The impact of financial incentives on utilization and outcomes of diabetes prevention programs among Medicaid managed care adults in New York state
The impact of financial incentives on utilization and outcomes of diabetes prevention programs among Medicaid managed care adults in New York state
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DOI：
10.1016/j.cct.2020.105960
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发表时间：
2020-04-01
影响因子：
2.2
通讯作者：
Roohan, Patrick
中科院分区：
文献类型：
--
作者：
Chin, Jo-Yu;Matson, Jacqueline;Roohan, Patrick
糖尿病患病率迅速上升，已成为全球健康挑战。糖尿病预防计划(DPP)已被证明可以预防或延缓糖尿病前期患者的糖尿病发展。然而，医疗补助人群中的糖尿病预防研究有限，结果喜忧参半。本研究旨在评估不同财务激励策略对纽约州医疗补助管理保健成人对DPP利用的影响。本研究对患有糖尿病前期和/或肥胖的医疗补助管理保健成年人进行了四臂随机对照试验。研究参与者被提供了为期16周的DPP，其中包含基于课堂出勤率和减肥的各种激励策略，如下所示：仅出席，仅减肥，以及同时出席和减肥。对照组给予DPP，没有参加或减肥的奖励。我们评估了奖励对计划完成和减肥里程碑的影响。接受仅参加课程奖励的参与者最不可能失去后续行动，更有可能完成计划，与对照组相比，达到减肥里程碑的百分比高出两倍。其他激励队列的结果好坏参半。参加9次或以上课程的参与者，不论采用何种激励策略，都与减肥有很强的正相关关系。为DPP课程的出勤率提供金钱奖励对项目的完成和实现减肥里程碑有积极的影响。然而，这项研究的结果表明，尽管有激励措施，参与者的登记和留住仍然是挑战。
Diabetes prevalence has risen rapidly and has become a global health challenge. The Diabetes Prevention Program (DPP) has been shown to prevent or delay the development of diabetes among individuals with prediabetes. Yet, diabetes prevention studies within the Medicaid population are limited and results are mixed. This study aimed to evaluate the impact of different financial incentive strategies on the utilization of the DPP for Medicaid managed care adults in New York State.A four-arm randomized controlled trial was conducted among Medicaid managed care adult enrollees diagnosed with prediabetes and/or obesity. Study participants were offered a 16-week DPP with various incentive strategies based on class attendance and weight loss as follows: Attendance-Only, Weight-Loss Only, and both Attendance and Weight-Loss. A control group was offered DPP with no incentives for attendance or weight loss. We evaluated the impact of incentives on achievement of the program completion and weight-loss milestone.Participants who received incentives for the Attendance-Only class were least likely to be lost to follow-up, more likely to complete the program, and had two times higher percentage of meeting the weight-loss milestone compared to the control group. Results for the other incentive cohorts were mixed. A strong positive association was observed for participants who attended 9 or more classes and weight-loss regardless of incentive strategies.Providing monetary incentives for DPP class attendance had a positive impact on program completion and achieving the weight-loss milestone. However, the results from this study indicate that participant enrollment and retention remained challenges despite the incentives.