Lessons from the Real World: Financial Incentives to Improve Glycemic Control in Patients with Type 2 Diabetes

作     者：June F. O’Leary Janelle Howe Jeremy Rich Glenn Melnick 

作者机构：Sol Price School of Public Policy University of Southern California Los Angeles CA USA DaVita HealthCare Partners Medical Group El Segundo CA USA HealthCare Partners Institute for Applied Research and Education El Segundo CA USA 

出 版 物：《Health》 (健康（英文）)

年 卷 期：2018年第10卷第2期

页      面：171-180页

学科分类：1002[医学-临床医学] 100214[医学-肿瘤学] 10[医学] 

主　　题：Diabetes Glycemic Control Financial Incentives Behavioral Economics Group Appointments 

摘      要：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 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.