1. 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
Health Promotion Live
October 26th, 2012
National Center for Chronic Disease Prevention and Health Promotion
Centers for Disease Control and Prevention

2. 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?

3. 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

4. Why develop the CDC Worksite Health ScoreCard?
 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

5. 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

6. The CDC Worksite Health ScoreCard (HSC)
Assesses best practice health promotion interventions
(policies, programs, environmental supports)
 Organizational supports  High blood pressure
 Tobacco control  High cholesterol
 Nutrition  Diabetes
 Physical activity  Signs and symptoms of
 Weight management heart attack and stroke
 Stress management  Emergency response to
 Depression heart attack and stroke

7. What does the CDC-HSC look like?
~100 Yes/No Questions

8. 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

9. 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

10. 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

11. 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”

12. Developing the CDC-HSC (cont.)
Available at: http://www.cdc.gov/dhdsp/pubs/docs/HSC_Score_Method.pdf
 Description of the Rating
System
 How impact scores and
weights were assigned
 How final score was
derived for each question
 Citations and references

13. 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+

14. 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

15. 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)
Average HSC Scores for Study Sample
99 Employer Size
112 Groups
Very small: 10–99
129 Small: 100–249
153 Medium: 250–749
129 Large: 750+
0 50 100 150 200
Very small Small Medium Large All Employers

16. 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

17. 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

18. Ongoing Dissemination
 Conferences and Webinars
 E-blast
 Listservs
 NHWP Constant Contact
 Targeted Trainings

19. 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

20. 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

21. Health Improvement Plan Template and Sample

22. 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

23. The CDC Worksite Health ScoreCard
http://www.cdc.gov/dhdsp/pubs/worksite_scorecard.htm

24. Resources
www.cdc.gov/WorkplaceHealthPromotion www.cdc.gov/NationalHealthyWorksite/

25. 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)

26. Resources
CDC LEAN Works!
www.cdc.gov/leanworks

27. Resources
Tobacco Cessation

28. 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/pub
s/employers_toolkit.htm

29. 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

30. Contact Information
Dyann M. Matson Koffman, DrPH, MPH, CHES
Health Scientist
Division for Heart Disease and Stroke Prevention
Email: dfm1@cdc.gov
Jason E. Lang, MPH, MS
Team Lead, Workplace Health Programs
Division of Population Health
Email: bzl0@cdc.gov

31. Thank You!
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: cdcinfo@cdc.gov 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.
National Center for Chronic Disease Prevention and Health Promotion
Centers for Disease Control and Prevention