Financial incentive strategies for smoking cessation in high-risk, hospitalized patients.

高危住院患者戒烟的经济激励策略。

基本信息

批准号：
10089430
负责人：
Joseph Abiodun Ladapo
金额：
$ 67.15万
依托单位：
UNIVERSITY OF CALIFORNIA LOS ANGELES
依托单位国家：
美国
项目类别：
财政年份：
2019
资助国家：
美国
起止时间：
2019-02-15 至 2023-12-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10089430
关键词：
Achievement Address Ambulatory Care Biochemical Cerebrovascular Disorders Chronic Chronic Disease Contracts Coronary heart disease Data Decision Making Documentation Economics Effectiveness Evidence based treatment Goals Government Agencies Habits Health Health behavior Healthcare Systems Hospitals Incentives Individual Insurance Carriers Investments Knowledge Life Malignant Neoplasms Outcome Patients Pharmaceutical Preparations Population Privatization Pulmonary Emphysema Quality of life Randomized Randomized Controlled Trials Relapse Science Smoker Smoking Smoking Cessation Intervention Structure Testing Tobacco use arm base cigarette smoking cost cost effectiveness cost estimate cost-effectiveness ratio design evidence base experience financial incentive high risk incentive program incentive strategies innovation nicotine replacement preference programs quitline randomized trial smoking abstinence smoking cessation treatment as usual

项目摘要

Abstract Financial incentives for motivating changes in health behavior, particularly for smoking and other morbid habits, are increasingly being tested by health insurers, employers, and government agencies. However, a key unanswered question regarding smoking cessation is how to structure these incentive programs to maximize their (1) effectiveness; (2) acceptability to patients, underscored by the fact that programs that use “commitment” contracts requiring individuals to invest their own money upfront are effective, but unpopular; and (3) economic sustainability, as defined by their return on investment—a major factor in public and private decision-making. Hospitalized smokers represent an important population to target for effective smoking cessation interventions because they are typically hospitalized for conditions related to tobacco use, experience a disproportionate burden of serious smoking-related illnesses—including coronary heart disease, cerebrovascular disease, emphysema, and cancer—have high rates of relapse to cigarette use after discharge, and impose $110 billion in costs on the healthcare system annually. They are high-risk for all of these reasons. Drs. Joseph Ladapo and Scott Sherman, the UCLA and NYU PIs of this proposal, are currently testing financial incentives in the first pilot randomized trial of incentives in hospitalized smokers (NCT02506829), and preliminary data show they are effective in helping smokers quit (6-month biochemically confirmed smoking cessation rate is 27% in incentive group vs. 9% in controls, P=0.02). We are near study completion. However, our pilot does not address the important question of whether goal-directed incentives (incentives weighted toward use of evidence-based therapies) or outcome-based incentives (incentives for successful achievement of an outcome, like successfully quitting) are more effective for promoting smoking cessation, and prior studies of smoking cessation incentives have emphasized only the latter. We propose a three-arm randomized controlled trial that will address this important knowledge gap among high-risk, hospitalized smokers, with implications for other serious chronic health conditions, and for smokers in ambulatory care settings. Comparing goal-directed incentives to outcome-based incentives and usual care, we will assess their impact on sustained smoking abstinence, use of evidenced-based therapy, and quality of life, and evaluate their short-term and long-term return on investment.

抽象的激励健康行为变化的经济激励措施，尤其是吸烟和其他病态习惯，越来越多地受到健康保险公司，雇员和政府机构的考验。但是，一个钥匙关于戒烟的未解决问题是如何构建这些激励计划以最大化他们（1）有效性；（2）对患者的可接受性，并强调了使用的程序要求个人预先投资自己的钱的“承诺”合同有效，但不受欢迎；（3）经济可持续性，由其投资回报率定义，这是公共和私人的主要因素决策。住院的吸烟者代表着针对有效戒烟干预措施的重要人群因为它们通常在与烟草使用有关的情况下住院，所以经历不成比例的严重吸烟有关的疾病的负担 - 包括冠状动脉疾病，脑血管疾病，肺气肿和癌症 - 出院后的香烟退休率很高，并施加了1,100亿美元每年的医疗保健系统成本。由于所有这些原因，它们都是高风险的。博士。约瑟夫·拉达波（Joseph Ladapo）和加州大学洛杉矶分校和纽约大学PIS的斯科特·谢尔曼目前正在测试第一个经济激励措施预科吸烟者中激励措施的试验随机试验（NCT02506829）和初步数据显示它们有效地帮助吸烟者退出（6个月的生化确认的戒烟率为27％激励组为对照组的9％，p = 0.02）。我们即将完成学习。但是，我们的飞行员没有解决目标指导激励措施是否加权的重要问题基于证据的疗法）或基于结果的激励措施（成功实现结果的激励措施，像成功的安静一样）更有效地促进戒烟和先前的吸烟研究停止激励措施仅强调了后者。我们提出了一个三臂随机对照试验，该试验将解决这一重要知识差距高风险，住院的吸烟者，对其他严重的慢性健康状况有影响，对吸烟者有影响在门诊护理环境中。将目标指导的激励措施与基于结果的激励措施和通常的护理进行比较，我们将评估它们对持续戒烟的影响，使用基于证据的治疗以及质量生活，并评估他们的短期和长期投资回报。