most programs are offered at low or no cost, making those offered for the community readily accessible. If input from the community is used and programming is aimed at specific health needs of rural populations, the rural hospital could make a significant contribution to an overall primary prevention strategy, lowering community health care costs.     

Developing workplace health promotion programs through university and corporate collaboration. A review of the Corporate Health Promotion Research Program.

The unique collaboration of the UCSF School of Medicine with community and national leaders in corporate health promotion has, in less than three years, made the Corporate Health Promotion Research Program a valuable resource to participating corporations. We are able to offer them sound consultation on health promotion programs, based on state-of-the-art research, at minimal cost to the employer or employees. In addition, we are educating employers about quality programs and the process and need for evaluation, in an effort to generate sound findings on the effects of corporate health promotion programs. Corporations are beginning to see that instead of being reactive and spending great sums of money only after employees become ill, it makes good sense to institute programs designed to prevent employees from becoming ill in the first place. With such programs, corporations not only improve the health of their employees (a worthy objective in its own right), but they contribute to containing medical costs at the same time--a clear "win-win" situation for all concerned. In short, corporations are finding that an ongoing, active interest in the health of their employees has a direct bearing on their own long-range health as a business. With this in mind, we feel that medical benefit plans of the future will be comprised of three elements: medical care plus cost-containment plus health promotion programs. With this order of complexity, no one company or professional organization has all the answers--and that should be acknowledged from the outset.(ABSTRACT TRUNCATED AT 250 WORDS)     

Health promotion in physician organizations: results from a national study

BACKGROUND: Health promotion programs can be effective in improving the delivery of clinical preventive services and in improving population health; however, the availability of health promotion programs offered through physician organizations, such as medical groups and independent practice associations, are largely unknown. METHODS: This research uses data from the National Study of Physician Organizations and the Management of Chronic Illness, conducted by the University of California, Berkeley, to document the extent to which physician organizations offer health promotion programs. Of 1587 physician organizations nationally with 20 or more physicians, 1104 participated, for a response rate of 70%. RESULTS: Overall, 60% of physician organizations offer at least one health promotion program targeting one or more of eight areas: prenatal education (42%), smoking cessation (39%), nutrition (39%), weight loss (34%), health risk assessments (25%), stress management (25%), substance abuse (20%), and sexually transmitted disease prevention (16%). Factors positively associated with offering health promotion programs include the following: outside reporting of quality measures, public recognition for quality measures, clinical information technology systems, being a medical group, and ownership by a hospital or health plan. CONCLUSIONS: Physician organizations in the United States have a long way to go in offering these important programs to their patients. However, our findings also suggest that health plans, purchasers, and policymakers can play a positive role in increasing the use of these programs. By offering recognition and incentives for quality improvement, and by funding the expansion of information technology, the healthcare community can encourage and enable physician organizations to increase the availability of health promotion programs nationally.     

Wellness programs: a remedy for reducing healthcare costs

Offering wellness programs has become a popular method for preserving the health of employees in the hope of generating lower healthcare expenses and, in turn, higher profits. This article offers a cost/benefits analysis of providing wellness programs, to determine whether such programs could add value to a company. Recommendations follow for how to implement a successful wellness program with minimal initial costs should an analysis find that wellness initiatives would prove beneficial.     

Wellness Programs: A Remedy for Reducing Healthcare Costs

Offering wellness programs has become a popular method for preserving the health of employees in the hope of generating lower healthcare expenses and, in turn, higher profits. This article offers a cost/benefits analysis of providing wellness programs, to determine whether such programs could add value to a company. Recommendations follow for how to implement a successful wellness program with minimal initial costs should an analysis find that wellness initiatives would prove beneficial.     

