Harvard Medical School, Massachusetts General Hospital, Boston.
University of Chicago Harris School of Public Policy, Chicago, Illinois.
JAMA. 2019 Apr 16;321(15):1491-1501. doi: 10.1001/jama.2019.3307.
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.
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.
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.
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.
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).
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.
ClinicalTrials.gov Identifier: NCT03167658.
重要性：雇主越来越多地投资于工作场所健康计划，以改善员工的健康状况并降低医疗保健成本。然而，关于这些计划的效果，实际上验证据很少。
目的：评估类似于美国雇主提供的多成分工作场所健康计划。
设计、设置和参与者：这项集群随机试验于 2015 年 1 月至 2016 年 6 月在 160 个工作场所进行。从 2016 年 1 月至 6 月 30 日，连续收集行政索赔和就业数据；2016 年 7 月 1 日至 8 月 31 日，收集来自调查和生物标志物的数据。
干预措施：有 20 个随机选择的治疗工作场所（4037 名员工）和 140 个随机选择的对照工作场所（28937 名员工，包括 20 个主要对照工作场所[4106 名员工]）。对照工作场所没有接受健康计划。该计划包括 8 个模块，重点关注营养、体育活动、减压和相关主题，由注册营养师在治疗工作场所实施。
主要结果和测量：评估了四个结果领域。通过调查比较 20 个干预和 20 个主要对照地点的自我报告的健康和行为（29 项结果）和通过筛查评估的健康的临床指标（10 项结果）；通过行政数据比较 20 个干预和 140 个对照地点的医疗保健支出和使用（38 项结果）和就业结果（3 项结果）。
结果：在 32974 名员工中（平均[标准差]年龄，38.6[15.2]岁；15272 名[45.9%]女性），干预地点的调查和筛查的平均参与率为 36.2%至 44.6%（n=4037 名员工），主要对照地点的平均参与率为 34.4%至 43.0%（n=4106 名员工）（平均完成 1.3 个计划模块）。在 18 个月后，在干预组中，2 项自我报告的结果的比率高于对照组：经常锻炼（69.8%比 61.9%；调整差异，8.3 个百分点[95%CI，3.9-12.8]；调整后的 P=.03）和积极控制体重（69.2%比 54.7%；调整差异，13.6 个百分点[95%CI，7.1-20.2]；调整后的 P=.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、睡眠质量和食物选择）、10 项健康的临床指标（包括胆固醇、血压和体重指数）、38 项医疗和药品支出和使用措施以及 3 项就业结果（缺勤、工作任期和工作绩效）。
结论和相关性：在美国一家大型仓库零售公司的员工中，与未接触的员工相比，工作场所健康计划使接触的员工中一些积极的自我报告健康行为的比例显著增加，但在 18 个月后，在临床健康指标、医疗保健支出和使用以及就业结果方面没有显著差异。尽管一些结果的数据不完整，但这些发现可能会降低对健康计划在短期内带来投资回报的期望。
试验注册：ClinicalTrials.gov 标识符：NCT03167658。
