9.0% if ≥ 65 years) were randomized to 1) no DGA, 2) DGA with no financial incentives (non-incentive DGA) or 3) DGA with financial incentives (incentive DGA). Results: Nine sites among four regions of the greater Los Angeles area participated. Each site offered one non-incentive DGA and one incentive DGA. Over 1500 patients were identified for recruitment and at the peak of enrollment, 299 patients were enrolled in 18 DGAs. On average, hemoglobin A1c values dropped more for patients participating in the incentive DGA (9.9% to 8.7%, -1.2%) versus non-incentive DGA (9.7% to 9.0%, -0.7%) versus no DGA group (9.1% to 8.7%, -0.4%). Several unexpected implementation challenges arose which complicated evaluation but provide important learning lessons. Conclusions: Management of chronic diseases like diabetes is challenging for patients and the primary care system alike. Continuing to implement and evaluate programs under “real-world” conditions can provide further insight into how best to support patients with diabetes and their primary care teams in order to achieve glycemic control and avoid preventable complications." /> 9.0% if ≥ 65 years) were randomized to 1) no DGA, 2) DGA with no financial incentives (non-incentive DGA) or 3) DGA with financial incentives (incentive DGA). Results: Nine sites among four regions of the greater Los Angeles area participated. Each site offered one non-incentive DGA and one incentive DGA. Over 1500 patients were identified for recruitment and at the peak of enrollment, 299 patients were enrolled in 18 DGAs. On average, hemoglobin A1c values dropped more for patients participating in the incentive DGA (9.9% to 8.7%, -1.2%) versus non-incentive DGA (9.7% to 9.0%, -0.7%) versus no DGA group (9.1% to 8.7%, -0.4%). Several unexpected implementation challenges arose which complicated evaluation but provide important learning lessons. Conclusions: Management of chronic diseases like diabetes is challenging for patients and the primary care system alike. Continuing to implement and evaluate programs under “real-world” conditions can provide further insight into how best to support patients with diabetes and their primary care teams in order to achieve glycemic control and avoid preventable complications." /> Lessons from the Real World: Financial Incentives to Improve Glycemic Control in Patients with Type 2 Diabetes
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 Health  Vol.10 No.2 , February 2018
Lessons from the Real World: Financial Incentives to Improve Glycemic Control in Patients with Type 2 Diabetes
Abstract: Objectives: While the value of glycemic control to minimize adverse health outcomes among patients with diabetes is clear, achieving hemoglobin A1c (A1c) goals remain a challenge. We evaluated the use of financial incentives to increase enrollment and improve glycemic control among patients invited to participate in a monthly diabetes group appointment (DGA) as part of their enrollment in DaVita HealthCare Partners, a large southern California managed care organization. Methods: Adult diabetes patients (≥18 years) with a currently uncontrolled hemoglobin A1c level (>8.0% if <65 years="" and="">9.0% if ≥ 65 years) were randomized to 1) no DGA, 2) DGA with no financial incentives (non-incentive DGA) or 3) DGA with financial incentives (incentive DGA). Results: Nine sites among four regions of the greater Los Angeles area participated. Each site offered one non-incentive DGA and one incentive DGA. Over 1500 patients were identified for recruitment and at the peak of enrollment, 299 patients were enrolled in 18 DGAs. On average, hemoglobin A1c values dropped more for patients participating in the incentive DGA (9.9% to 8.7%, -1.2%) versus non-incentive DGA (9.7% to 9.0%, -0.7%) versus no DGA group (9.1% to 8.7%, -0.4%). Several unexpected implementation challenges arose which complicated evaluation but provide important learning lessons. Conclusions: Management of chronic diseases like diabetes is challenging for patients and the primary care system alike. Continuing to implement and evaluate programs under “real-world” conditions can provide further insight into how best to support patients with diabetes and their primary care teams in order to achieve glycemic control and avoid preventable complications.
Cite this paper: O’Leary, J. , Howe, J. , Rich, J. and Melnick, G. (2018) Lessons from the Real World: Financial Incentives to Improve Glycemic Control in Patients with Type 2 Diabetes. Health, 10, 171-180. doi: 10.4236/health.2018.102014.
References

[1]   Centers for Disease Control and Prevention (2017) National Diabetes Statistics Report, 2017. 1-20.

