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），以激励初次初级保健就诊 加入医疗保健保险计划后6个月内。研究对象来自低收入家庭， 在计划下获得覆盖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。我们将提供财政激励措施，鼓励 在入组前6个月内进行初级保健访视，并评估初级保健访视是否改变了随后的 寻求健康的行为，并影响患者的满意度和其他结果，如自我报告的健康 status.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）与那些接受常规护理。患者将在入组时接受访谈 在研究结束时（入组后12个月），他们对激励措施的反馈， 健康状况，以及他们对医疗保健系统的经验。我们也将客观地评估它们的利用情况 通过对医疗索赔的分析所有的假设都测试了50美元和25美元的实验组， 另设对照组。我们的具体目标是： 目标1.在随机对照试验中招募低收入、无保险的成年人，以测试激励措施对访问初级保健的影响 在入组后6个月内对医疗服务提供者（PCP）进行评估，并在研究后12个月内测量医疗服务利用率 招生 H1：实验组中PCP就诊的可能性最高。 H1a：实验组中PCP就诊的时间延迟最短。 H1b：实验组的PCP平均就诊次数较高。 H2：在实验组中，预防性护理的使用率（从HEDIS措施中得出）较高。 H3：实验组总艾德、非急诊艾德、住院和门诊就诊次数较低 组 H4：实验组中使用的药物数量较低。 H5：实验组的医疗保健利用总成本会更低。 H6：实验组将更有可能重新参加弗吉尼亚州协调护理计划。 目标二。在随机化前和研究完成时进行半结构化访谈，以定性探索 激励的效果。 H1：实验组对医疗服务的满意度会更高。 H2：实验组的自我报告健康状况会更高。 H3：激励措施将是实验组患者寻求初级保健的主要动力。

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.