Managing multiple chronic conditions: a strategic framework for improving health outcomes and quality of life

The escalating problem of multiple chronic conditions (MCC) among Americans is now a major public health and medical challenge, associated with suboptimal health outcomes and rising health-care expenses. Despite this problem's growth, the delivery of health services has continued to employ outmoded "siloed" approaches that focus on individual chronic diseases. We describe an action-oriented framework--developed by the U.S. Department of Health and Human Services with additional input provided by stakeholder organizations--that outlines national strategies for maximizing care coordination and for improving health and quality of life for individuals with MCC. We note how the framework's potential can be optimized through some of the provisions of the new Patient Protection and Affordable Care Act, and through public-private partnerships.     

Health and productivity: a role for occupational health professionals

The impressive economic gains achieved by many nations within the past decade have been attributed primarily to improvements in productivity from technological changes. The resultant low unemployment levels, however, emphasize the importance of human capital in the success of any enterprise. Concurrently, some economists have proposed an alternative economic view regarding the relationship between health and income, postulating that improvements in the health of the nation's population have a substantial effect on its economic viability. Such a view directly pertains to occupational health professionals, who are often charged with promoting the health of the worker. Although studies relating the beneficial impact of occupational health on productivity and human performance are limited, some efforts have shown impressive effects, as measured primarily by reduced absenteeism. The prompt, assertive management of occupational injuries and illnesses and their treatment have been well documented. Illnesses not considered traditional occupational ailments, such as migraine headaches, allergic disorders, infectious diseases, and depression, offer opportunities for occupational health professionals to ensure an accurate diagnosis and proper treatment for minimizing the impact on work performance. Considerable opportunities exist for occupational health professionals to demonstrate the importance of certain services to productivity.     

Relationship between basic protective health behaviours and health related quality of life in Greek urban hospital employees

Summary Objective: The study aimed to explore the association between the presence of several protective health behaviors and physical and mental wellbeing/functioning among healthy hospital employees in Greece. Method: A randomly selected representative sample of 395 employees working in seven hospitals, both public and private, within the wider region of Athens participated in the study. Participants were assigned to the following professional categories: administrative, auxiliary and technical personnel, medical doctors and nurses. Four basic protective health behaviors were examined: following the Mediterranean diet, exercising, no smoking and moderate alcohol drinking. Employees’ health related quality of life was assessed with the self-administered SF-36 generic health status measure. Results: Technical and administrative hospital personnel reported more healthy behaviors than medical and auxiliary personnel. There was an increased likelihood of scoring higher in almost all SF-36 Physical health subscales in the accumulation of the above four protective health behaviors. In terms of mental health, even the presence of two or more protective health behaviors significantly increase the score on most SF-36 Mental health subscales. Conclusion: Results indicate that the protective role of basic health behaviors extends beyond physical health to mental wellbeing. Submitted: 26 June 2006; Revised: 10 April 2007; Accepted 17 July 2007     

Hunting for health,well-being,and quality of life

Health, well-being, quality of life, and lifestyle are central concepts within health science, although generally accepted definitions are still lacking. Lifestyle can either be seen as an independent variable and the cause of unhealthy behaviour or as a dependent variable, which is affected by conditions in the society. In the first case, the attention is directed on each individual case: maintaining or improving health requires changes in lifestyle and living habits. In this perspective, diet and physical activity are important features for health promotion. In the second case the attention is rather directed on structural conditions in society, for example the food industry, the lunches for children at school, and the “fast food” industry should be influenced to protect human health. The structural perspective has, so far, received restricted impact when it concerns prevention and promotion of health. Processes of individualisation in the society have to an increasing extent viewed health as an affair for the individual. The benefits of physical activity, healthy food and beverage, social support, and joy are documented scientifically. In general, the trend towards increasing responsibility for one''s lifestyle and health is positive, but might reinforce the inequality in health. With an even harder climate in society there might be a risk that individual health projects undermine the solidarity and the will to accept costs for medical treatment and care for people who risk their health through an unhealthy and risk-taking lifestyle. However, we argue that peoples’ well-being and quality of life presupposes a society that stands up for all people.     