[2]   Babey, S.H., et al. (2016) Prediabetes in California: Nearly Half of California Adults on Path to Diabetes. Policy Brief UCLA Cent Health Policy Res, PB2016-1, 1-8.

[3]   American Diabetes Association (2017) Standards of Medical Care in Diabetes—2017. Diabetes Care, 40, S1-S142.

[4]   Beck, J., et al. (2017) National Standards for Diabetes Self-Management Education and Support. Diabetes Care, 40, 1409-1419.
https://doi.org/10.2337/dci17-0025

[5]   Burke, R.E. and O’Grady, E.T. (2012) Group Visits Hold Great Potential for Improving Diabetes Care and Outcomes, But Best Practices Must Be Developed. Health Affairs (Millwood), 31, 103-109.
https://doi.org/10.1377/hlthaff.2011.0913

[6]   Kirsh, S., Watts, S., Pascuzzi, K., O’Day, M.E., Davidson, D., Strauss, G., Kern, E.O. and Aron, D.C. (2007) Shared Medical Appointments Based on the Chronic Care Model: A Quality Improvement Project to Address the Challenges of Patients with Diabetes with High Cardiovascular Risk. BMJ Quality & Safety, 16, 349-353.
https://doi.org/10.1136/qshc.2006.019158

[7]   Stults, C.D., et al. (2016) Shared Medical Appointments: A Promising Innovation to Improve Patient Engagement and Ease the Primary Care Provider Shortage. Population Health Management, 19, 11-16.
https://doi.org/10.1089/pop.2015.0008

[8]   Lorincz, I.S., Lawson, B.C. and Long, J.A. (2013) Provider and Patient Directed Financial Incentives to Improve Care and Outcomes for Patients with Diabetes. Current Diabetes Reports, 13, 188-195.
https://doi.org/10.1007/s11892-012-0353-9

[9]   Kullgren, J.T., Hafez, D., Fedewa, A. and Heisler, M. (2017) A Scoping Review of Behavioral Economic Interventions for Prevention and Treatment of Type 2 Diabetes Mellitus. Current Diabetes Reports, 17, 73.
https://doi.org/10.1007/s11892-017-0894-z

[10]   Long, J.A., et al. (2012) Peer Mentoring and Financial Incentives to Improve Glucose Control in African American Veterans: A Randomized Trial. Annals of Internal Medicine, 156, 416-424.
https://doi.org/10.7326/0003-4819-156-6-201203200-00004

[11]   Misra-Hebert, A.D., Hu, B., Taksler, G., Zimmerman, R. and Rothberg, M.B. (2016) Financial Incentives and Diabetes Disease Control in Employees: A Retrospective Cohort Analysis. Journal of General Internal Medicine, 31, 871-877.
https://doi.org/10.1007/s11606-016-3686-2

[12]   McCuistion, M.H., Stults Cheryl, D., Dohan, D., Frosch Dominick, L., Hung Dorothy, Y. and Tai-Seale, M. (2014) Overcoming Challenges to Adoption of Shared Medical Appointments. Population Health Management, 17, 100-105.
https://doi.org/10.1089/pop.2013.0035

[13]   Farina, K. (2013) Can Financial Incentives Improve Self-Management Behaviors? American Journal of Managed Care, 19, E8.

[14]   Kroenke, K., Spitzer, R.L. and Williams, J.B. (2001) The PHQ-9: Validity of a Brief Depression Severity Measure. Journal of General Internal Medicine, 16, 606-613.
https://doi.org/10.1046/j.1525-1497.2001.016009606.x

[15]   Blondon, K., Klasnja, P., Coleman, K. and Pratt, W. (2014) An Exploration of Attitudes toward the Use of Patient Incentives to Support Diabetes Self-Management. Psychology & Health, 29, 552-563.
https://doi.org/10.1080/08870446.2013.867346

[16]   Ferguson, M.O., et al. (2015) Low Health Literacy Predicts Misperceptions of Diabetes Control in Patients with Persistently Elevated A1C. The Diabetes Educator, 41, 309-319.
https://doi.org/10.1177/0145721715572446

 
 
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