Financial Incentives to Improve Patient Follow-Up and Weight Loss After Bariatric Surgery.

Abstract

OBJECTIVE\nTo examine effects of a financial incentives program on follow-up and weight loss after bariatric surgery.\n\n\nSUMMARY BACKGROUND DATA\nConsistent follow-up may improve weight loss and other health outcomes after bariatric surgery. Yet, rates of follow-up after surgery are often low.\n\n\nMETHODS\nPatients from 3 practices within a statewide collaborative were invited to participate in a 6-month financial incentives program. Participants received incentives for attending post-operative appointments at 1, 3, and 6\u200amonths which doubled when participants weighed less than their prior visit. Participants were matched with contemporary patients from control practices by demographics, starting BMI and weight, surgery date, and procedure. Pre-intervention estimates used matched historic patients from the same program and control practices with the criteria listed above. Patients between the two historic groups were additionally matched on surgery date to ensure balance on matched variables. We conducted difference-in-differences analyses to examine incentives program effects. Follow-up attendance and percent excess weight loss were measured post-operative months 1, 3, 6 and 12.\n\n\nRESULTS\n110 program participants from January 1, 2018 to July 31, 2019 were matched to 203 historic program practice patients (November 20 to December 27, 2017). The control group had 273 pre-intervention patients and 327 post-intervention patients. In difference-in-differences analyses, the intervention increased follow-up rates at 1\u200amonth (+14.8%, P<.0001), 3\u200amonths (+29.4%, P<.0001), and 6\u200amonths (+16.4%, P<.0001), but not at 12\u200amonths. There were no statistically significant differences in excess weight loss.\n\n\nCONCLUSIONS\nA financial incentives program significantly increased follow-up after bariatric surgery for up to 6\u200amonths, but did not increase weight loss. Our study supports use of incentivized approaches as one way to improve post-operative follow-up, but may not translate into greater weight loss without additional supports.