A randomized trial of mailed outreach with behavioral economic interventions to improve liver cancer surveillance.
A randomized trial of mailed outreach with behavioral economic interventions to improve liver cancer surveillance.
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DOI：
10.1097/hc9.0000000000000349
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发表时间：
2024-01-01
影响因子：
5.1
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中科院分区：
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肝硬化患者的HCC监测率仍然有限。我们评估了选择退出邮件外展是否在有或没有20美元无条件激励的情况下增加了吸收。这是一项在城市学术卫生系统中进行的实用随机对照试验，纳入了肝硬化或晚期纤维化成人患者，在过去2年中至少有1次专科就诊，并且在过去7个月内没有监测。患者以1：2：2的比例随机分配到（1）常规护理，（2）邮寄一封带有超声签名订单的信件，或（3）邮寄一封带有订单和20美元无条件奖励的信件。主要结局是6个月内完成超声检查的比例。在纳入的562例患者中，平均年龄为62.1岁（SD 11.1）; 56.8%为男性，51.1%有医疗保险，40.6%为黑人。6个月时，27.6%（95% CI：19.5-35.7）在泌尿系护理组中完成超声检查，54.5% Letter + Order组（95% CI：47.9-61.0）和54.1%（95% CI：47.5-60.6）。与家庭护理相比，信函+订单组的患者数量显著增加（绝对差异为26.9%; 95%CI：16.5-37.3; p<0.001），但与信函+订单相比，信函+订单+激励组没有显著增加（绝对差异为-0.4; 95%CI：-9.7至8.8; p=0.93）。通过邮寄外展、选择退出框架和签署订单单，HCC监测有所增加，但对财务激励的反应没有增加。
Surveillance rates for HCC remain limited in patients with cirrhosis. We evaluated whether opt-out mailed outreach increased uptake with or without a $20 unconditional incentive. This was a pragmatic randomized controlled trial in an urban academic health system including adult patients with cirrhosis or advanced fibrosis, at least 1 visit to a specialty practice in the past 2 years and no surveillance in the last 7 months. Patients were randomized in a 1:2:2 ratio to (1) usual care, (2) a mailed letter with a signed order for an ultrasound, or (3) a mailed letter with an order and a $20 unconditional incentive. The main outcome was the proportion with completion of ultrasound within 6 months. Among the 562 patients included, the mean age was 62.1 (SD 11.1); 56.8% were male, 51.1% had Medicare, and 40.6% were Black. At 6 months, 27.6% (95% CI: 19.5–35.7) completed ultrasound in the Usual care arm, 54.5% (95% CI: 47.9–61.0) in the Letter + Order arm, and 54.1% (95% CI: 47.5–60.6) in the Letter + Order + Incentive arm. There was a significant increase in the Letter + Order arm compared to Usual care (absolute difference of 26.9%; 95% CI: 16.5–37.3; p<0.001), but no significant increase in the Letter + Order + Incentive arm compared to Letter + Order (absolute difference of −0.4; 95% CI: −9.7 to 8.8; p=0.93). There was an increase in HCC surveillance from mailed outreach with opt-out framing and a signed order slip, but no increase in response to the financial incentive.