Health risk assessment

Last updated

A health risk assessment (also referred to as a health risk appraisal and health & well-being assessment) is a questionnaire about a person's medical history, demographic characteristics and lifestyle. It is one of the most widely used screening tools in the field of health promotion and is often the first step in multi-component health promotion programs. [1] [2] [3] [4]

Contents

Definition

A health risk assessment (HRA) is a health questionnaire, used to provide individuals with an evaluation of their health risks and quality of life. [5] Commonly a HRA incorporates three key elements –an extended questionnaire, a risk calculation or score, and some form of feedback, i.e. face-to-face with a health advisor or an automatic online report. [3] [5]

The Centers for Disease Control and Prevention define a HRA as: "a systematic approach to collecting information from individuals that identifies risk factors, provides individualised feedback, and links the person with at least one intervention to promote health, sustain function and/or prevent disease". [6]

There is a range of different HRAs available for adults and children. Some target specific populations. For example, in the US, Medicare HRAs ask seniors about their ability to perform daily activities. Medicaid assessments ask questions about health-care access, availability of food, and living conditions. Most HRAs capture information relating to: [3] [6] [7]

The main objectives of a HRA are to: [5]

In the US, HRAs used as part of the Medicare Annual Wellness Visit help identify issues important to a senior's health and well-being. HRAs used as part of Medicaid enrollment help identify individuals with health problems that need immediate attention. [8] [9] The Community Preventive Services Task Force (CPSTF) recommends the use of HRAs in workplace settings when used in combination with health education, [4] having found there is strong or satisfactory evidence that they help improve the following behaviors among employees: [10]

History

The original concept of the HRA can be traced back to the decision by the assistant Surgeon General of the United States to conduct a study to determine the probable 10-year lifespan of individuals based on lifestyles and predisposed conditions. The project, led by Lewis C. Robbins, MD, [11] of the Public Health Service, was the Framingham study. The study was based on in-depth longitudinal studies of 5,000 families in Framingham, Massachusetts, that continues to this day under funding from the National Institutes of Health.[ citation needed ]

Dr. Robbins left the Public Health Service and joined Methodist Hospital in Indianapolis where, working with Jack Hall, M.D., he developed the first set of health hazard tables. This culminated in the publication of How to Practice Prospective Medicine in 1970 – a guide for practising physicians, which outlined the health risk assessment questionnaire, risk computations and patient feedback strategies. [7] [11] During the 1960s, some researchers in California formed the Human Population Laboratory (HPL) to investigate factors contributing to quality of life. [12] Inspired by a research article [13] reporting on the HPL's Alameda County Study on the best lifestyle practices for good health, Don R. Hall, DrPH, developed a Health Age Assessment algorithm on a calculator while a masters student at Loma Linda University in 1972. [14] In 1977, Hall coded his longevity calculations on a TRS-80, creating the first computerized health risk assessment. Within a year, he had programmed 12 health assessments on single topics such as nutrition, fitness, weight, and stress. [15] In 1979, when personal desktop computers became readily available, he packaged all 12 assessments together on a floppy disk and marketed it as a comprehensive health risk assessment.[ citation needed ]

It was not until 1980, when the Centers for Disease Control and Prevention released a publicly available version, that the HRA became widely used, particularly in workplace settings. [5] Health and Welfare Canada reviewed How to Practice Prospective Medicine and created a mainframe version of the book. The Centers for Disease Control became aware of this product and adapted it to the newly available personal computer. When Prudential Life Insurance also took an interest and asked to fund an update of the program, the CDC, which could not accept private project funding at the time, transferred ownership to the Carter Center at Emory University where it was updated from 1986 to 1987. The transfer and subsequent program were managed by Dr. Ed Hutchins, who had worked on the HRA in positions at the University of Pennsylvania and Charlotte-Mecklenburg Hospital. At Charlotte Mecklenburg, he secured a contract with the World Health Organization to create a mainframe product that could be used on an international basis. The HRA was managed as a not-for-profit product. Copies were distributed to every state health department, and liaisons were assigned to each to work with their staffs to evaluate related data. Over 2,000 copies of the software were distributed to users who requested it, and approximately 70 copies of the code were provided to for-profit companies that were interested in developing proprietary products. This proliferation coincided with the rapid growth in interest in corporate health promotion programs as awareness developed on health risks and for-profit vendors monetized the programs.[ citation needed ]