Rural hospital health promotion: Programs,methods, resource limitations

Most hospitals provide health promotion programs for community residents. There is little information concerning the specific types of services offered by rural hospitals. A questionnaire was sent to every acute care hospital in Iowa (N=124), including 99 rural hospitals and 25 urban hospitals. Surveys were returned from 95 rural hospitals (96%) and 20 urban hospitals (80%). Results indicated that 98.9% of rural hospitals offered health promotion services to community residents. These services provided on average 7.5 programs on a regular basis, while using only 1.2 full-time equivalent (FTE) employees. Urban hospitals provided 9.5 regular programs with 2.4 FTE. The most common types of rural promotion programs were blood pressure screening, cholesterol screening, safety and protection programs, diet/nutrition programs, prenatal/maternal health, and breast cancer screening. Over 40% of rural respondents stated that other less common programs, including substance abuse prevention and mental health promotion, were needed but could not be offered because of resource limitations; these types of services were offered more commonly in urban hospitals. Rural hospital health promotion programs are attempting to meet a wide variety of programming needs with limited resources, and attention may be well directed towards finding how best to provide various programs with limited resources to maximize their impact on community health.Michael S. Hendryx is an Associate in the Graduate Program in Hospital and Health Administration and Center for Health Services Research, University of Iowa, Iowa City, Iowa.Supported by a grant from the Department of Iowa Ladies' Auxiliary, Veterans of Foreign Wars, through the University of Iowa Cancer Center. The author acknowledges the assistance of Richard DeGowin, M.D., for helpful comments during the course of this study.     

Public health week: marketing the concept of public health.

The Public Health Programs and Services (PHP&S) Branch of the Los Angeles County Department of Health Services began a strategic planning effort in January 1986 to meet new disease trends, curb rising health care costs, consolidate limited resources, and handle shifting demographics. A strategic plan was designed to assess the opportunities and challenges facing the agency over a 5-year horizon. Priority areas were recognized, and seven strategic directives were formulated to guide PHP&S in expanding public health services to a changing community. Health promotion was acknowledged as a critical target of the strategic planning process. Among the most significant results of the health promotion directive was the establishment of an annual Public Health Week in Los Angeles County. Beginning in 1988, 1 week per year was selected to enhance the community's awareness of public health programs and the leadership role PHP&S plays in providing these programs to nearly 9 million residents of Los Angeles County. Events in Public Health Week include a professional lecture series and the honoring of an outstanding public health activist and a media personality who has fostered health promotion. Other free community activities such as mobile clinics, screenings, and health fairs are held throughout the county. With intensive media coverage of Public Health Week, PHP&S has been aggressive in promoting its own services and accomplishments while also educating the community on vital wellness issues. The strategic methodology employed by PHP&S, with its emphasis on long-range proactive planning, is receiving national recognition and could be adopted by similar agencies wishing to enhance their image and develop unique health promotion projects in their communities.     

Employee health and fitness: the state of the art

Health care and health promotion measures currently are undergoing critical cost/benefit or cost/effectiveness scrutiny. An employee fitness program offers a convenient means for realizing community goals of lifestyle change but also has the potential to augment worker productivity. The costs of exercise testing and program development for an employee program ($100-$350 per participant year, measured in 1982 U.S. dollars) compare favorably with nonoccupational approaches to the promotion of fitness and a healthy lifestyle. The combined savings from a reduction of appraised age, improvement in lifestyle, decreased use of hospital and physician services, decrease in absenteeism and employee turnover, improved productivity, and decreased need for geriatric care substantially exceed the likely outlay. Given a 20% participation rate, the order of benefit from these factors is over $700 per year for each member of the labor force. In a company employing 1,000 people, a cost of perhaps $40,000 for 200 participants would yield a dividend of $650-$700,000 per year. Arguments continue on the specificity of exercise-induced gains in health and performance, but the burden of proof rests with those who maintain that equal benefits could be obtained from other tactics.     

