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How does a comprehensive workplace wellness program affect health, health beliefs, and medical use among university employees after 24 months?
In a 2-year randomized clinical trial of 4834 employees at a large US university, employees invited to join a wellness program showed no significant differences in biometrics, medical diagnoses, or medical use relative to the control group. The intervention increased self-reports of having a primary care physician and improved a set of employee health beliefs among the treatment group.
The workplace wellness changed health beliefs and increased self-reports of having a primary care physician but did not significantly affect clinical outcomes.
Many employers use workplace wellness programs to improve employee health and reduce medical costs, but randomized evaluations of their efficacy are rare.
To evaluate the effect of a comprehensive workplace wellness program on employee health, health beliefs, and medical use after 12 and 24 months.
Design, Setting, and Participants
This randomized clinical trial of 4834 employees of the University of Illinois at Urbana-Champaign was conducted from August 9, 2016, to April 26, 2018. Members of the treatment group (n = 3300) received incentives to participate in the workplace wellness program. Members of the control group (n = 1534) did not participate in the wellness program. Statistical analysis was performed on April 9, 2020.
The 2-year workplace wellness program included financial incentives and paid time off for annual on-site biometric screenings, annual health risk assessments, and ongoing wellness activities (eg, physical activity, smoking cessation, and disease management).
Main Outcomes and Measures
Measures taken at 12 and 24 months included clinician-collected biometrics (16 outcomes), administrative claims related to medical diagnoses (diabetes, hypertension, and hyperlipidemia) and medical use (office visits, inpatient visits, and emergency department visits), and self-reported health behaviors and health beliefs (14 outcomes).
Among the 4834 participants (2770 women; mean [SD] age, 43.9 [11.3] years), no significant effects of the program on biometrics, medical diagnoses, or medical use were seen after 12 or 24 months. A significantly higher proportion of employees in the treatment group than in the control group reported having a primary care physician after 24 months (1106 of 1200 [92.2%] vs 477 of 554 [86.1%]; adjusted P = .002). The intervention significantly improved a set of employee health beliefs on average: participant beliefs about their chance of having a body mass index greater than 30, high cholesterol, high blood pressure, and impaired glucose level jointly decreased by 0.07 SDs (95% CI, −0.12 to −0.01 SDs; P = .02); however, effects on individual belief measures were not significant.
Conclusions and Relevance
This randomized clinical trial showed that a comprehensive workplace wellness program had no significant effects on measured physical health outcomes, rates of medical diagnoses, or the use of health care services after 24 months, but it increased the proportion of employees reporting that they have a primary care physician and improved employee beliefs about their own health.
American Economic Association Randomized Controlled Trial Registry number: AEARCTR-0001368
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CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships. If applicable, all relevant financial relationships have been mitigated.
Accepted for Publication: March 23, 2020.
Corresponding Author: David Molitor, PhD, Gies College of Business, University of Illinois at Urbana-Champaign, 31206 S Sixth St, 40 Wohlers Hall, Champaign, IL 61820 (email@example.com).
Published Online: May 26, 2020. doi:10.1001/jamainternmed.2020.1321
Author Contributions: Drs Reif and Molitor had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.
Concept and design: Reif, Jones, Payne, Molitor.
Acquisition, analysis, or interpretation of data: All authors.
Drafting of the manuscript: All authors.
Critical revision of the manuscript for important intellectual content: All authors.
Statistical analysis: Reif, Jones, Molitor.
Obtained funding: Reif, Jones, Payne, Molitor.
Administrative, technical, or material support: All authors.
Supervision: Reif, Jones, Molitor.
Conflict of Interest Disclosures: Drs Reif, Jones, Payne, and Molitor reported receiving grants from the National Institutes of Health, the Abdul Latif Jameel Poverty Action Lab (J-PAL) North America US Health Care Delivery Initiative, the National Science Foundation, the Robert Wood Johnson Foundation, and the W. E. Upjohn Institute for Employment Research during the conduct of the study. No other disclosures were reported.
Funding/Support: This research was supported by award R01AG050701 from the National Institute on Aging of the National Institutes of Health; grant 1730546 from the National Science Foundation; the J-PAL North America US Health Care Delivery Initiative; Evidence for Action (E4A), a program of the Robert Wood Johnson Foundation; and the W. E. Upjohn Institute for Employment Research. Illinois Human Resources provided in-kind logistical support for developing the program.
Role of the Funder/Sponsor: The funding sources had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.
Data Sharing Statement: See Supplement 4.
Additional Contributions: Lauren Geary, MPH, University of Illinois at Urbana-Champaign, provided project management; she was compensated for her contribution. Michele Guerra, MS, Certificate of Advanced Study, University of Illinois at Urbana-Champaign, provided input into the design of the wellness program and the selection of wellness activities; she was not compensated for her contribution. Illinois Human Resources provided institutional support without financial compensation. Marian Huhman, PhD, University of Illinois at Urbana-Champaign, Mark Stehr, PhD, Drexel University, David Studdert, LLB, ScD, MPH, Stanford University, and seminar participants at the American Society of Health Economists provided comments on this article; they were not compensated for their contributions.
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