Health risk assessments are a cornerstone tool for wellness programs and patient engagement efforts. Yet not much research has validated what instruments work best, how good are the assessments at predicting potential health issues and do they lead to better follow-up and ultimate health outcomes. The Agency for Healthcare Research & Quality released a technology assessment exploring these issues. (AHRQ Report) As is typical with these AHRQ reports, this one is basically a literature search for relevant reported research. In this case, about 118 studies were examined and graded and the results synthesized.
The key questions were how an HRA is defined, what are the components, what populations are they used on, who administers them, how is feedback given, what are the followup periods and what effect do HRAs appear to have on health outcomes. An assumption needs to be made that the study populations are representative of the actual population that takes HRAs when considering the report’s findings. The authors identified three key components for an HRA: participants provide self-reported information to identify individual disease risk factors; these participants received individual health-related feedback based on the data they reported; and the data was used to give participants a recommendation or intervention to improve their health. This definition of an HRA tends to include subsequent intervention programs.
Overall, the quality of research on the effects of HRAs was methodologically fair to poor. In particular, the authors found that there was basically insufficient evidence in these studies to conclude that particular components had a clear relationship to improved health outcomes. At best, the research results suggest that use of an HRA may improve intermediate outcomes such as blood pressure or cholesterol levels. Part of this is due to followup periods being too short. Most of the studies were in a workplace setting with people in the employee population, so the results may not be applicable to other populations like Medicare beneficiaries. Part of the message is just that there isn’t adequate research to really understand the value of such a common tool as an HRA, or how important it is for the HRA to be linked to a followup health education or coaching program.