Incentives to Encourage Primary Care Use: A Randomized Controlled Trial in a Safe

项目摘要 我们建议实施一项随机对照试验(RCT)，以激励最初的初级保健就诊 在参加医疗保险计划后的6个月内。研究对象来自低收入家庭 根据一项方案获得覆盖范围和获得社区初级保健服务的成年人口 由学术安全网医院管理。我们将提供财政奖励，鼓励最初的 在登记后6个月内进行初级保健访问，并评估初级保健访问是否改变了随后的访问 求医行为和影响患者满意度和其他结果，如自我报告的健康 状态。使用混合方法，我们将比较接受两种方法之一的患者的结果。 奖励水平(25美元，50美元)与那些接受普通护理的人相比。患者将在登记时接受采访 在研究结束时(注册后12个月)，为了获得他们对激励措施的反馈，他们的 健康状况，以及他们在医疗保健系统中的经历。我们也会客观地评估它们的使用情况。 通过对医疗索赔的分析。所有假设都对50美元和25美元的试验组进行了对比测试 其他组和对照组。我们的具体目标是： 目标1.让低收入、未参保的成年人参加随机对照试验，以测试激励措施对初级保健的影响 在注册后6个月内提供(PCP)，并在研究结束后12个月衡量医疗保健利用情况 招生。 H1：在试验组中，PCP访问的可能性最高。 H1a：实验组到PCP就诊的时间延迟最短。 H1B：试验组PCP平均就诊次数较高。 H2：实验组的预防性护理(借鉴HEDIS措施)的使用率较高。 H3：试验组急诊总例数、非急诊急诊例数、住院和门诊例数均较低 组。 H4：实验组使用的药物数量较少。 H5：试验组的医疗服务利用总成本较低。 H6：试验组将更有可能重新参加弗吉尼亚州协调护理计划。 目标2.在随机化前和研究完成时进行半结构化访谈，以定性地探索 激励措施的效果。 H1：试验组对医疗服务的满意度更高。 H2：试验组的自我报告健康状况会更高。 H3：激励措施将是试验组患者寻求初级保健的主要动机。

Project Summary We propose to implement a randomized controlled trial (RCT) of incentives for an initial primary care visit within 6 months of enrollment in a health care coverage program. Study subjects are drawn from a low-income adult population that gains coverage and access to community-based primary care services under a program administered by an academic safety-net hospital. We will offer financial incentives to encourage an initial primary care visit within 6 months of enrollment and evaluate whether the primary care visit altered subsequent health seeking behavior and influenced patient satisfaction and other outcomes such as self-reported health status. Using a mixed methods approach, we will compare outcomes among patients who receive one of two levels of incentives ($25, $50) versus those who receive usual care. Patients will be interviewed at enrollment and at the end of the study (12 months following their enrollment) for their feedback on the incentives, their health status, and their experience with the health care system. We will also objectively assess their utilization through the analysis of medical claims. All hypotheses test the $50 and $25 experimental groups against each other and the control group. Our specific aims are to: Aim 1. Enroll low-income, uninsured adults in an RCT to test the impact of incentives on visiting a primary care provider (PCP) within 6 months of enrollment and to measure health care utilization 12 months following study enrollment. H1: The likelihood of a PCP visit is highest in the experimental groups. H1a: Time delay to a PCP visit is shortest in the experimental groups. H1b: The average number of PCP visits is higher in the experimental groups. H2: The use of preventive care (drawing from HEDIS measures) is higher in the experimental groups. H3: The number of total ED, non-emergent ED, inpatient and outpatient visits is lower in the experimental groups. H4: The number of pharmaceuticals used is lower in the experimental groups. H5: Total cost of health care utilization will be lower in the experimental groups. H6: The experimental groups will be more likely to re-enroll in the Virginia Coordinated Care program. Aim 2. Administer semi-structured interviews at pre-randomization and study completion to qualitatively explore the effects of incentives. H1: Satisfaction with health care services will be higher in the experimental groups. H2: Self-reported health status will be higher in the experimental groups. H3: Incentives will be the primary motivator for patients in the experimental groups to seek primary care.