Uses of Youth Risk Behavior Survey and School Health Profiles data: applications for improving adolescent and school health

BACKGROUND: To monitor priority health risk behaviors and school health policies and practices, respectively, the Centers for Disease Control and Prevention (CDC) developed the Youth Risk Behavior Surveillance System (YRBSS) and the School Health Profiles (Profiles). CDC is often asked about the use and application of these survey data to improve adolescent and school health. The purpose of this article is to describe the importance and potential impact of Youth Risk Behavior Survey (YRBS) and Profiles data based on examples from participating sites. METHODS: The authors spoke with representatives from 25 state and 8 local agencies funded by CDC to learn how data from the YRBS, Profiles, and other data sources are used. The authors identified common themes in the responses and categorized the responses accordingly. RESULTS: Representatives indicated survey data are used to describe risk behaviors and school health policies and practices, inform professional development, plan and monitor programs, support health‐related policies and legislation, seek funding, and garner support for future surveys. Examples presented highlight the range of possible uses of survey data. CONCLUSIONS: State and local agencies use YRBS and Profiles data in many ways to monitor and address issues related to adolescent and school health. Innovative uses of survey data are encouraged, although it is also crucial to continue the more fundamental uses of survey data. If the data are not disseminated, the current health needs of students may not be adequately addressed.     

Health promotion groups for improving autonomy, living conditions and health

This article presents the methodology of Health Promotion Groups, which were conceived as a means of contributing towards developing autonomy, improving living conditions and promoting health. The method is identified as a collective and interdisciplinary health intervention, consisting of a group process. It guides the development of attitudes and behavioral patterns towards continually transforming participants' health levels and living conditions. The Health Promotion Groups are identified within the context of the National Health System (Sistema Unico de Saúde) as a means of surpassing the biomedical model. It stimulates the development of actions in which the positive aspects of health are emphasized, while at the same time it can serve to more effectively meet the demands for care for the elderly in health systems.     

An effective exercise-based intervention for improving mental health and quality of life measures: a randomized controlled trial

OBJECTIVES: This study investigates the effectiveness of 24-week aerobic and weight-training exercise plus behavior modification for mental health and quality of life (QOL) outcomes. METHODS: Mental health and QOL data was collected using the Depression Anxiety and Stress Scales and SF-36 Health Status Survey, respectively. Employees from a single work-site were randomized into either treatment or wait-list control groups. RESULTS: Mental Health (P = 0.005), Vitality (P < 0.001), General Health (P = 0.009), Bodily Pain (P = 0.005), Physical Functioning (P = 0.004), Depression (P = 0.048), and Stress (P = 0.036) scales significantly improved for the treatment group compared to wait-list controls after 24 weeks. CONCLUSIONS: Multimodal exercise is as effective as other single-modality exercise treatments for depressive symptoms and, in contrast to other studies, does improve stress symptoms and QOL outcomes.     

Health care use and at-work productivity among employees with mental disorders

This study examines the differential medical care use and work productivity of employees with and without anxiety and with other mental disorders at a large national firm. A unique aspect of this study is that we integrate medical claims and employer-provided, objective productivity data for the same employees. We find extensive mental health comorbidities among anxious employees. Although medical care use differs considerably among employees having no, one, or several treated mental disorders, in most cases their annual average absenteeism and average at-work productivity performance do not differ. Differences among subgroups are observed for job tenure and maternity claims. We discuss these long-term average productivity findings in relation to other literature encompassing shorter time periods.     

Retiree health insurance for public school employees: Does it affect retirement?

Despite the widespread provision of retiree health insurance for public sector workers, little attention has been paid to its effects on employee retirement. This is in contrast to the large literature on health-insurance-induced “job-lock” in the private sector. I use the introduction of retiree health insurance for public school employees in combination with administrative data on their retirement to identify the effects of retiree health insurance. As expected, the availability of retiree health insurance for older workers allows employees to retire earlier. These behavioral changes have budgetary implications, likely making the programs self-financing rather than costly to taxpayers.     