The Carter Center's interest shifted to Africa and Dr. Hutchins founded the Healthier People Network (HPN) in 1991 to continue the work. HPN raised funds to support the HRA, but additional funding was not forthcoming from government sources. As a result, the Carter Center and HPN could not underwrite basic supporting activities such as annual conferences and, over time, the State-based liaison network and associated intellectual capital atrophied as programs lost funding and liaisons moved on.[ citation needed ]

The use of HRAs and corporate wellness programs has been most prevalent in the United States, with comparatively slower growth elsewhere. [7] [16] However, there has been recent[ when? ] strong growth in corporate wellness outside the US, particularly in Europe and Asia. [17]

Usage

Once an individual completes a HRA, they usually receive a report, detailing their health rating or score, often broken down into specific sub scores and areas such as stress, nutrition and fitness. [3] The report can also provide recommendations on how individuals can reduce their health risks by changing their lifestyle. [11]

In addition to individual feedback, HRAs are also used to provide aggregated data reporting for employers and organizations. [7] [16] These reports include demographic data of participants, highlight health risk areas and often include cost projections and savings in terms of increased healthcare, absence and productivity. [7] Organization-level reports can then be used to provide a first step by which organizations can target and monitor appropriate health interventions within their workforce. [16]

HRA delivery

The delivery of HRAs has changed over the years in conjunction with advances in technology. Initially distributed as paper-based, self-scoring questionnaires through on-site workplace health promotion sessions, HRAs are now most commonly implemented online. [5] Other delivery methods include telephone, mail and face-to-face. [5] [6]

The advantages of online HRAs include: [5]

Efficacy

Extensive research has shown that HRAs can be used effectively to:

There is also recent evidence to suggest that taking a HRA alone can have a positive effect on health behavior change and health status. [25] [26] However, it is generally accepted that HRAs are most effective at promoting behavior change when they form part of an integrated, multi-component health promotion program. [3] [7] [27] Applied in this way, the HRA is used primarily as a tool to identify health risks within a population and then target health interventions and behavior change programs to address these areas. [5]

Limitations

The limitations of a HRA are largely related to its usage and it is important to recognise that a HRA highlights health risks but does not diagnose disease and should not replace consultation with a medical or health practitioner. [3]

Providers

There are reportedly over 50 different HRA providers in the market, offering a variety of versions and formats. [3] Major vendors generally have National Committee for Quality Assurance (NCQA) Wellness and Health Promotion (WHP) Certification [28] or Health Information Products (HIP) Certification.

Related Research Articles

<span class="mw-page-title-main">Medicaid</span> United States social health care program for families and individuals with limited resources

In the United States, Medicaid is a government program that provides health insurance for adults and children with limited income and resources. The program is partially funded and primarily managed by state governments, which also have wide latitude in determining eligibility and benefits, but the federal government sets baseline standards for state Medicaid programs and provides a significant portion of their funding.

Multiple chemical sensitivity (MCS), also known as idiopathic environmental intolerances (IEI), is an unrecognized and controversial diagnosis characterized by chronic symptoms attributed to exposure to low levels of commonly used chemicals. Symptoms are typically vague and non-specific. They may include fatigue, headaches, nausea, and dizziness.

<span class="mw-page-title-main">Occupational injury</span> Bodily damage resulting from working

An occupational injury is bodily damage resulting from working. The most common organs involved are the spine, hands, the head, lungs, eyes, skeleton, and skin. Occupational injuries can result from exposure to occupational hazards, such as temperature, noise, insect or animal bites, blood-borne pathogens, aerosols, hazardous chemicals, radiation, and occupational burnout.

<span class="mw-page-title-main">Bernardino Ramazzini</span> Italian malariologist

Bernardino Ramazzini was an Italian physician.

<span class="mw-page-title-main">Community health</span> Field of public health

Community health refers to simple health services that are delivered by laymen outside hospitals and clinics. Community health is also the subset of public health that is taught to and practiced by clinicians as part of their normal duties. Community health volunteers and community health workers work with primary care providers to facilitate entry into, exit from and utilization of the formal health system by community members.

Presenteeism or working while sick is the act or culture of employees continuing to work as a performative measure, despite having reduced productivity levels or negative consequences. Reduced productivity during presenteeism is often due to illness, injury, exhaustion, or other conditions, but presenteeism can also describe working while contagiously sick, which has the added risk of creating a workplace epidemic.

