A Randomized Trial of Behavioral Economic Interventions to Reduce CVD Risk

降低 CVD 风险的行为经济干预措施的随机试验

• 批准号: 8060346
• 负责人: DAVID A ASCH
• 金额: $ 1248.88万
• 依托单位: UNIVERSITY OF PENNSYLVANIA
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-09-30 至 2014-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8060346
• 关键词: Accounting; Address; Adherence; Ambulatory Care Facilities; American; Architecture; Behavior; Behavioral; Cardiovascular Diseases; Caring; Cause of Death; Chronic Disease; Clinical; Clinical Trials; Data; Disease Outcome; Economics; Effectiveness; Enrollment; Evaluation; Feedback; Health; Health behavior; Health system; Healthcare; Incentives; Intervention; LDL Cholesterol Lipoproteins; Lipids; Low-Density Lipoproteins; Modification; Nurse Practitioners; Outcome; Patients; Pennsylvania; Performance; Physicians; Population; Primary Care Physician; Process; Process Measure; Provider; Psychology; Randomized; Randomized Controlled Trials; Relative (related person); Risk Management; Savings; Services; Techniques; Testing; United States; Universities; Validation; abstracting; arm; base; cardiovascular disorder risk; cardiovascular risk factor; cholesterol control; comparative effectiveness; compare effectiveness; compliance behavior; cost; cost effectiveness; effective intervention; effectiveness research; financial incentive; high risk; improved; novel strategies; payment; randomized trial; success; system architecture; treatment as usual; uptake

DESCRIPTION (provided by applicant): Cardiovascular disease (CVD) is the leading cause of death in the United States. Despite strong evidence that reducing low-density lipoproteins (LDL) with statins successfully lowers CVD risk, physicians under-prescribe statins, physicians fail to intensify treatment when indicated, and more than 50% of patients stop taking statins within one year of first prescription though such therapy typically should be lifelong. In this study, we will test the effectiveness of different behavioral economic interventions in increasing statin use and reducing LDL cholesterol among patients with poor cholesterol control who are at very high risk for CVD. The application of conceptual approaches from behavioral economics offers considerable promise in advancing health and health care. Pay for performance initiatives represent one such potential application but one in which incorporating the underlying psychology of decision makers has not generally been done, and experimental tests have not been conducted. We will test these approaches among primary care physicians and their patients at very high risk of CVD at Geisinger Health System and University of Pennsylvania outpatient clinics. Using a 6-arm, cluster-randomized controlled trial, we aim to answer these questions: [1] How does the provision of provider incentives compare to the provision of patient incentives, to a combination of patient and provider incentives, or to no incentives at all? [2] Is success with provider incentives improved with enhanced information about patient adherence? [3] How does the provision of financial incentives compare to an alternative clinical approach in which lipid management defaults to a nurse practitioner rather than physician? [4] Are results sustained after incentives and other interventions are withdrawn? [5] How do these approaches compare in implementation, acceptability, cost, and cost-effectiveness? PUBLIC HEALTH RELEVANCE: Comparative effectiveness research (CER) has identified many approaches to reduce cardiovascular risk. However, the uptake of practices known to be successful is significantly lower than what is needed to optimize the health of the American population. This project proposes to test a novel strategy - financial incentives - to improve uptake of CER findings among physicians and patients to reduce cardiovascular risk.

描述（由申请人提供）：心血管疾病（CVD）是美国死亡的主要原因。尽管有强有力的证据表明，用他汀类药物降低低密度脂蛋白（LDL）可以成功降低心血管疾病的风险，但医生对他汀类药物的处方不足，医生在指征时未能加强治疗，超过50%的患者在首次处方后一年内停止服用他汀类药物，尽管这种治疗通常应该是终身的。在这项研究中，我们将测试不同的行为经济干预在增加他汀类药物使用和降低LDL胆固醇方面的有效性，这些患者的胆固醇控制不佳，心血管疾病的风险很高。

项目成果

Framing Social Comparison Feedback With Financial Incentives for Physical Activity Promotion: A Randomized Trial.

用经济激励来促进体育活动的社会比较反馈：随机试验。

• DOI: 10.1123/jpah.2019-0313
• 发表时间: 2020
• 期刊: Journal of physical activity & health
• 影响因子: 3.1
• 作者: Patel,MiteshS;Asch,DavidA;Rosin,Roy;Small,DylanS;Bellamy,ScarlettL;Hoffer,Karen;Shuttleworth,David;Hilbert,Victoria;Zhu,Jingsan;Yang,Lin;Wang,Xingmei;Volpp,KevinG
• 通讯作者: Volpp,KevinG

Financial Incentives and Cholesterol Levels--Reply.

经济激励和胆固醇水平——答复。

• DOI: 10.1001/jama.2016.0315
• 发表时间: 2016
• 期刊: JAMA
• 作者: Troxel,AndreaB;Asch,DavidA;Volpp,KevinG
• 通讯作者: Volpp,KevinG