Worksite Health Promotion

Although the significant majority of employers offer health promotion programs, for most companies the size and impact of existing programs is minor. Recent research has yielded substantial data in support of worksite health promotion activities, from both medical and economic perspectives. Yet despite this compelling information, corporations have been slow to incorporate more substantial health promotion activities.Employers must come to see that an investment in employee health promotion programs is an investment in their workforce, likely their greatest asset. The impact of health promotion programs needs to be viewed not simply in the context of a business operations cost. In the face of rapidly escalating healthcare costs, successful health promotion programs have the potential to reduce those expenditures as well as enhance employee performance, resulting in improved business productivity.To be effective, worksite health promotion programs must be implemented in a systematic manner. To gain senior management support, education regarding the principles of health and productivity is critical. Program selection and implementation must be carefully planned, reflecting the health promotion interests, needs, culture and resources of the organization. Objective, easily measurable parameters of program quality and outcome must be identified prior to program implementation, in order to assess program effectiveness, from both employee health and business productivity perspectives. Collaborative data review through regular reporting can identify program strengths and weaknesses, leading to corrective modifications.     

Effectiveness of health promotion programs in moderating medical costs in the USA

Although evidence from scientific evaluations of health promotionprograms has demonstrated improvements in selected health outcomes,the relationship between participation in health programs anddefinitive economic returns in medical cost savings has beenmore difficult to establish. The purpose of this study is toevaluate the effect of employee participation in health promotionprograms with selected medical cost outcomes. Program participationwas operationalized as a summed participation score based onemployee program participation data. Increasing levels of programparticipation were associated with increasingly higher medicalcosts but not with higher numbers of health risks. A Cost ChangeModel was developed to investigate the relationship betweenprogram participation and changes in cost status (high cost/lowcost) over a 6-year time period. Program participation was highestamong the high-cost employees. Participation patterns may havereflected the appeal of most health promotion programming tohigh-risk/high-cost employees. Over time those employees whoparticipated in a comprehensive health promotion program, includingintervention programs, experienced moderation in medical costs.In contrast, for those employees with participation primarilyconcentrated in health risk awareness and identification programs,medical costs continued to increase. These findings provideevidence for the effectiveness of a comprehensive health promotionprogram in moderating medical care costs.     

Impact of Bipolar Disorder on Employers

Among the typical employer’s workforce, there are employees with various physical and psychological conditions that may affect their healthcare costs and productivity. One such condition, bipolar disorder, is especially costly. Despite many available treatments, a large portion of bipolar disorder-related costs are not related to direct healthcare expenditures, but rather are indirect expenditures related to lost productivity. Thus, ensuring that employees who exhibit symptoms of bipolar disorder receive a timely and correct diagnosis followed by appropriate treatment may prove cost effective. To accomplish this, employer-sponsored health plans should have adequate resources to provide treatment to employees and dependents with bipolar disorder and use evidence-based guidelines to treat the disorder. Increasing awareness of bipolar disorder through education and training in the workplace or the establishment of employee assistance programs may help link those with the disorder to treatment. The provision of reasonable workplace accommodations to employees with bipolar disorder may increase productivity, resulting in additional savings. The coordination of all health plan programs and related services provided to employees is an important consideration. By becoming knowledgeable about bipolar disorder and its treatments, employers can better work with insurers, health management vendors, and intermediary organizations to provide worksite and health plan programs to assist their affected employees.     

The long-term impact of Johnson & Johnson's Health & Wellness Program on employee health risks

To be viewed as successful, corporate health promotion and disease prevention programs must demonstrate that they can improve the risk profile of employees as a whole, and, in particular, those employees at highest risk. This study reports the effectiveness of Johnson & Johnson's newly configured Health & Wellness Program in reducing the health risks of 4586 employees who participated in two serial health screening programs, with a minimum of 1 year between screenings. The study also examines the impact of participation in a high-risk intervention program called Pathways to Change on health risk factors. McNemar chi-squared and z-test statistics were used to evaluate changes in health risks over time. Results indicate significant risk reduction in 8 of 13 risk categories examined for all employees who participated in two health risk assessments over an average of 2 3/4 years. When comparing Pathways to Change participants with non-participants, participants outperformed their non-participant counterparts in six categories but performed worse in five other categories that were not specifically targeted by the high-risk program. In two categories, no differences were found. The study underscores the ability of large-scale, well-attended, and comprehensive corporate health and productivity management programs to positively impact the health and well-being of workers.     

