Health Promotion Live

October 26th, 2012

The CDC Worksite Health ScoreCard: An Organizational Health Assessment

Tool

Jason E. Lang, MPH, MS Division of Population Health

Dyann M. Matson Koffman, DrPH, MPH

Division for Heart Disease and Stroke Prevention

National Center for Chronic Disease Prevention and Health Promotion

Centers for Disease Control and Prevention

The CDC Worksite Health ScoreCard

Why develop the CDC-Health

ScoreCard (HSC)?

What is it?

Who should use it?

How was it developed?

How was is validated?

What did we learn?

Next Steps?

How do you use the CDC-HSC?

Why develop the CDC Worksite Health ScoreCard?

The United States is facing an unparalleled health

epidemic, driven largely by chronic diseases

Chronic diseases represent 75 percent of the nation’s

$2.2 trillion medical care costs

American businesses’ competitiveness threatened due to lost

productivity and unsustainable health care costs

A wellness program aimed at keeping employees

healthy is a key long term human asset management

strategy

Comprehensive worksite health promotion program

Evidence-based individual risk reduction programs

Environmental supports for healthy behaviors

Policy and wellness activities

Only 6.9 percent of employers offer a comprehensive

worksite health promotion program Linnan L, et al. Results of the 2004 National Worksite Health Promotion Survey.

Am J Public Health 2008;98(8):1.

Few validated worksite tools that adequately measure

a comprehensive worksite health promotion program

Why develop the CDC Worksite Health ScoreCard?

The CDC Worksite Health ScoreCard (HSC)

A 100 item tool designed to help employers assess the

extent to which they have implemented evidence-based health promotion interventions in their worksites to

prevent heart disease, stroke, and related chronic

conditions.

Available at:

http://www.cdc.gov/dhdsp/pubs/worksite_scorecard.htm

http://www.cdc.gov/workplacehealthpromotion

http://www.cdc.gov/nationalhealthyworksite

The CDC Worksite Health ScoreCard (HSC)

Organizational supports

Tobacco control

Nutrition

Physical activity

Weight management

Stress management

Depression

Assesses best practice health promotion interventions

(policies, programs, environmental supports)

High blood pressure

High cholesterol

Diabetes

Signs and symptoms of

heart attack and stroke

Emergency response to

heart attack and stroke

What does the CDC-HSC look like? ~100 Yes/No Questions

Who can use the CDC-HSC tool?

Employers, human resource managers, health benefit

managers, health education staff, occupational nurses,

medical directors, wellness directors, or others

responsible for worksite health promotion to:

Help employees adopt healthy lifestyles

Establish benchmarks and track improvements over time

Integrate efforts with business objectives

State health departments can use the tool to:

Assist employers and business coalitions to establish healthier

workplaces

Monitor worksite practices

Establish best practice benchmarks and track improvements in

worksite health promotion programs over time

How was the CDC-HSC developed?

The CDC Division for Heart Disease and Stroke Prevention

developed the HSC in collaboration with:

Emory University, Institute for Health and Productivity

Studies

Dr. Ron Goetzel, Dr. Enid Chung Roemer, and staff

Research Triangle Institute

CDC’s National Center for Chronic Disease Prevention

and Health Promotion Workplace Workgroup

An expert panel of federal, state, academic, and private

sector representatives

Developing the CDC-HSC

Examined existing worksite inventories and resources

Identified reliable and valid questions from the Heart

Check and Heart Check Lite assessment tools

Identified new domains and questions to add from

other surveys

Pre-tested the tool to help ensure that it was clear, easy

to understand, and simple to complete (cognitive test)

9 employers in 2008

9 employers in 2010

70+ worksite health promotion practitioners nationwide in 2010

Developing the CDC-HSC (cont.)

Revised the HSC tool based on employer feedback

Weighted each question based on level of:

Scientific evidence (1-4)

Impact on intended health behavior (1-3)

Summed the scores and adjusted/ assigned value:

1=good, 2=better, and 3=best evidence/impact.

For example, promotion of stair use got a “Strong-4” rating on

strength of evidence and a “Large-3” on impact to increase

physical activity by more than 3 percentage points. This question

gets an adjusted score of 3 for “best evidence/impact”

Developing the CDC-HSC (cont.)

Description of the Rating

System

How impact scores and

weights were assigned

How final score was

derived for each question

Citations and references

Available at: http://www.cdc.gov/dhdsp/pubs/docs/HSC_Score_Method.pdf

HSC Employer Recruitment

Recruited employer participants nationwide through

State HDSP Programs,

National Business Coalition on Health

National Safety Council

Goal: 30 organizations for each employer size worksite

Very small -- 10-99

Small -- 100-249

Medium -- 250-749

Large -- 750+

How was the CDC-HSC Validated?

