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
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: [email protected]
Jason E. Lang, MPH, MS
Team Lead, Workplace Health Programs
Division of Population Health
Email: [email protected]
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: [email protected] 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