Are health risk assessments effective? Three systematic reviews have sought to answer this question.
One of the most rigorous and most recent analyses, Health Risk Assessment: Technology Report, conducted by McMaster University Evidence-based Practice Center for Agency for the Healthcare Research and Quality, examined 118 studies of health outcomes associated with HRAs. The report concluded:
Many HRA programs demonstrated improvements on intermediate health outcomes such as blood pressure, cholesterol, physical activity, or fat intake. However, only one article considered hard health outcomes (i.e., freedom from any of the following after 24-month followup: death, myocardial infarction, stroke, Class II-IV angina, or severe asymptomatic ischemia ). Also, followup periods were often shorter than 24 months. Therefore, we were unable to assess whether HRA programs produced health benefits over the medium to long term.
A previous, similarly comprehensive, review was conducted by Rand Corporation. Rand’s study endeavored to evaluate the effectiveness of HRAs for Medicare populations, but in order to do that their study focused on the evidence of HRAs’ effectiveness in any setting, especially worksites. Rand’s conclusions foreshadowed the AHRQ study, stating, “Interventions that combine HRA feedback with health promotion programs are most likely to show beneficial effects… It is not known if these effects persist over the long term.” But Rand also examined cost-effectiveness — importantly for corporate wellness programs — and added:
Current literature is insufficient to accurately estimate the cost effectiveness of programs using HRA. Limited evidence suggests that a carefully designed program that uses a systematic approach to implement HRA and subsequent disease prevention/health promotion interventions has the potential to be cost-beneficial. Considerable effort is needed to optimize program design, implementation, and evaluation.
Yet another study, conducted by the Task Force on Community Preventive Services and published in the American Journal of Preventive Medicinein 2010, suggested more positive outcomes for HRAs, but still with qualifications. The study concluded that HRAs with feedback “has utility as a gateway intervention to a broader worksite health promotion program that includes health education lasting at least one hour or being repeated multiple times during one year….Results of this review suggest that this intervention may be more effective for some outcomes (e.g., smoking behavior or cholesterol) than for others (e.g., change in body composition).”
(These three reviews, in addition to trying to measure the value of HRAs, also provide comprehensive background information about HRAs — their history, their intended purpose, their modes of delivery, their strengths and weaknesses. If you haven’t studied HRA methodology, I strongly recommend that you read at least one of these reviews. As I mentioned in a previous post, many managers responsible for HRA implementation haven’t had an opportunity to learn what an HRA really is — how it’s supposed to work or what it’s supposed to achieve. Any of these three reviews will provide much-needed context. The AHQR review is the best place to start.)
Each of these reviews suggests that there is or may be some potential for HRAs in evoking positive health outcomes for individuals, but none of them are a ringing endorsement. In an upcoming post, I’ll offer my own opinion on why employers may want to hang in there with their HRAs.
[This is one in a series of posts about health risk and health risk appraisals.]