Ritabelle Fernandes1, Chuan C Chinn2, Dongmei Li3, Timothy Halliday4, Timothy B Frankland5, Christina M B Wang2, Zi Wang2, Misha Morioka2, Robin G Arndt6, Rebecca Rude Ozaki2. 1. 1 Department of Geriatric Medicine, John A. Burns School of Medicine, University of Hawai'i at Mānoa, Honolulu, HI, USA. 2. 2 Center on Disability Studies, University of Hawai'i at Mānoa, Honolulu, HI, USA. 3. 3 University of Rochester School of Medicine and Dentistry, Rochester, NY, USA. 4. 4 Department of Economics, University of Hawai'i at Mānoa, Honolulu, HI, USA. 5. 5 Kaiser Permanente, Center for Health Research Hawai'i, Honolulu, HI, USA. 6. 6 Myron B. Thompson School of Social Work, University of Hawai'i at Mānoa, Honolulu, HI, USA.
Abstract
PURPOSE: The Hawaii Patient Reward and Incentives to Support Empowerment (HI-PRAISE) project examined the impact of financial incentives on Medicaid beneficiaries with diabetes. DESIGN: Observational pre-post study and randomized controlled trial (RCT). SETTING:Federally qualified health centers (FQHCs) and Hawaii Kaiser Permanente. PARTICIPANTS: The observational study included 2003 Medicaid beneficiaries with diabetes from FQHCs. The RCT included 320 participants from Kaiser Permanente. INTERVENTION: Participants could earn up to $320/year of financial incentives for a minimum of 1 year. MEASURES: (1) Clinical outcomes of change in hemoglobinA1c (HbA1c), blood pressure, and cholesterol; (2) compliance with American Diabetes Association (ADA) standards of diabetes care; and (3) cost effectiveness. ANALYSIS: Generalized estimating equation models were used to assess differences in clinical outcomes. General linear models were utilized to estimate the medical costs per patient/day. RESULTS: Changes in clinical outcomes in the observational study were statistically significant. Mean HbA1c decreased from 8.56% to 8.24% ( P < .0001) and low-density lipoprotein decreased from 106.17 mg/dL to 98.55 mg/dL ( P < .0001). No significant differences were found between groups in the RCT. Improved ADA compliance was observed. No reduction in total health cost during the project period was demonstrated. CONCLUSION: The HI-PRAISE found no conclusive evidence that financial incentives had beneficial effect on diabetes clinical outcomes or cost saving measures.
RCT Entities:
PURPOSE: The Hawaii Patient Reward and Incentives to Support Empowerment (HI-PRAISE) project examined the impact of financial incentives on Medicaid beneficiaries with diabetes. DESIGN: Observational pre-post study and randomized controlled trial (RCT). SETTING: Federally qualified health centers (FQHCs) and Hawaii Kaiser Permanente. PARTICIPANTS: The observational study included 2003 Medicaid beneficiaries with diabetes from FQHCs. The RCT included 320 participants from Kaiser Permanente. INTERVENTION: Participants could earn up to $320/year of financial incentives for a minimum of 1 year. MEASURES: (1) Clinical outcomes of change in hemoglobin A1c (HbA1c), blood pressure, and cholesterol; (2) compliance with American Diabetes Association (ADA) standards of diabetes care; and (3) cost effectiveness. ANALYSIS: Generalized estimating equation models were used to assess differences in clinical outcomes. General linear models were utilized to estimate the medical costs per patient/day. RESULTS: Changes in clinical outcomes in the observational study were statistically significant. Mean HbA1c decreased from 8.56% to 8.24% ( P < .0001) and low-density lipoprotein decreased from 106.17 mg/dL to 98.55 mg/dL ( P < .0001). No significant differences were found between groups in the RCT. Improved ADA compliance was observed. No reduction in total health cost during the project period was demonstrated. CONCLUSION: The HI-PRAISE found no conclusive evidence that financial incentives had beneficial effect on diabetes clinical outcomes or cost saving measures.
Authors: Leonard E Egede; Jennifer A Campbell; Rebekah J Walker; Aprill Z Dawson; Joni S Williams Journal: BMC Health Serv Res Date: 2021-01-13 Impact factor: 2.655
Authors: Faisal S Malik; Kirsten D Senturia; Cara D Lind; Kristen D Chalmers; Joyce P Yi-Frazier; Seema K Shah; Catherine Pihoker; Davene R Wright Journal: Pediatr Diabetes Date: 2020-01-14 Impact factor: 3.409