Incentives to Encourage Primary Care Use: A Randomized Controlled Trial in a Safe

鼓励初级保健使用的激励措施：安全环境中的随机对照试验

• 批准号: 8612264
• 负责人: Cathy J Bradley
• 金额: $ 94.33万
• 依托单位: VIRGINIA COMMONWEALTH UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-09-30 至 2015-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8612264
• 关键词: Incentives; Encourage; Primary; Care; Use

Project Summary We propose to implement a randomized controlled trial (RCT) of incentives for an initial primary care visit within 6 months of enrollment in a health care coverage program. Study subjects are drawn from a low-income adult population that gains coverage and access to community-based primary care services under a program administered by an academic safety-net hospital. We will offer financial incentives to encourage an initial primary care visit within 6 months of enrollment and evaluate whether the primary care visit altered subsequent health seeking behavior and influenced patient satisfaction and other outcomes such as self-reported health status. Using a mixed methods approach, we will compare outcomes among patients who receive one of two levels of incentives ($25, $50) versus those who receive usual care. Patients will be interviewed at enrollment and at the end of the study (12 months following their enrollment) for their feedback on the incentives, their health status, and their experience with the health care system. We will also objectively assess their utilization through the analysis of medical claims. All hypotheses test the $50 and $25 experimental groups against each other and the control group. Our specific aims are to: Aim 1. Enroll low-income, uninsured adults in an RCT to test the impact of incentives on visiting a primary care provider (PCP) within 6 months of enrollment and to measure health care utilization 12 months following study enrollment. H1: The likelihood of a PCP visit is highest in the experimental groups. H1a: Time delay to a PCP visit is shortest in the experimental groups. H1b: The average number of PCP visits is higher in the experimental groups. H2: The use of preventive care (drawing from HEDIS measures) is higher in the experimental groups. H3: The number of total ED, non-emergent ED, inpatient and outpatient visits is lower in the experimental groups. H4: The number of pharmaceuticals used is lower in the experimental groups. H5: Total cost of health care utilization will be lower in the experimental groups. H6: The experimental groups will be more likely to re-enroll in the Virginia Coordinated Care program. Aim 2. Administer semi-structured interviews at pre-randomization and study completion to qualitatively explore the effects of incentives. H1: Satisfaction with health care services will be higher in the experimental groups. H2: Self-reported health status will be higher in the experimental groups. H3: Incentives will be the primary motivator for patients in the experimental groups to seek primary care.

项目概要 我们建议对初次初级保健就诊的激励措施实施随机对照试验 (RCT) 加入医疗保险计划后 6 个月内。研究对象来自低收入群体 根据一项计划获得覆盖并获得基于社区的初级保健服务的成年人口 由学术安全网医院管理。我们将提供财政激励措施以鼓励初步 入组后 6 个月内进行初级保健就诊，并评估初级保健就诊是否改变了随后的情况 寻求健康行为并影响患者满意度和其他结果，例如自我报告的健康状况 地位。使用混合方法，我们将比较接受以下两种治疗之一的患者的结果 与接受常规护理的人相比，激励水平（25 美元、50 美元）。患者将在入组时接受采访 在研究结束时（入学后 12 个月），了解他们对激励措施的反馈， 健康状况以及他们对医疗保健系统的体验。我们也会客观评估他们的利用率 通过对医疗索赔的分析。所有假设均针对 50 美元和 25 美元的实验组进行检验 其他和对照组。我们的具体目标是： 目标 1. 让低收入、未参保的成年人参加随机对照试验，以测试激励措施对就诊初级保健的影响 注册后 6 个月内提供者 (PCP) 并在研究后 12 个月内衡量医疗保健利用率 注册。 H1：实验组中 PCP 就诊的可能性最高。 H1a：实验组中 PCP 就诊的时间延迟最短。 H1b：实验组的平均就诊 PCP 次数较高。 H2：实验组中预防性护理的使用（来自 HEDIS 措施）较高。 H3：实验中急诊总次数、非急诊急诊次数、住院和门诊就诊次数较低 组。 H4：实验组中使用的药物数量较少。 H5：实验组的医疗保健利用总成本会较低。 H6：实验组更有可能重新加入弗吉尼亚协调护理计划。 目标 2. 在预随机化和研究完成时进行半结构化访谈，以定性探索 激励措施的效果。 H1：实验组对医疗保健服务的满意度会更高。 H2：实验组的自我报告健康状况会更高。 H3：激励措施将是实验组患者寻求初级保健的主要动力。