Fernandes Ritabelle, Chinn Chuan C, Li Dongmei, Frankland Timothy B, Wang Christina Mb, Smith Myra D, Ozaki Rebecca Rude
Associate Professor in the Department of Geriatric Medicine at the University of Hawaii in Honolulu. E mail:
Associate Specialist at the Center on Disability Studies at the University of Hawaii in Honolulu.
Perm J. 2018;22:17-080. doi: 10.7812/TPP/17-080.
The Medicaid Incentives for Prevention of Chronic Diseases program was authorized by the Affordable Care Act to determine the effectiveness of providing financial incentives.
To examine the impact of incentives on adult Medicaid beneficiaries' diabetes self-management using the Hawaii Patient Reward And Incentives to Support Empowerment project.
A randomized controlled trial study was conducted at Kaiser Permanente Hawaii with 320 participants (159 intervention group/161 control group). Participants could earn up to $320/y of financial incentives, distributed in the form of a debit card. Evaluation measures included 1) clinical outcomes of change in hemoglobin A, blood pressure, and cholesterol; 2) compliance with American Diabetes Association standards; 3) cost effectiveness; 4) quality of life; 5) self-management activities; and 6) satisfaction with incentives.
No significant differences in clinical outcomes were found between groups. There were no differences in observance of American Diabetes Association standards of medical care between the intervention and control group. The project also did not show reduction in health cost. However, participants in the intervention group reported significantly higher adherence with the recommended general diet than those in the control group during the course of the study. They also reported statistically better physical health than their control counterparts at the midpoint of the study; however, the perception of increased physical health didn't sustain to the end of the study. Participants' satisfaction with incentives was high.
Overall, this study found no conclusive evidence that financial incentives alone had beneficial effects on improving standards of medical care in diabetes.
《可负担医疗法案》授权了“医疗补助慢性病预防激励计划”，以确定提供经济激励措施的有效性。
利用夏威夷患者奖励与激励支持赋权项目，研究激励措施对成年医疗补助受益人的糖尿病自我管理的影响。
在夏威夷凯撒医疗机构开展了一项随机对照试验研究，有320名参与者（159名干预组/161名对照组）。参与者每年最多可获得320美元的经济激励，以借记卡形式发放。评估指标包括：1）糖化血红蛋白、血压和胆固醇变化的临床结果；2）符合美国糖尿病协会标准的情况；3）成本效益；4）生活质量；5）自我管理活动；6）对激励措施的满意度。
两组之间在临床结果上未发现显著差异。干预组和对照组在遵循美国糖尿病协会医疗护理标准方面没有差异。该项目也未显示出医疗成本的降低。然而，在研究过程中，干预组参与者报告的推荐常规饮食依从性显著高于对照组。在研究中期，他们报告的身体健康状况在统计学上也优于对照组；然而，身体健康状况改善的感觉并未持续到研究结束。参与者对激励措施的满意度很高。
总体而言，本研究没有确凿证据表明，仅经济激励措施对改善糖尿病医疗护理标准有有益影响。