An interview survey for health promotion for older residents in T District, Sendai City

OBJECTIVE: To plan a program for promoting health and improving quality of life among the older residents in T District, Miyagino Ward, Sendai City. SUBJECTS & METHOD: T District has the highest rate of aged individuals and the largest number of elderly living alone in the Ward. Based upon our community-based health and welfare activities, we recognized that many older residents in T District had health and social problems. In order to grasp these problems and plan a program for health promotion, we conducted an interview survey (using the Esnographic method) of resource persons and older residents in the District. The information obtained at interviews was analyzed by the KJ method. RESULTS: The interview survey indicated the most prominent needs for the older residents were extension of the network for human relationships and increase in opportunities for communication and meeting each other. The older residents did not have enough information on the health and welfare services provided by Miyagino Public Health and Welfare Center, and we realized the importance of promoting communication between residents, private organizations and our Center. We informed the residents of these results, and discussed the strategies to promote health and improving quality of life among the older residents in T District in 2001. Based upon the survey and discussion, we started to publish and circulate "Community Information for Older Residents", established a class for residents to become supporters of the needy older population in T District, and facilitated their active participation in the community activities. CONCLUSION: The interview survey using the Esnographic approach and analysis with the KJ method were useful tools for us to plan and implement a program for health promotion for older residents.     

Is prevention really better than cure? Parameters of the debate and implications for program evaluation design

The relative contributions of health promotion programs andservices to the improvement of community health is the subjectof long-standing debate. Critics of health promotion have arguedthat it does not save costs, has low cost-effectiveness comparedto treatment services, does not attract strong community supportand may be inequitable. The arguments and counter-argumentsthat form the basis of this debate are canvassed in this paper.This is done by applying these various claims not to healthpromotion in isolation, but in comparison with treatment andcare services. The special problems for health promotion—namelythat its benefits are often considerably delayed and only uncertainlyapply to a particular individual and are less in demand thanservices with more immediate benefits-are examined. Demand forhealth promotion and other programs is considered from a politicalperspective. The relative importance of equity and effectivenessas program goals is an important consideration for program andservice managers, not only for health promotion but all healthcare programs. To address further these issues, evaluation of health promotionprograms is urgently needed to establish which programs shouldbe expanded or contracted. These evaluations need to incorporateeconomic appraisal techniques and to assess program demand andequity. The two latter themes can most appropriately occur aspart of process and impact evaluation studies. Implicationsfor the evaluation of different types of health promotion programsare explored. Even if health promotion programs can be demonstratedto justify support on cost, effectiveness and equity grounds,they will face continued political obstacles to their funding.     

Past and future priorities in health promotion in the United States: a survey of experts

BACKGROUND. The purpose of this study was to determine past and future priorities of the health promotion industry. Parameters included target markets, program staff, ethical issues, corporate programs, and program sites. METHODS. This study focused on the predictive perceptions of 76 prominent health and fitness professionals. Participants completed an inventory designed to compare past and future practices in health promotion. The Wilcoxon rank-sign test was used to determine changes in perceived importance from past to future periods. RESULTS. The most important markets in the future were women and the elderly. Predictions regarding staffing included an expected increase in staff size in many program settings, a high importance rating for marketers and health educators, and standardized training and certification for health promotion personnel. Many employers in the future were predicted to link medical care costs and reimbursements with lifestyle behaviors, support confidentiality of health status information, and offer voluntary participation in health promotion programs to all employees. Employers were also predicted to provide more healthful work environments. DISCUSSION. Future success of these projected programs will depend upon administrative flexibility, creativity, and strategic planning.     

Worksite health promotion programs in the United States: progress, lessons and challenges

Worksite health promotion programs have become increasinglyprevalent in the United States, and one or more health promotionprograms are found in two-thirds of all private worksites with50 or more employees. Reasons for recent growth in program frequencyinclude increased concern for worker health, rapidly escalatingemployer payments for health care benefits to workers, and growingevidence of a strong linkage between employee health and productivity.Published results of evaluations to date suggest that worksitehealth promotion programs can have positive impacts on healthbehaviors and health status. In addition, economic analysesare suggesting that some programs can affect the slope of healthcare costs and have the potential of high cost-effectivenesscompared to some clinical interventions. A number of researchchallenges remain, particularly understanding the influencesof the worksite environment and how employee health promotionprograms affect individual and organizational productivity.     

