Financial incentives to promote cardiac rehabilitation participation and adherence among Medicaid patients.
Financial incentives to promote cardiac rehabilitation participation and adherence among Medicaid patients.
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在医疗补助患者中促进心脏康复参与和依从性的经济激励措施。
DOI：
10.1016/j.ypmed.2015.11.032
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发表时间：
2016-11
影响因子：
5.1
通讯作者：
Ades PA
中科院分区：
文献类型：
--
作者：
Gaalema DE;Savage PD;Rengo JL;Cutler AY;Higgins ST;Ades PA
心脏康复（CR）可改善心肌梗死或冠状动脉血运重建后的医疗结局。社会经济地位（SES）较低的患者参与和完成CR的可能性较小。本研究的目的是测试经济激励是否可以增加低SES患者对CR的参与和依从性。有资格参加CR与医疗补助保险覆盖的患者被纳入。患者被放置在一个不断升级的激励计划的财政奖励取决于CR出席。将CR参与与研究前18个月内符合CR条件的101名Medicaid患者的常规护理组进行比较。比较两组的出勤率（参与≥ 1次CR治疗）和依从性（完成36次治疗）。研究于2013-2015年在美国佛蒙特州进行。在13名参与研究并接受激励的患者中，有10名（77%）同意参与。所有10例患者均完成了至少一次CR，显著高于对照组的25/101（25%）（p < 0.001）。两组中至少参加一次CR的患者中，干预组的依从性更高（平均完成31.1次治疗，对照组为13.6次，p < 0.001）。在干预期间，CR完成率也较高，10例干预患者中有8例（80%）完成了所有36个疗程，而25例对照患者中只有2例（8%）完成了所有36个疗程（p < 0.001）。财政激励可能是一种有效的策略，增加CR参与和医疗补助患者之间的依从性。
Cardiac rehabilitation (CR) improves medical outcomes after myocardial infarction or coronary revascularization. Lower socioeconomic status (SES) patients are less likely to participate in and complete CR. The aim of this study was to test whether financial incentives may increase participation and adherence to CR among lower-SES patients. Patients eligible to participate in CR with Medicaid insurance coverage were approached for inclusion. Patients were placed on an escalating incentive schedule of financial incentives contingent upon CR attendance. CR participation was compared to a usual care group of 101 Medicaid patients eligible for CR in the 18 months prior to the study. Attendance (participating in ≥ one CR sessions) and adherence (sessions completed out of 36) were compared between groups. Study conducted in Vermont, USA, 2013–2015. Of 13 patients approached to be in the study and receive incentives, 10 (77%) agreed to participate. All 10 patients completed at least one session of CR, significantly greater than the 25/101 (25%) in the control condition (p < 0.001). Of patients in both groups who attended at least one session of CR, adherence was higher in the intervention group (average of 31.1 sessions completed vs. 13.6 in the control group, p < 0.001). CR completion rates were also higher during the intervention with 8 of 10 (80%) intervention patients completing all 36 sessions compared to only 2 of 25 (8%) control patients (p < 0.001). Financial incentives may be an efficacious strategy for increasing CR participation and adherence among Medicaid patients.