Comparative effectiveness of process and outcomes incentives for lipid management

脂质管理过程和结果激励措施的比较有效性

基本信息

  • 批准号:
    8631263
  • 负责人:
  • 金额:
    $ 80.82万
  • 依托单位:
  • 依托单位国家:
    美国
  • 项目类别:
  • 财政年份:
    2014
  • 资助国家:
    美国
  • 起止时间:
    2014-01-15 至 2018-12-31
  • 项目状态:
    已结题

项目摘要

I. PROJECT SUMMARY Cardiovascular disease (CVD) is the leading cause of death in the United States (US) and costs the US healthcare system $500 billion annually. Statins, also known as HMG-CoA reductase inhibitors, have been shown to improve cholesterol and lower mortality from CVD in multiple clinical trials. The majority of patients with CVD or diseases with equivalent cardiovascular risk, such as diabetes, require a statin to achieve the low- density cholesterol (LDL) targets in clinical practice guidelines. Despite the substantial benefits and reasonable risks associated with statins, adherence is strikingly poor with adherence rates often about 50% within the year following a heart attack. Therefore, reducing CVD-related morbidity, mortality and health care costs will depend to a great degree on effective strategies to help patients improve medication adherence. Financial incentives have been shown to be effective at improving patient health behaviors including medication adherence in a wide variety of contexts. The delivery of such incentives has been enhanced by the recent development of new wireless technologies that facilitate the measurement of daily medication adherence and the provision of incentives in an automated fashion. However, the relative effectiveness of incentives based on process (e.g. statin adherence) versus outcome (e.g. improvements in LDL cholesterol) is unknown. The results will grow in policy relevance with the implementation of Section 2705 of the Affordable Care Act in 2014, which allows employers to utilize as much as 30% of premiums (50% if programs include smoking) for outcome-based incentives for metrics like LDL cholesterol. We propose a randomized controlled trial to evaluate the relative effectiveness and cost-effectiveness of improving cholesterol levels among participants who are at high risk of CVD (goal LDL <100 mg/dl) and who have elevated LDL cholesterol levels (>130 mg/dl) by testing process versus outcomes financial incentives. Participants will use electronic pill bottles that continuously monitor statin adherence. The primary outcome will be change in LDL cholesterol over 12 months. LDL cholesterol will be measured again at 18 months, six months after the intervention has ended, to assess the durability of financial incentives on the outcome. The trial will have a 2 x 2 factorial design in which the 624 participants receive either: 1) lottery-based financial incentives for statin adherence -- with participants eligible each day they take their medication correctly ("process" incentive group); 2) financial incentives for lowering LDL cholesterol by >10 mg/dl every 3 months ("outcome" incentive group); 3) a combination of daily lottery incentives and incentives for lowering LDL cholesterol ("process plus outcomes"); or 4) usual care (the "control"). The study will achieve the following Specific Aims: 1) Assess the effectiveness of a process-based incentive on lowering LDL cholesterol; 2) Assess the effectiveness of an outcome-based incentive on lowering LDL cholesterol; 3) Assess the effectiveness of a combined process plus outcomes incentive on lowering LDL cholesterol; 4) Assess the cost-effectiveness of each of the interventions.
I.项目摘要 心血管疾病(CVD)是美国(US)的主要死亡原因, 医疗保健系统每年5000亿美元。他汀类药物,也称为HMG-CoA还原酶抑制剂,已经被 在多项临床试验中显示可改善胆固醇和降低CVD死亡率。大多数患者 心血管疾病或具有同等心血管风险的疾病,如糖尿病,需要他汀类药物来实现低- 密度胆固醇(LDL)的临床实践指南的目标。尽管有大量的好处和合理的 与他汀类药物相关的风险,依从性非常差,一年内的依从率通常约为50 心脏病发作后因此,降低心血管疾病相关的发病率、死亡率和医疗费用将取决于 在很大程度上,有效的策略,以帮助患者提高服药依从性。 经济激励措施已被证明在改善患者健康行为方面是有效的, 在各种情况下的药物依从性。这些激励措施的实施得到了加强, 最近发展的新无线技术,便于测量日常用药 以自动化的方式提供激励。然而,相对有效性 基于过程(例如他汀类药物依从性)与结果(例如LDL胆固醇改善)的激励措施, 未知随着《经济适用法》第2705条的实施,其结果将在政策相关性方面有所增加。 2014年的《护理法案》允许雇主利用高达30%的保费(如果计划包括 吸烟)为结果为基础的激励指标,如低密度脂蛋白胆固醇。 我们建议进行一项随机对照试验,以评估 改善CVD高风险(目标LDL <100 mg/dl)和 LDL胆固醇水平升高(> 130 mg/dl),通过测试过程与结果的财务激励。 参与者将使用电子药瓶,持续监测他汀类药物的依从性。主要成果将 LDL胆固醇的变化超过12个月。LDL胆固醇将在18个月后再次测量, 在干预结束后的几个月,评估财政激励措施对结果的持久性。的 试验将采用2 × 2析因设计,其中624名参与者接受:1)基于彩票的财务 他汀类药物依从性的激励措施-参与者每天都有资格正确服用药物 ("过程"激励组); 2)每3个月降低LDL胆固醇> 10 mg/dl的经济激励 ("结果"激励组); 3)每日抽奖激励和降低LDL激励相结合 胆固醇("过程加结果");或4)常规护理("对照")。 本研究将达到以下具体目的:1)评估以过程为基础的 降低LDL胆固醇的激励措施; 2)评估基于结果的降低LDL胆固醇的激励措施的有效性 LDL胆固醇; 3)评估联合过程加结果激励对降低LDL的有效性 胆固醇; 4)评估每种干预措施的成本效益。

