Healthy Measures

Test effectiveness of two different magnitudes of financial incentives for improving adherence to remote-monitoring regimens among patients with diabetes.

Aditi P. Sen, PhD
Investigator
George Loewenstein, PhD
Investigator

Background and Aim

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

Intervention and Design

Study looked at 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 Outcomes and 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).

Way to Health Use

  • Study Enrollment: Enroll and randomize participants across the study arms

  • Behavioral Economics: Lottery-based incentives if adherent

  • Device Integration: Collect data from the devices of patients

Findings and Conclusions

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).

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.

Publications


Financial Incentives for Home-Based Health Monitoring: A Randomized Controlled Trial Stages of Change and Patient Activation Measure Scores in the Context of Incentive-Based Health Interventions