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.

项目摘要 我们建议实施一项随机对照试验（RCT）的初步初级保健访问 在入学卫生保险计划的6个月内。研究对象来自低收入 根据计划获得覆盖范围并获得基于社区的初级保健服务的成年人口 由一家学术安全网医院管理。我们将提供经济激励措施，以鼓励初始 入学后6个月内访问初级保健，并评估初级保健访问是否随后发生了变化 健康寻求行为并影响患者满意度和其他结果，例如自我报告的健康 地位。使用混合方法方法，我们将比较接受两个接受的患者的结果 与接受常规护理的激励措施相比，激励措施（25美元，50美元）。患者将在入学率上接受采访 在研究结束时（入学后12个月），他们对激励措施的反馈 健康状况以及他们在医疗保健系统方面的经验。我们还将客观地评估他们的利用 通过分析医疗主张。所有假设都测试了50美元和25美元的实验组 其他和对照组。我们的具体目的是： AIM 1。招募低收入，未保险的成年人参加RCT，以测试激励措施对初级保健的影响 提供者（PCP）在入学后的6个月内，并在研究后12个月衡量医疗保健利用 注册。 H1：PCP访问的可能性在实验组中最高。 H1A：在实验组中，PCP访问的时间延迟最短。 H1B：实验组的PCP访问的平均数量较高。 H2：在实验组中，使用预防保健（从HEDIS测量中绘制）较高。 H3：实验中的ED，非发射器ED，住院和门诊就诊的数量较低 组。 H4：实验组中使用的药物的数量较低。 H5：实验组的医疗保健利用率总成本将较低。 H6：实验组将更有可能重新获得弗吉尼亚州协调的护理计划。 AIM 2。在随机化和研究完成时进行半结构化访谈以定性探索 激励措施的影响。 H1：在实验组中，对医疗服务的满意度将更高。 H2：在实验组中，自我报告的健康状况将更高。 H3：激励措施将是实验组患者寻求初级保健的主要动机。