项目成果

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PETER PHILIP REESE其他文献

PETER PHILIP REESE的其他文献

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{{ truncateString('PETER PHILIP REESE', 18)}}的其他基金

Mentored research in solid organ transplantation: outcomes using organs from Hepatitis C virus infected donors for uninfected recipients
实体器官移植的指导研究:使用丙型肝炎病毒感染的捐赠者的器官移植未感染的接受者的结果
  • 批准号:
    9805083
  • 财政年份:
    2019
  • 资助金额:
    $ 80.82万
  • 项目类别:
Mentored research in solid organ transplantation: outcomes using organs from Hepatitis C virus infected donors for uninfected recipients
实体器官移植的指导研究:使用丙型肝炎病毒感染的捐赠者的器官移植未感染的接受者的结果
  • 批准号:
    10202427
  • 财政年份:
    2019
  • 资助金额:
    $ 80.82万
  • 项目类别:
Mentored research in solid organ transplantation: outcomes using organs from Hepatitis C virus infected donors for uninfected recipients
实体器官移植的指导研究:使用丙型肝炎病毒感染的捐赠者的器官移植未感染的接受者的结果
  • 批准号:
    10427258
  • 财政年份:
    2019
  • 资助金额:
    $ 80.82万
  • 项目类别:
Mentored research in solid organ transplantation: outcomes using organs from Hepatitis C virus infected donors for uninfected recipients
实体器官移植的指导研究:使用丙型肝炎病毒感染的捐赠者的器官移植未感染的接受者的结果
  • 批准号:
    10651658
  • 财政年份:
    2019
  • 资助金额:
    $ 80.82万
  • 项目类别:
Waiting List and Kidney Transplant Outcomes for Patients with Hepatitis C Infection
丙型肝炎感染患者的等候名单和肾移植结果
  • 批准号:
    9317642
  • 财政年份:
    2017
  • 资助金额:
    $ 80.82万
  • 项目类别:
Harnessing Behavior to Decrease Urinary Stone Disease Morbidity Research Project
利用行为降低泌尿系结石疾病发病率研究项目
  • 批准号:
    10707893
  • 财政年份:
    2016
  • 资助金额:
    $ 80.82万
  • 项目类别:
Harnessing Behavior to Decrease Urinary Stone Disease Morbidity Research Project
利用行为降低泌尿系结石疾病发病率研究项目
  • 批准号:
    10345287
  • 财政年份:
    2016
  • 资助金额:
    $ 80.82万
  • 项目类别:
Age, functional status, and survival benefit from kidney transplantation
肾移植对年龄、功能状态和生存的益处
  • 批准号:
    8540420
  • 财政年份:
    2011
  • 资助金额:
    $ 80.82万
  • 项目类别:
Age, functional status, and survival benefit from kidney transplantation
肾移植对年龄、功能状态和生存的益处
  • 批准号:
    8727997
  • 财政年份:
    2011
  • 资助金额:
    $ 80.82万
  • 项目类别:
Age, functional status, and survival benefit from kidney transplantation
肾移植对年龄、功能状态和生存的益处
  • 批准号:
    8322802
  • 财政年份:
    2011
  • 资助金额:
    $ 80.82万
  • 项目类别:

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