Effect of a Workplace Wellness Program on Employee Health and Economic Outcomes A Randomized Clinical Trial
Effect of a Workplace Wellness Program on Employee Health and Economic Outcomes A Randomized Clinical Trial
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DOI：
10.1001/jama.2019.3307
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发表时间：
2019-04-16
影响因子：
120.7
通讯作者：
Baicker, Katherine
中科院分区：
文献类型：
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作者：
Song, Zirui;Baicker, Katherine
重要的是，雇主越来越多地投资于工作场所健康计划，以改善员工健康并降低医疗成本。然而，关于这些计划的效果，几乎没有实验证据。目的评估一个类似于美国雇主提供的计划的多成分工作场所健康计划。设计、设置和参与者这项随机分组试验于2015年1月至2016年6月在160个工作地点进行。从2016年7月1日到2016年8月31日，连续收集行政申领和就业数据；从2016年7月1日到2016年8月31日，收集调查和生物统计学数据。干预措施随机选择20个治疗工作地点(4037名员工)和140个随机选择的对照工作地点(28 937名员工，包括20个主要对照工作地点[4106名员工])。控制工地没有接受健康规划。该计划包括8个模块，重点关注营养、体力活动、压力减轻以及注册营养师在治疗工作场所实施的相关主题。比较了20个干预点和20个主控制点的自我报告的健康和行为(29个结果)和筛查健康的临床测量(10个结果)；比较了20个干预点和140个控制点的卫生保健支出和利用(38个结果)和来自行政数据的就业结果(3个结果)。干预点调查筛查平均参与率为36.2%~44.6%(n=4037人)，主控制点调查和筛查平均参与率为34.4%~43.0%(n=4106人)(平均完成1.3个项目模块)。18个月后，干预组有2项自我报告结果的发生率高于对照组：经常锻炼(69.8%比61.9%；调整后差异8.3个百分点[95%CI，3.9~12.8]；调整后P=0.03)；积极管理体重(69.2%比54.7%；调整后差异13.6个百分点[95%CI，7.1~20.2]；调整后P=0.02)。该计划对其他预先指定的结果没有显著影响：27项自我报告的健康结果和行为(包括自我报告的健康状况、睡眠质量和食物选择)，10项临床健康指标(包括胆固醇、血压和体重指数)，38项医疗和药品支出和利用指标，以及3项就业结果(缺勤、工作年限和工作绩效)。结论与美国一家大型仓储零售公司的员工相关，工作场所健康计划导致接触者与未接触者相比，一些积极的自我报告健康行为的比率显著增加，但临床健康指标没有显著差异。医疗保健支出和利用率，以及18个月后的就业结果。尽管这些发现受到一些结果的不完整数据的限制，但它们可能会降低人们对健康计划在短期内可以带来的投资回报的预期。
IMPORTANCE Employers have increasingly invested in workplace wellness programs to improve employee health and decrease health care costs. However, there is little experimental evidence on the effects of these programs.OBJECTIVE To evaluate a multicomponent workplace wellness program resembling programs offered by US employers. DESIGN, SETTING, AND PARTICIPANTS This clustered randomized trial was implemented at 160 worksites from January 2015 through June 2016. Administrative claims and employment data were gathered continuously through June 30, 2016; data from surveys and biometrics were collected from July 1, 2016, through August 31, 2016.INTERVENTIONS There were 20 randomly selected treatment worksites (4037 employees) and 140 randomly selected control worksites (28 937 employees, including 20 primary control worksites [4106 employees]). Control worksites received no wellness programming. The program comprised 8 modules focused on nutrition, physical activity, stress reduction, and related topics implemented by registered dietitians at the treatment worksites.MAIN OUTCOMES AND MEASURES Four outcome domains were assessed. Self-reported health and behaviors via surveys (29 outcomes) and clinical measures of health via screenings (10 outcomes) were compared among 20 intervention and 20 primary control sites; health care spending and utilization (38 outcomes) and employment outcomes (3 outcomes) from administrative data were compared among 20 intervention and 140 control sites.RESULTS Among 32 974 employees (mean [SD] age, 38.6 [15.2] years; 15 272 [45.9%] women), the mean participation rate in surveys and screenings at intervention sites was 36.2% to 44.6%(n = 4037 employees) and at primary control sites was 34.4% to 43.0% (n = 4106 employees) (mean of 1.3 program modules completed). After 18 months, the rates for 2 self-reported outcomes were higher in the intervention group than in the control group: for engaging in regular exercise (69.8% vs 61.9%; adjusted difference, 8.3 percentage points [95% CI, 3.9-12.8]; adjusted P = .03) and for actively managing weight (69.2% vs 54.7%; adjusted difference, 13.6 percentage points [95% CI, 7.1-20.2]; adjusted P = .02). The program had no significant effects on other prespecified outcomes: 27 self-reported health outcomes and behaviors (including self-reported health, sleep quality, and food choices), 10 clinical markers of health (including cholesterol, blood pressure, and body mass index), 38 medical and pharmaceutical spending and utilization measures, and 3 employment outcomes (absenteeism, job tenure, and job performance).CONCLUSIONS AND RELEVANCE Among employees of a large US warehouse retail company, a workplace wellness program resulted in significantly greater rates of some positive self-reported health behaviors among those exposed compared with employees who were not exposed, but there were no significant differences in clinical measures of health, health care spending and utilization, and employment outcomes after 18 months. Although limited by incomplete data on some outcomes, these findings may temper expectations about the financial return on investment that wellness programs can deliver in the short term.