The Park Nicollet Health Education Program (PNHEP) is the comprehensive community, worksite and patient health education program of the Park Nicollet Medical Foundation that has provided cost effective, risk reduction services to hundreds of companies and thousands of patients since 1974. PNHEP provides company employees and patients with health screening and health risk appraisals for early detection of illness, incentive systems for increasing participation in programs, and health education programs with documented effectiveness in reducing health care costs, increasing knowledge and changing behavior.
Program Description
Narrative Description of Program
The Park Nicollet Health Education Program (PNHEP) is the comprehensive community, worksite and patient health education program of the Park Nicollet Medical Foundation that has provided cost effective, risk reduction services to hundreds of companies and thousands of patients since 1974. PNHEP provides company employees and patients with health screening and health risk appraisals for early detection of illness, incentive systems for increasing participation in programs, and health education programs with documented effectiveness in reducing health care costs, increasing knowledge and changing behavior.
The Health Education Center has aligned its services to complement the medical guidelines development activities of the Institute for Clinical Systems Integration (ICSI), a consortium of Park Nicollet, Health Partners, Group Health and Mayo working together on continuous quality improvement teams. PNHEP and ICSI, both founded by Dr. James Reinertsen, serve the Business Health Care Action Group (BHCAG), a buyers coalition of over 20 large employers in the Twin Cities. (1) By linking health education programs with the medical guidelines developed by major health care providers, we have increased participation in preventive health screening, improved hypertension management outcomes and reduced health care costs through consumer self-care.
In addition to providing evaluation services for BHCAG companies separately, we surveyed the population of companies collectively in order to compare the health status of employees between companies. Survey findings are being used to link health risks with employee medical claims experience and plan for further cost-effective interventions.
Contact Summary
| General Information | |
|---|---|
| Program Name | The Park Nicollet Health Education Program |
| Company Name and Address | Park Nicollet Medical Foundation5000 W. 30th St.
Minneapolis, MN 55416 |
| Contact Person | James L. Reinertsen, M.D.President and Chief Quality Officer
(612) 932-3691 |
| Program Information | |
| Program Category | Insurance |
| Year begun | 1974 |
| Total number of individual participants | 95,000 |
| Number of currently actively enrolled | 8,500 |
| Number of companies/groups involved | 75 |
| Access to Program | Marketed broadly, replicated |
| Cost per participant per year | $5.00-$150.00 |
| Data available to external reviewers or investigators | Yes |
| Program targeted at Healthy People 2000 goals |
Yes |
| Program goals (in priority order) | (1) Cost-effectiveness(2) Cost-benefit
(3) Health outcome improvement (4) Risk factor reduction |
Evaluation Summary
PNHEP outcomes studies have been conducted with HMO members and through the medical clinics where BHCAG employees receive care. Results from our ongoing evaluations show:
Improved Knowledge of Prevention Guidelines:
Employees were randomly assigned to an experimental group receiving an education guidebook on preventive services and a control group receiving unrelated health information. The intervention group was two to five times more accurate in reporting the risk-based guidelines of the U.S. Preventive Services Task Force than the control group.
Reduced Unnecessary Treatment for Hypertension and Improved Hypertension Management Outcomes
Of 275 employees referred to the PNHEP Hypertension Management Program for screening, 78% had normal blood pressure. This data suggests that the use of screening techniques using multiple methods ensures that patients will not be unnecessarily treated. At entry into the management phase of our program, only 17% of patients had blood pressure within controlled limits. By the 12 month follow-up, this proportion had increased to 44% (p<.001 ), which compares to control rates of 27% in reference groups. The 6 mmHg average decrease in systolic blood pressure found in this study is associated with a 34% reduction in strokes and a 24%reduction in heart disease according to epidemiological evidences.
Saved Three Dollars in Health Care Costs for Each Dollar Spent in Self-Care Education
Self Care brochures were sent to a random sample of 14,917 patients along with invitations to self-care education sessions. We had significantly less utilization for colds in the month following the program compared to a control group. Trends in the direction of decreased utilization were also found for earaches. Less net medical charges for the intervention group resulted in a 3 to 1 cost savings.
Park Nicollet Health Education Program
Other evaluation studies:
Reduced Risks in Accordance with Healthy People 2000 Goals.
A randomized, controlled trial showed PNHEP worksite program participants had significantly greater improvements in blood pressure and aerobic capacity (a measure of physical fitness) and better self-reported health habits than control groups.
Increased Physician Counseling of Employees Requesting HIV tests.
Over a six month period we provided family practice physicians with patient education resources, guidelines about HIV-antibody testing, and information about how their patient counseling practices compared to other physicians. Following this randomized, controlled intervention, a chart audit showed that documentation of patient counseling had doubled.
Other PNHEP Collaborative Studies and Programs Based on External Research
PNHEP participated in the Minnesota Heart Health Program, one of the largest community based trials funded by the National Institutes of Health. Positive outcomes in smoking cessation, cholesterol and hypertension management and cardiovascular disease prevention were achieved. We have conducted "health audits" for numerous BHCAG companies and have published our approach to worksite program evaluation. (10) PNHEP participated in the University of Michigan project comparing the effects of health screening, health education, and follow-up counseling. PNHEP manages the Wellness Center of the Ford plant which attracted one of the highest participation rates among all sites for this study nationwide. Changes in blood pressure, weight and smoking were significantly greater in sites with intensive interventions compared to those with less intensive programs. PNHEP offers "Quit and Win", a smoking cessation program; six month abstinence rates were 26% for the intervention group compared to 12% for a control group. A phone counseling/self study based smoking cessation program we also offer called "Free and Clear" demonstrated 23% quit rates at 16 months for those who received both self study and phone counseling versus 14% quit rates for those offered self-help materials only.
Evaluation Documentation
Critique
Park Nicollet Health Education Program - Health Education Program
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
Park Nicollet Medical Foundationís program begun in 1974 provides self-care materials for community, employer and patient health education at costs between $5 and $150 per year per participant as tested on about 15,000 patients, has saved $3 for each $1 spent, by helping participants understand when professional care was needed and when it was not necessary. The comprehensive program includes prevention guidelines, hypertension screening, guidelines and counseling on HIV testing, a heart program, and a "Quit and Win" program that cut smoking over six months by 26 percent.
In January 1993 they began an ambitious health promotion program that links many employers to HMOs and three group practices. The linkage is designed to deliver health promotion and the program is well designed. Some of its content is based on components that have had adequate testing for effectiveness. They have provided two well-designed evaluations of blood pressure change in their SHAPE program and in an HIV testing program. Both used a randomized treatment-control design, a truly rare phenomenon. There are many informal publications. There is a self-care emphasis. There are broad program capabilities. These are low-cost education strategies which appear effective.
Evaluation of their new program beginning in 1993 is not all available. The study design of the reduction in visits for colds study is weak. Program evaluations focus more on changes and knowledge, attitudes, and behaviors than on cost reductions. The program description did not provide all the details needed to assess. The strength of the evaluations could be improved.