The PRECEDE/PROCEED model provides the theoretical framework for the UPRR health promotion program. To address both the social and epidemiological concerns, three analyses – a needs assessment, a cultural audit and a comprehensive examination of health care claims were initially conducted.
Narrative Description of Program
Union Pacific Railroad (UPRR) is a transportation company consisting of 28,000 employees distributed geographically throughout 19 states. Employees are mobile, unionized, blue-collars workers.
The PRECEDE/PROCEED model provides the theoretical framework for the UPRR health promotion program. To address both the social and epidemiological concerns, three analyses - a needs assessment, a cultural audit and a comprehensive examination of health care claims were initially conducted.
These analyses demonstrated that both individual and organizational health indicators should be addressed through our health promotion program. Top management support was critical in establishing a company wide program directed at our diverse employee population.
Over the last seven years, UPRR policy makers and health professionals have delivered and implemented a comprehensive initiative driven by the analyses mentioned above focusing on the following lifestyle concerns:
- medical self-care,
- high risk identification and
- alcohol abuse prevention.
To date, all programs have been subjected to ongoing evaluation to demonstrate effectiveness in the areas of employee morale, productivity and cost savings. Evaluation results have also been used to facilitate ongoing program design. UPRR results have appeared in a variety of scholarly journals and have been presented at a number of national health conferences. As a result of its demonstrated success, the UPRR health promotion initiative has been formally integrated into the organizational operating structure.
|Program Name||Project Health Track|
|Company Name and Address||Union Pacific Railroad1416 Dodge St.Omaha, NE 68179-0101|
|Contact Person||Joseph A. Leutzinger, PhD(402) 271-5814|
|Total number of individual participants||28,000|
|Access to Program||Marketed broadly, replicated|
|Cost per participant per year||$50|
|Available to external reviewers or investigators||Yes|
|Program targeted at Healthy People 2000 goals
|Program goals (in priority order)||(1) Risk factor reduction(2) Health outcome improvement(3) Cost-effectiveness(4) Cost-benefit(5) Enhanced labor relations|
Our four major programs have been evaluated by looking at process, impact and outcome data.
Process: Studies demonstrate a high satisfaction rate with our company sponsored exercise program.
Impact: Two studies have demonstrated a positive relationship between exercise and perceived worker productivity. (pages 4 & 5)
Medical Self Care (MSC)
Process: Participants liked program delivery and contents.
Impact: Studies show an elimination of unnecessary physician visits.
Outcome: Self report data suggests that the program paid for itself in the first three months.
Costs related to MSC procedures (non-chronic conditions ) decreased when comparing pre(one year) to post(one year ) program health care claims for a projected savings of $1,260,000. (page 6)
Project Health Track
Process: Mid year results showed participants were extremely pleased with program and counseling.
Impact: Results show 40% of the blood pressure and 34% of the cholesterol treatment groups had eliminated their risk. Twenty-one percent quit smoking while 17% of the weight control treatment group moved out of the at-risk range.
Outcome: An econometric analyses based on previous published articles reveals a positive benefit cost ratio of 1.57:1.00. (pages 8 & 9)
By The Numbers O-1-2-4 (New Program)
Process: A preliminary evaluation demonstrates that participants in the intervention liked the delivery and understood the objectives.
Outcome: Have pre-program data, will compare to post-program data next year. (page 10)
The following assessment of program strengths and weaknesses has been abstracted from reviews by the Task Force on Program Selection of The Health Project. Where weaknesses are postulated, it must be taken into account that the review Task Force is very critical, that no programs are perfect, that the Award Winning programs have been selected from over 300 candidate programs and represent the very best, that the materials reviewed may have been incomplete, that suggested deficiencies may have resulted from incomplete understanding of the program by the reviewers or that any problems may have been corrected since the time of review.
Evaluation: Union Pacific Railroad (UPRR) with 28,000 participants in 19 states and medical costs approaching $6,000 per employee, felt that personal health management should be tried. A modest medical self care (MSC) initiative at an annual cost of $50 per person, netted savings of $1.26 million. Reduced blood pressure and cholesterol intake produced a benefit-cost ratio of 1.57 to 1.00. Over 90 percent of the UPRR workforce is union blue collar workers and half are transient with limited supervision.
An excellent example of carrying out interventions in multiple sites in 19 states in a predominately blue collared group, including part-time workers. The medical self-care programs appear to have succeeded in achieving cost reductions. Projected savings ratios are 1.6 to 1 with medical self-care savings reaching 1.3 million dollars per year. The program incorporates financial rebates and three-pronged initial assessment. The use of the quality audit is commendable. They had a good evaluation design and did good measurement norms and evaluation of the work climate before designing their program. Consumer input was solicited. Cost data is incorporated in the evaluation.
The benefit/cost ratio for high risk counseling is encouraging and 1.57 to 1 but no data to substantiate these results are presented. There is some question of the validity of dollar savings without more formal evaluation. The medical self-care programs were not designed to effect chronic disease changes. The strength of the intervention can be questioned.