Cost Effective Health Promotion for Older Workers

描述（由申请人提供）：55岁以上的工人人数预计将从2002年的1 920万增加到2015年的3 180万（GAO报告，2003年）。鉴于这些预计的增长，为这一人群制定和测试具有成本效益的健康促进干预措施是一项紧迫的国家优先事项。如果我们能够在老年人仍在工作时接触他们，并成功地使他们参与持续的健康促进活动，我们就可能对未来的医疗保健支出产生重大影响。该项目通过测试两种循证健康促进/行为改变干预措施的比较成本效益来解决这一紧迫问题。第一个干预，教练计划，使用个性化的电话强化，以加强遵守。第二个是RealAge计划，完全基于网络。这两个方案都管理标准化的风险评估，制定风险概况，并为老年工人提供一套健康行为行动计划的选择，以解决改善饮食/营养，体育活动和戒烟问题。目前，这两种方法的比较吸引力及其比较成本效益尚不清楚。这项拟议的研究将测试两种干预措施的成本效益与支持人员50-59岁在一个主要的内城中西部大学使用随机临床试验设计与450名参与者。参与者将被随机分配到教练组，RealAge组或健康教育对照组。将收集关于干预措施使用和遵守行动计划的过程数据。将在基线、6个月和12个月时收集的指标包括介质、主要和次要结局。中介变量包括特定行为变化的准备阶段和自我效能，主要结果包括医疗保健使用和成本，缺勤和残疾天数，次要结果包括活力，抑郁，生活质量，血压和BMI。将通过从卫生保健利用中获得的节省和短期、中期和长期生活质量调整年的收益中减去项目成本来评估成本效益。

DESCRIPTION (provided by applicant): The number of workers over age 55 is expected to increase from 19.2 million in 2002 to 31.8 million by 2015 (GAO Report, 2003). Given these projected increases, the development and testing of cost-effective health promotion interventions for this population is an urgent national priority. If we can reach older adults while they are still working and engage them successfully in sustained health promotion activities, we may be able to make a major impact on future health care expenditures. This project addresses this urgent problem by testing the comparative cost effectiveness of two evidence-based health promotion/ behavior change interventions. The first intervention, the COACH program, uses individualized telephone reinforcement to bolster adherence. The second, the RealAge program, is totally web-based. Both programs administer standardized risk assessments, develop risk profiles, and provide a set of choices for older adult workers with respect to health behavior Action Plans to address improved diet/nutrition, physical activity, and smoking cessation. At present, the comparative appeal of these two approaches and their comparative cost-effectiveness is unknown. The proposed study will test the cost-effectiveness of the two interventions with support staff 50-59 years of age at a major inner city Midwest University using a randomized clinical trial design with 450 participants. Consenting participants will be randomly assigned to a COACH group, a RealAge group, or a health education control group. Process data on intervention use and adherence to Action Plans will be collected. Measures that will be collected at baseline, six, and 12 months include mediators, primary, and secondary outcomes. Mediating variables include stages of readiness for and self-efficacy for specific behavior changes, primary outcomes include health care use and cost, absenteeism, and disability days, and secondary outcomes include vitality, depression, quality of life, blood pressure, and BMI. Cost-effectiveness will be assessed by subtracting program costs from savings obtained in health care utilization and gains in short, intermediate, and long term quality of life adjusted years.