Providers link health with human service

This issue's cover story looks at a handful of hospital leaders who appear to be radically redefining their hospital's role, but who are really just returning to the basics of hospital management and the basic hospital mission of community service. These CEOs of innercity hospitals are taking a leadership role in community development programs, ranging from literacy to housing. They bring together community groups to solve problems, work to find funding for projects, and attract new business to the hospital's service area. They also provide community residents with a sense of hope and a sense of stability. But their actions have ramifications that extend beyond their communities. These leaders may also be providing other health care executives with an approach to strategic planning that will add new meaning to the term "community hospital" in the 1990s.     

The WAMI Rural Hospital Project. Part 3: Building health care leadership in rural communities.

The WAMI Rural Hospital Project (RHP) intervention combined aspects of community development, strategic planning and organizational development to address the leadership issues in six Northwest rural hospitals. Hospitals and physicians, other community health care providers and local townspeople were involved in this intervention, which was accomplished in three phases. In the first phase, extensive information about organizational effectiveness was collected at each site. Phase two consisted of 30 hours of education for the physician, board, and hospital administrator community representatives covering management, hospital board governance, and scope of service planning. In the third phase, each community worked with a facilitator to complete a strategic plan and to resolve conflicts addressed in the management analyses. The results of the evaluation demonstrated that the greatest change noted among RHP hospitals was improvement in the effectiveness of their governing boards. All boards adopted some or all of the project's model governance plan and had successfully completed considerable portions of their strategic plans by 1989. Teamwork among the management triad (hospital, board, and medical staff) was also substantially improved. Other improvements included the development of marketing plans for the three hospitals that did not initially have them and more effective use of outside consultants. The project had less impact on improving the functioning of the medical chief of staff, although this was not a primary target of the intervention. There was also relatively less community interest in joining regional health care associations. The authors conclude that an intervention program tailored to address specific community needs and clearly identified leadership deficiencies can have a positive effect on rural health care systems.     

Keeping health promotion in the pink. Documentation can show how programs contribute to hospital goals

Health promotion encompasses a wide range of services, including health information, health education, wellness, and employee health programs--important efforts, but hardly life-or-death matters. So with increased pressure to put programs to an institutional "worth" test, few health promotion programs make the grade, not because they fail, but because their managers do not know how to document and demonstrate their contributions to hospital goals. The tools that can be used to track program impact range from simple hand-written record keeping on file cards to more complicated and computer-supported systems of data gathering and analysis. It is a mistake to assume that only computer-based systems can yield meaningful information. In the documentation process it may be necessary to start small, but it is necessary to start. Sound management decisions depend on practical evidence that a program is helping a hospital's operations. When one hospital implemented an employee assistance program, program managers set out to document how the program saved the hospital money, improved the work environment, and improved quality of care. At another hospital, the manager of the inpatient cardiac rehabilitation program enlisted the assistance of the medical records department to document to the hospital that patients not in the program had longer lengths of stay than program participants.     

成都市社区老年健康促进项目社区诊断研究

目的：在成都市东风南路社区800名老年人中开展健康促进工作,为了确定干预人群,制订干预目标,筛选干预策略,评价干预效果。我们开展了社区诊断工作。方法：通过死因监测资料。住院病人档案,生命质量问卷调查,确定社区中老年人口存在的主要卫生问题;通过行为危险因素调查,测量个体危险因素水平,通过人文环境调查,调查社区内与人们健康行为有关的政策。媒介,设施支持情况,通过社区资料开发,寻找社区中可利用的组织。结果：社区诊断使干预工作有的放矢,取得事半功倍的效果。结论：社区诊断有利于健康促进。