Health promotion is, as stated in the 1986 World Health Organization (WHO) Ottawa Charter for Health Promotion, the "process of enabling people to increase control over, and to improve their health."

In the healthcare industry, pay for performance (P4P), also known as "value-based purchasing", is a payment model that offers financial incentives to physicians, hospitals, medical groups, and other healthcare providers for meeting certain performance measures. Clinical outcomes, such as longer survival, are difficult to measure, so pay for performance systems usually evaluate process quality and efficiency, such as measuring blood pressure, lowering blood pressure, or counseling patients to stop smoking. This model also penalizes health care providers for poor outcomes, medical errors, or increased costs. Integrated delivery systems where insurers and providers share in the cost are intended to help align incentives for value-based care.

Workplace wellness, also known as corporate wellbeing outside the United States, is a broad term used to describe activities, programs, and/or organizational policies designed to support healthy behavior in the workplace. This often involves health education, medical screenings, weight management programs, and onsite fitness programs or facilities. It can also include flex-time for exercise, providing onsite kitchen and eating areas, offering healthy food options in vending machines, holding "walk and talk" meetings, and offering financial and other incentives for participation.

A lifestyle management programme is an intervention designed to promote positive lifestyle and behaviour change and is widely used in the field of health promotion.

Workplace health promotion is the combined efforts of employers, employees, and society to improve the mental and physical health and well-being of people at work. The term workplace health promotion denotes a comprehensive analysis and design of human and organizational work levels with the strategic aim of developing and improving health resources in an enterprise. The World Health Organization has prioritized the workplace as a setting for health promotion because of the large potential audience and influence on all spheres of a person's life. The Luxembourg Declaration provides that health and well-being of employees at work can be achieved through a combination of:

Total Worker Health is a trademarked strategy defined as policies, programs, and practices that integrate protection from work-related safety and health hazards with promotion of injury and illness prevention efforts to advance worker well-being. It was conceived and is funded by the National Institute for Occupational Safety and Health (NIOSH). Total Worker Health is tested and developed in six Centers of Excellence for Total Worker Health in the United States.

The Patient Activation Measure (PAM) is a commercial product which assesses an individual's knowledge, skill, and confidence for managing one's health and healthcare. Individuals who measure high on this assessment typically understand the importance of taking a pro-active role in managing their health and have the skills and confidence to do so.

Patricia A. Berglund is a researcher at the University of Michigan's Institute for Social Research. She was included in the 2014, 2015 and 2016 Clarivate Analytics lists of "highly cited researchers" in the fields of psychiatry and psychology.

Occupational cardiovascular diseases (CVD) are diseases of the heart or blood vessels caused by working conditions, making them a form of occupational illness. These diseases include coronary heart disease, stroke, cardiomyopathy, arrythmia, and heart valve or heart chamber problems. Cardiovascular disease is the leading cause of death in the United States and worldwide. In the United States, cardiovascular diseases account for one out of four deaths. The 6th International Conference on Work Environment and Cardiovascular Diseases found that within the working age population about 10-20% of cardiovascular disease deaths can be attributed to work. Ten workplace stressors and risk factors were estimated to be associated with 120,000 U.S. deaths each year and account for 5-8% of health care costs.

Travel health nursing is a nursing specialty which promotes the health and safety of national and international travelers. Similar to travel medicine, it is an interdisciplinary practice which draws from the knowledge bases of vaccines, epidemiology, tropical medicine, public health, and health education. Travel nursing has experienced an increase in global demand due to the evolution of travel medicine. Travel health nursing was recognized during the 1980s as an emerging occupation to meet the needs of the traveling public, and additional education and training was established. Travel health nurses typically work in "private practice, hospital outpatient units, universities, the government, and the military", and have more opportunities and leadership roles as travel has become more common. However, they also experience organizational and support-related conflicts with general practitioners and patients in healthcare settings.

Elizabeth Anne (Lianne) Sheppard is an American statistician. She specializes in biostatistics and environmental statistics, and in particular in the effects of air quality on health. She is a Professor of Environmental and Occupational Health Sciences and a Professor of Biostatistics in the University of Washington School of Public Health. In 2021, Dr. Sheppard was named to the Rohm & Haas Endowed Professorship of Public Health Sciences.