Field tested the tool for validity, reliability, and

feasibility of adopting the tool’s interventions

93 worksites in 2011

24 very small, 13 small, 16 medium, and 40 large

Conducted inter-rater reliability and content & face

validity

93 employers (2 respondents per site completed online survey)

20 employers (random sample from the 93) participated in

telephone interviews

9 employers (random sample from the 93) participated in site visits

What did we learn?

Employers like the HSC and reported that most

interventions are feasible to adopt

There is a linear relationship between employer size

and number of interventions in place (215 max score)

129 153

129 112

99

0 50 100 150 200

Average HSC Scores for Study Sample

Very small Small Medium Large All Employers

Employer Size

Groups

Very small: 10–99

Small: 100–249

Medium: 250–749

Large: 750+

Next Steps

Using HSC as the main organizational assessment tool

in CDC National Healthy Worksite Program

Submitting peer-reviewed manuscript

Developing an online application to use the HSC

Continuing Dissemination

Developing New Module; available in 2013

New Module Development

Three new modules to be tested as part of the CDC

National Healthy Worksite Program (NHWP)

Lactation Support - 6 questions

Occupational Health and Safety – 10 questions

Vaccine Preventable Diseases - 6 questions

Additional questions on community resources and

partnerships (not scored)

Testing will follow the same validation procedures as

the original modules

Ongoing Dissemination

Conferences and Webinars

E-blast

Listservs

NHWP Constant Contact

Targeted Trainings

How Do You Use the CDC-HSC?

1. Complete the Health ScoreCard using the instructions

(page 8)

Gather a small team of individuals representing different

organizational units,

e.g., Human Resources, Health Benefits, Occupational Health,

Worksite Wellness Committee

Answer “yes” or “no” for each question on the tool.

Answer all questions consistent with practices and programs

that are current or have been in place within the last 12

months

If you are a large organization with multiple worksites,

complete this tool for each worksite separately

How Do You Use the CDC-HSC? (cont.)

2. Tally your score for each topic, e.g., hypertension (page 9)

3. Review your scores and use them as a planning tool and

to identify potential gaps in your worksite program

4. Identify which of your priority strategies are feasible for

implementation in the short-term and long-term

Determine which of these strategies are relevant, feasible, and

consistent with your organization and employee needs

Identify the highest impact strategies not currently in place at your

worksite.

Use this information to develop an Annual Worksite Health

Improvement Plan and Budget

Health Improvement Plan Template and Sample

How Do You Use the CDC-HSC? (cont.)

5. Consult the Resource Links section

6. Contact your State Health Department for technical

assistance with your worksite program

http://www.cdc.gov/workplacehealthpromotion/organizations/

index.htm

http://www.chronicdisease.org/membership/members-

directory

7. Use benchmarking to demonstrate progress over time

Complete the survey annually to document and report progress

8. Inform and educate employees and management about

the status and progress of your organization’s health

promotion program

The CDC Worksite Health ScoreCard

http://www.cdc.gov/dhdsp/pubs/worksite_scorecard.htm

Resources

www.cdc.gov/WorkplaceHealthPromotion

www.cdc.gov/NationalHealthyWorksite/

Resources A Purchaser’s Guide to Clinical Preventive Services

Developed by CDC, the

Agency for Healthcare

Research and Quality

(AHRQ), and the National

Business Group on Health

(NBGH)

Recommended clinical

preventive services for

health benefits design

Targeted to all health

care purchasers (public

and private)

Resources CDC LEAN Works!

www.cdc.gov/leanworks

Resources

Tobacco Cessation

Resources

Successful Business Strategies to Prevent Heart Disease

and Stroke Toolkit

Provides information on

recommended preventive health benefits and services and worksite health promotion interventions

Available at: http://www.cdc.gov/dhdsp/pubs/employers_toolkit.htm

Resources

National Diabetes Education Program (NDEP) Business Health

Strategy Workgroup (BHS) Goals and Partners

To increase awareness of the benefits of quality diabetes care among employers, benefits managers and managed care decision makers

To provide employers, health plans and employees with tools and information for incorporating diabetes education programs into the workplace

To promote the value of investing in prevention

www.ndep.nih.gov www.Diabetesatwork.org

Contact Information

Dyann M. Matson Koffman, DrPH, MPH, CHES

Health Scientist

Division for Heart Disease and Stroke Prevention

Email: dfm1@cdc.gov

Jason E. Lang, MPH, MS

Team Lead, Workplace Health Programs

Division of Population Health

Email: bzl0@cdc.gov

For more information please contact Centers for Disease Control and Prevention

1600 Clifton Road NE, Atlanta, GA 30333

Telephone, 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348

E-mail: cdcinfo@cdc.gov Web: www.cdc.gov

The findings and conclusions in this report are those of the authors and do not necessarily represent the official

position of the Centers for Disease Control and Prevention.

Thank You!

National Center for Chronic Disease Prevention and Health Promotion

Centers for Disease Control and Prevention