Author + information
- Received October 18, 2018
- Revision received November 25, 2018
- Accepted December 9, 2018
- Published online June 24, 2019.
- Diann E. Gaalema, PhDa,b,∗ (, )@vtcenterbh,
- Rebecca J. Elliott, BAa,
- Patrick D. Savage, MSc,
- Jason L. Rengo, MSc,
- Alex Y. Cutler, BSa,
- Irene Pericot-Valverde, PhDa,
- Jeffrey S. Priest, PhDd,
- Donald S. Shepard, PhDe,
- Stephen T. Higgins, PhDa,b and
- Philip A. Ades, MDc
- aDepartment of Psychiatry, University of Vermont, Burlington, Vermont
- bDepartment of Psychology, University of Vermont, Burlington, Vermont
- cDivision of Cardiology, University of Vermont Medical Center, Burlington, Vermont
- dDepartment of Medical Biostatistics, University of Vermont, Burlington, Vermont
- eHeller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts
- ↵∗Address for correspondence:
Dr. Diann E. Gaalema, Department of Psychiatry, University of Vermont, 1 South Prospect Street, OH3 UHC MS 482, Burlington, Vermont 05405.
Objectives This study sought to examine the efficacy of financial incentives to increase Medicaid patient participation in and completion of cardiac rehabilitation (CR).
Background Participation in CR reduces morbidity, mortality, and hospitalizations while improving quality of life. Lower-socioeconomic status (SES) patients are much less likely to attend and complete CR, despite being at increased risk for recurrent cardiovascular events.
Methods A total of 130 individuals enrolled in Medicaid with a CR-qualifying cardiac event were randomized 1:1 to receive financial incentives on an escalating schedule ($4 to $50) for completing CR sessions or to receive usual care. Primary outcomes were CR participation (number of sessions completed) and completion (≥30 sessions completed). Secondary outcomes included changes in sociocognitive measurements (depressive/anxious symptoms, executive function), body composition (waist circumference, body mass index), fitness (peak VO2) over 4 months, and combined number of hospitalizations and emergency department (ED) contacts over 1 year.
Results Patients randomized to the incentive condition completed more sessions (22.4 vs. 14.7, respectively; p = 0.013) and were almost twice as likely to complete CR (55.4% vs. 29.2%, respectively; p = 0.002) as controls. Incentivized patients were also more likely to experience improvements in executive function (p < 0.001), although there were no significant effects on other secondary outcomes. Patients who completed ≥30 sessions had 47% fewer combined hospitalizations and ED visits (p = 0.014), as reflected by a nonsignificant trend by study condition with 39% fewer hospital contacts in the incentive condition group (p = 0.079).
Conclusions Financial incentives improve CR participation among lower-SES patients following a cardiac event. Increasing participation among lower-SES patients in CR is critical for positive longer-term health outcomes. (Increasing Cardiac Rehabilitation Participation Among Medicaid Enrollees; NCT02172820)
Supported by U.S. National Institutes of Health Center of Biomedical Research Excellence award P20GM103644 from the National Institute of General Medical Sciences. The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received October 18, 2018.
- Revision received November 25, 2018.
- Accepted December 9, 2018.
- 2019 American College of Cardiology Foundation
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