<span class="mw-page-title-main">Well-Being Index</span>

The Well-Being Index is an online self-assessment tool invented by researchers at Mayo Clinic that measures mental distress and well-being in seven-nine items. The Well-Being Index is an anonymous tool that allows participants to reassess on a monthly basis, track their well-being scores over time, compare their results to peers' and national averages, and access customized resources based on their assessment results. There are six clinically-validated versions of the Well-Being Index: Advanced Practice Provider, Employee, Medical Student, Nurse, Physician, and Resident/Fellow.

Richard A. Smith (1932–2017) was an American physician who was part of the five-person team composing the Surgeon General's Office of Equal Health Opportunity (OEHO), which was charged with desegregating US hospitals in the mid-1960s. Smith developed one of the first Physician Assistant (PA) training programs in the US, MEDEX, and later founded MEDEX International.

<span class="mw-page-title-main">National Firefighter Registry for Cancer</span> Registry of firefighters used to evaluate cancer risk

The National Firefighter Registry for Cancer (NFR) is a voluntary registry of firefighters in the United States used to evaluate cancer rates and risk factors in the U.S. fire service through collecting relevant occupational, lifestyle, and health information on firefighters. It aims to use these data to reduce cancer in firefighters.

References

  1. 1 2 3 Yen L, McDonald T, Hirschland D, Edington DW (October 2003). "Association between wellness score from a health risk appraisal and prospective medical claims costs". Journal of Occupational and Environmental Medicine . 45 (10): 1049–57. doi:10.1097/01.jom.0000088875.85321.b9. PMID   14534445. S2CID   19359893.
  2. ↑ Gazmararian JA, Foxman B, Yen LT, Morgenstern H, Edington DW (October 1991). "Comparing the predictive accuracy of health risk appraisal: the Centers for Disease Control versus Carter Center program". American Journal of Public Health . 81 (10): 1296–301. doi:10.2105/ajph.81.10.1296. PMC   1405330 . PMID   1656798.
  3. 1 2 3 4 5 6 7 Alexander G (2000). "Health risk appraisal" (PDF). The International Electronic Journal of Health Education. 3 (Special): 133–137.[ permanent dead link ]
  4. 1 2 Community Preventive Services Task Force (February 2007). "Worksite: Assessment of Health Risks with Feedback (AHRF) to Change Employees' Health – AHRF Plus Health Education With or Without Other Interventions".
  5. 1 2 3 4 5 6 7 8 Baker K, DeJoy D, and Wilson M. Using online health risk assessments, The Journal of Employee Assistance. April 2007.
  6. 1 2 3 "Redirect Page". www.cdc.gov.
  7. 1 2 3 4 5 6 Warshaw, L. Chapter 15: Health risk appraisal Archived 7 April 2011 at the Wayback Machine , International Labour Organization's Encyclopaedia of Occupational Health and Safety 4th ed. 1998
  8. ↑ Centers for Medicare & Medicaid Services. "Preventive visit & yearly wellness exams".[ permanent dead link ]
  9. ↑ Center for Medicaid and CHIP Services and Centers for Medicare & Medicaid Services. "Core Set of Children's Health Care Quality Measures for Medicaid and CHIP (Child Core Set)" (PDF). Archived from the original (PDF) on 8 February 2015. Retrieved 13 February 2015.
  10. ↑ Soler, Robin; et al; the Task Force on Community Preventive Services (2010). "A Systematic Review of Selected Interventions for Worksite Health Promotion: The Assessment of Health Risks with Feedback" (PDF). American Journal of Preventive Medicine . 38(2S) (2 Suppl): S237–S262. doi:10.1016/j.amepre.2009.10.030. PMID   20117610 – via Elsevier Science Direct.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  11. 1 2 3 Schoenbach VJ (April 1987). "Appraising health risk appraisal". American Journal of Public Health. 77 (4): 409–11. doi:10.2105/AJPH.77.4.409. PMC   1646957 . PMID   3826457.
  12. ↑ Housman, Jeff; Dorman, Steve (2005). "The Alameda County Study: a Systematic, Chronological Review" (PDF). The American Journal of Health Education. 36 (5): 302–308. doi:10.1080/19325037.2005.10608200. S2CID   39133965 – via ERIC.