Health seeking behaviours among Chinese-Australian women: implications for health promotion programmes

Preventive medicine is an important element of the Australian health care system. An essential aspect of the biomedical model of health care is screening for the early detection of disease in otherwise asymptomatic people. There is ample evidence that acceptance levels of western medicine vary and that a variety of health epistemologies and health practices coexist. To examine the extent to which Chinese-Australian women integrate western medicine practices in their health seeking behaviour, a qualitative study was conducted, which involved in-depth interviews in Cantonese with 20 women. Although adherence to western health beliefs and practices varied, in general these Chinese-Australian women sought medical help only after they felt unwell. Commonly, they first tried traditional remedies for minor diseases. Many saw no reason to participate in screening when they were asymptomatic. Direct communication with health care providers who speak the same language appears to be important to many Chinese-Australian women when seeking health care services. It is recommended that ethnic health workers should participate in screening programmes and other health promotion activities.     

The quest for quality and productivity in health services

The leaders of health care organizations across the country are facing significant pressures to improve the quality of their services while reducing the rate of cost increases within the industry. Total Quality Management (TQM) has been credited, by many leaders in the manufacturing industry, as an effective tool to manage their organizations. This article presents key concepts of TQM as discussed by quality experts, namely, Deming, Juran, and Crosby. It discusses 12 key concepts that have formed the foundation of TQM implementation at Henry Ford Health System. The process of implementation is presented in detail, and the role of TQM in clinical applications is discussed. Success factors and visible actions by senior management designed to reinforce the implementation of TQM in any organization are presented.     

Do more with less: strategies for improving productivity in community health nursing

Nursing productivity in all types of health care organizations is difficult to define and to measure. However, the difficulty of the task must not deter the first-line nurse supervisor from the task. The process of defining and measuring productivity will help Eve to develop the strategies needed to solve her dilemma. This critical activity will help to ensure the nurses' survival in today's tight economic climate and create a vision of the nurse's place in the health care setting of the future. Before data collection methods and productivity expectations can be standardized in community health nursing, nurses must communicate, through publication, their concerns regarding nursing productivity, their data collection methods, and their productivity expectations so that the methods and expectations can be standardized. Such cross-fertilization of ideas is an essential part of the process of managing nurse productivity.     

The health related quality of life of the employees in the Greek hospitals: assessing how healthy are the health workers

Background  

The main aim of the study was to assess the health status and health related quality of life of the personnel of the Hellenic Network of Health Promotion Hospitals. The instrument used was SF-36. An additional aim was to contribute to the validation of the SF-36.     

Health related quality of life measures by demographics and common health risks, Jordan 2004

Objective:  

To measure health-related quality of life (HRQOL) in Jordan     

企业员工职业应激对健康生产力的影响

目的 分析企业员工职业应激对健康生产力的影响.方法 通过横断面调查的方法获取基本数据,采用多因素logistic逐步回归方法分析职业应激与健康生产力的关系.结果 员工的性别、学历、生活方式(吸烟、饮酒、体育锻炼和参加兴趣小组)、工作要求和社会支持对健康所致总体生产力受损有影响.女性(OR=1.60,95%CI=1.30～1.96)、高学历(以高中及以下为参照,大专OR=1.47,95%CI=1.18～1.83;本科及以上OR=1.98,95%CI=1.60～2.42)、高工作要求(以低工作要求为参照,中等工作要求OR=1.60,95%CI=1.27～2.02;高工作要求OR=1.91,95%CI=1.50～2.42)、低社会支持(以低社会支持为参照,中等社会支持OR=0.65,95%CI=0.53～0.80;高社会支持OR=0.63,95%CI=0.49～0.80)、有不良生活方式[吸烟(OR=1.28,95%CI=1.03～1.60)、饮酒(OR=1.35,95%CI=1.11～1.65)、无规律的体育锻炼(以无体育锻炼为参照,OR=0.65,95%CI=0.54～0.78)和未参加单位的兴趣小组(以不参加为参照,OR=0.72,95%CI=0.57～0.90)]会增大健康生产力受损的风险.结论 员工的职业应激程度影响其生产力;适度降低工作要求、增加社会支持,有利于减少因健康所导致的总体生产力损失.