Financial Incentives for Home-Based Health Monitoring: A Randomized Controlled Trial

ABSTRACT

BACKGROUND

Home wireless device monitoring could play an important role in improving the health of patients with poorly controlled chronic diseases, but daily engagement rates among these patients may be low.

OBJECTIVE

To test the effectiveness of two different magnitudes of financial incentives for improving adherence to remote-monitoring regimens among patients with poorly controlled diabetes.

DESIGN

Randomized, controlled trial. (Clinicaltrials.gov Identifier: NCT01282957).

PARTICIPANTS

Seventy-five patients with a hemoglobin A1c greater than or equal to 7.5 % recruited from a Primary Care Medical Home practice at the University of Pennsylvania Health System.

INTERVENTIONS

Twelve weeks of daily home-monitoring of blood glucose, blood pressure, and weight (control group; n = 28); a lottery incentive with expected daily value of $2.80 (n = 26) for daily monitoring; and a lottery incentive with expected daily value of $1.40 (n = 21) for daily monitoring.

MAIN MEASURES

Daily use of three home-monitoring devices during the three-month intervention (primary outcome) and during the three-month follow-up period and change in A1c over the intervention period (secondary outcomes).

KEY RESULTS

Incentive arm participants used devices on a higher proportion of days relative to control (81 % low incentive vs. 58 %, P = 0.007; 77 % high incentive vs. 58 %, P = 0.02) during the three-month intervention period. There was no difference in adherence between the two incentive arms (P = 0.58). When incentives were removed, adherence in the high incentive arm declined while remaining relatively high in the low incentive arm. In month 6, the low incentive arm had an adherence rate of 62 % compared to 35 % in the high incentive arm (P = 0.015) and 27 % in the control group (P = 0.002).

CONCLUSIONS

A daily lottery incentive worth $1.40 per day improved monitoring rates relative to control and had significantly better efficacy once incentives were removed than a higher incentive.

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Acknowledgements

Contributors

We thank Paula Gray, MSN, CRNP and Amanda Parent, MSN, CRNP for their participation in and support of this study.

Funders

This work was supported by grants RC2AG036592 and P30AG034546 from the National Institute on Aging.

Prior presentations

We presented an earlier version of this paper on a research panel at AcademyHealth’s 2013 Annual Research Meeting in Baltimore, MD in June, 2013.

Conflict of Interest

The authors declare that they do not have a conflict of interest. Drs. Asch, Loewenstein, and Volpp have served as consultants for VAL Health, and Drs. Loewenstein and Volpp have served as consultants for CVS Caremark. Dr. Volpp has also received research funding from Weight Watchers, CVS Caremark, Humana, Horizon BCBS, and McKinsey, none of which is directly related to the subject of this study. Dr. Loewenstein has also received research funding from CVS Caremark and Humana. The other authors (Sen, Sewell, Riley, Stearman, Bellamy, Hu, Park, Tao, and Zhu) have no financial disclosures or other conflicts of interest to report.

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Correspondence to Aditi P. Sen MA.

Additional information

Clinicaltrials.gov Identifier: NCT01282957.

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Sen, A.P., Sewell, T.B., Riley, E.B. et al. Financial Incentives for Home-Based Health Monitoring: A Randomized Controlled Trial. J GEN INTERN MED 29, 770–777 (2014). https://doi.org/10.1007/s11606-014-2778-0

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KEY WORDS

  • chronic disease
  • health information technology
  • health behavior
  • disease management
  • adherence