American Journal of Health Promotion

To determine if a mailed health promotion program reduced outpatient visits while improving health status.

Randomized controlled trial.

A midsized, group practice model, managed care organization in Ohio.

Members invited (N = 3214) were high utilizers, 18 to 64 years old, with hypertension, diabetes, or arthritis (or all). A total of 886 members agreed to participate, and 593 members returned the initial questionnaires. The 593 members were randomized to the following groups: 99 into arthritis treatment and 100 into arthritis control, 94 into blood pressure treatment and 92 into blood pressure control, and 104 into diabetes treatment and 104 into diabetes control.

Outpatient utilization, health status, and self-efficacy were followed over 30 months.

Health risk appraisal questionnaires were mailed to treatment and control groups before randomization and at 1 year. The treatment group received three additional condition-specific (arthritis, diabetes, or hypertension) questionnaires and a health information handbook. The treatment group also received written health education materials and an individualized feedback letter after each returned questionnaire. The control group received condition-specific written health education materials and reimbursement for exercise equipment or fitness club membership after returning the 1-year end of the study questionnaire.

Changes in visit rates were disease specific. Parameter estimates were calculated from a Poisson regression model. For intervention vs. controls, the arthritis group decreased visits 4.84 per 30 months (p < 0.00), the diabetes group had no significant change, and the hypertension group increased visits 2.89 per 30 months (p < 0.05), the overall health status improved significantly (−6.5 vs. 2.3, p < 0.01) for the arthritis group but showed no significant change for the other two groups, and coronary artery disease and cancer risk scores did not change significantly for any group individually. Overall self-efficacy for intervention group completers improved by −8.6 points (p < 0.03) for the arthritis group, and the other groups showed no significant change.

This study demonstrated that in a population of 18 to 64 years with chronic conditions, mailed health promotion programs might only benefit people with certain conditions.

This study was designed to examine the association between health status/behaviors and changes in these measures over time with health costs.

This study employed a 6-year (1993–1998) retrospective cohort design to examine the relationship between health indicator variables, health insurance costs, and utilization. The outcome variables of interest were measures of health insurance costs and utilization of health care services.

Public employer located in the northeastern United States.

In all, 1940 employees were included in the study on the basis of their membership in the worksite health plan and their having complete health indicator data collected during each of the two time periods (1993–1995 and 1996–1998).

The health insurance data were obtained directly from the organization's Third Party Administrator. The health indicator variables included blood pressure, cholesterol, body mass index, and smoking status.

At-risk employees had a greater probability of submitting health insurance claims than did no-risk employees in approximately 70% of the 18 Major Diagnostic Codes that were examined. Higher costs were associated with the at-risk classification (mean = $3237 and median = $433) over time, and lower costs (mean = $1626 and median = $49) were associated with maintaining a no-risk status over time.

These findings support the notions that lower health risk and maintaining a no-risk status over time are associated with lower health insurance costs.

To operationalize, estimate the prevalence, and ascertain the epidemiology of complete health.

Cross-sectional analyses of self-reported survey data collected via a telephone interview and a self-administered questionnaire.

Households in the 48 contiguous states in the United States in 1995.

Random-digit dialing sample of 3032 adults between the ages of 25 and 74, with a response rate of 61%.

Physical illness and health were measured with a total of 37 items—a checklist of 29 chronic health conditions, a six-item scale of limitations of daily living, and a single item for perceived current health and for perceived 5-year change in energy. Mental illness and health were measured with the Composite International Diagnostic Interview Short Form diagnostic scale of major depression, panic, and generalized anxiety disorders and three established multi-item scales of subjective well-being (emotional, psychological, and social well-being). Completely healthy adults have high levels of physical and mental health and low levels of physical and mental illnesses; completely unhealthy adults have high levels of physical and mental illnesses and low levels of physical and mental health. Incompletely healthy adults consisted of two groups: one group is physically healthy (high physical health and low physical illness) and mentally unhealthy, and the second group is mentally healthy (high mental health and low mental illness) and physically unhealthy.

Nineteen percent of adults were completely healthy, 18.8% were completely unhealthy, and 62.2% had a version of incomplete health. Compared with completely unhealthy adults, completely healthy adults are likely to be young (25–34 years of age) or old (55–64 and 65–74 years), are married, are male, are college educated, and have higher household incomes.

Operationalizing complete health highlights objectives for increasing the prevalence of complete health, and reducing the prevalence of complete ill-health and incomplete health.

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.

This article represents the pooling of results from multiple studies using a variety of designs, including pilot tests, cross-sectional analyses, and quasi-experiments.

Worksites covering the spectrum of employers across industry types and size, and throughout all of New York State.

Over 10,000 New York employees and 1000 New York employers are represented in the multiple phases of this research.

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.

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.

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.