  13. ↑ Belloc, Nedra; Breslow, Lester (August 1972). "Relationship of physical health status and health practices". Preventive Medicine. 1 (3): 409–421. doi:10.1016/0091-7435(72)90014-X. PMID   5085007.
  14. ↑ "Commencement program" (PDF). home.llu.edu. 2019. Retrieved 9 July 2019.
  15. ↑ "Don-Hall". Wellsource.
  16. 1 2 3 Mills PR (2005). "The development of a new corporate specific health risk measurement instrument, and its use in investigating the relationship between health and well-being and employee productivity". Environmental Health. 4 (1): 1. doi: 10.1186/1476-069X-4-1 . PMC   548523 . PMID   15679885.
  17. ↑ Working well: A global survey of health promotion and workplace wellness strategies (PDF). Buck Consultants. October 2008. Archived from the original (PDF) on 16 August 2009. Retrieved 28 October 2009.[ page needed ]
  18. 1 2 Yen L, Schultz A, Schnueringer E, Edington DW (September 2006). "Financial costs due to excess health risks among active employees of a utility company". Journal of Occupational and Environmental Medicine. 48 (9): 896–905. doi:10.1097/01.jom.0000235987.75368.d0. PMID   16966956. S2CID   31296603.
  19. 1 2 Anderson DR, Whitmer RW, Goetzel RZ, et al. (2000). "The relationship between modifiable health risks and group-level health care expenditures. Health Enhancement Research Organization (HERO) Research Committee". American Journal of Health Promotion. 15 (1): 45–52. doi:10.4278/0890-1171-15.1.45. PMID   11184118. S2CID   3315766.
  20. 1 2 Burton WN, Chen CY, Conti DJ, Schultz AB, Edington DW (August 2003). "Measuring the relationship between employees' health risk factors and corporate pharmaceutical expenditures". Journal of Occupational and Environmental Medicine. 45 (8): 793–802. doi:10.1097/01.jom.0000079090.95532.db. PMID   12915781. S2CID   24012788.
  21. ↑ Boles M, Pelletier B, Lynch W (July 2004). "The relationship between health risks and work productivity". Journal of Occupational and Environmental Medicine. 46 (7): 737–45. doi:10.1097/01.jom.0000131830.45744.97. PMID   15247814. S2CID   30451976.
  22. ↑ Loeppke R, Taitel M, Richling D, et al. (July 2007). "Health and productivity as a business strategy". Journal of Occupational and Environmental Medicine. 49 (7): 712–21. doi:10.1097/JOM.0b013e318133a4be. PMID   17622843. S2CID   28699665.
  23. ↑ Mills PR, Kessler RC, Cooper J, Sullivan S (2007). "Impact of a health promotion program on employee health risks and work productivity". American Journal of Health Promotion. 22 (1): 45–53. doi:10.4278/0890-1171-22.1.45. PMID   17894263. S2CID   2128599.
  24. ↑ Burton WN, Chen CY, Conti DJ, Schultz AB, Edington DW (March 2006). "The association between health risk change and presenteeism change". Journal of Occupational and Environmental Medicine. 48 (3): 252–63. doi:10.1097/01.jom.0000201563.18108.af. PMID   16531829. S2CID   23074251.
  25. ↑ Ozminkowski RJ, Dunn RL, Goetzel RZ, Cantor RI, Murnane J, Harrison M (1999). "A return on investment evaluation of the Citibank, N.A., health management program". American Journal of Health Promotion. 14 (1): 31–43. doi:10.4278/0890-1171-14.1.31. PMID   10621522. S2CID   46780572.
  26. ↑ Ozminkowski RJ, Goetzel RZ, Wang F, et al. (November 2006). "The savings gained from participation in health promotion programs for Medicare beneficiaries". Journal of Occupational and Environmental Medicine. 48 (11): 1125–32. doi:10.1097/01.jom.0000240709.01860.8a. PMID   17099448. S2CID   32811954.
  27. ↑ Anderson DR, Staufacker MJ (1996). "The impact of worksite-based health risk appraisal on health-related outcomes: a review of the literature". American Journal of Health Promotion. 10 (6): 499–508. doi:10.4278/0890-1171-10.6.499. PMID   10163313. S2CID   3239046.
  28. ↑ National Committee for Quality Assurance. "Wellness & Health Promotion Report Card".[ permanent dead link ]
This page is based on this Wikipedia article
Text is available under the CC BY-SA 4.0 license; additional terms may apply.
Images, videos and audio are available under their respective licenses.