Jingsan Zhu

A Randomized Controlled Trial of Financial Incentives for Smoking Cessation

Background: Although 435,000 Americans die each year of tobacco-related illness, only ∼3% of smokers quit each year. Financial incentives have been shown to be effective in modifying behavior within highly structured settings, such as drug treatment programs, but this has not been shown in treating chronic disease in less structured settings. The objective of this study was to determine whether modest financial incentives increase the rate of smoking cessation program enrollment, completion, and quit rates in a outpatient clinical setting. Methods: 179 smokers at the Philadelphia Veterans Affairs Medical Center who reported smoking at least 10 cigarettes per day were randomized into incentive and nonincentive groups. Both groups were offered a free five-class smoking cessation program at the Philadelphia Veterans Affairs Medical Center. The incentive group was also offered

Impact of a Prescription Copayment Increase on Lipid-Lowering Medication Adherence in Veterans

20 for each class attended and

Individual-versus group-based financial incentives for weight loss, A randomized, controlled trial

100 if they quit smoking 30 days post program completion. Self-reported smoking cessation was confirmed with urine cotinine tests. Results: The incentive group had higher rates of program enrollment (43.3% versus 20.2%; P < 0.001) and completion (25.8% versus 12.2%; P = 0.02). Quit rates at 75 days were 16.3% in the incentive group versus 4.6% in the control group (P = 0.01). At 6 months, quit rates in the incentive group were not significantly higher (6.5%) than in the control group (4.6%; P > 0.20). Conclusion: Modest financial incentives are associated with significantly higher rates of smoking cessation program enrollment and completion and short-term quit rates. Future studies should consider including an incentive for longer-term cessation. (Cancer Epidemiol Biomarkers Prev 2006;15(1):12–8)

Effects of Resident Duty Hour Reform on Surgical and Procedural Patient Safety Indicators Among Hospitalized Veterans Health Administration and Medicare Patients

Background— In February 2002, the Department of Veterans Affairs (VA) increased copayments from

Association of the 2011 ACGME Resident Duty Hour Reforms With Mortality and Readmissions Among Hospitalized Medicare Patients

2 to

Framing Financial Incentives to Increase Physical Activity Among Overweight and Obese Adults: A Randomized, Controlled Trial

7 per 30-day drug supply of each medication for many veterans. We examined the impact of the copayment increase on lipid-lowering medication adherence. Methods and Results— This quasiexperimental study used electronic records of 5604 veterans receiving care at the Philadelphia VA Medical Center from November 1999 to April 2004. The all copayment group included veterans subject to copayments for all drugs with no annual cap. Veterans subject to copayments for drugs only if indicated for a non–service-connected condition with an annual cap of

Effect of Financial Incentives to Physicians, Patients, or Both on Lipid Levels: A Randomized Clinical Trial

840 for out-of-pocket costs made up the some copayment group. Veterans who remained copayment exempt formed a natural control group (no copayment group). Patients were identified as adherent if the proportion of days covered with lipid-lowering medications was ≥80%. Patients were identified as having a continuous gap if they had at least 1 continuous episode with no lipid-lowering medications for ≥90 days. A difference-in-difference approach compared changes in lipid-lowering medication adherence during the 24 months before and after copayment increase among veterans subject to the copayment change with those who were not. Adherence declined in all 3 groups after the copayment increase. However, the percentage of patients who were adherent (proportion of days covered ≥80%) declined significantly more in the all copayment (−19.2%) and some copayment (−19.3%) groups relative to the exempt group (−11.9%). The incidence of a continuous gap increased significantly at twice the rate in both copayment groups (all copayment group, 24.6%; some copayment group, 24.1%) as the exempt group (11.7%). Compared with the exempt group, the odds of having a continuous gap in the after relative to the before period were significantly higher in both the all copayment group (odds ratio, 3.04; 95% confidence interval, 2.29 to 4.03) and the some copayment group (odds ratio, 1.85; 95% confidence interval, 1.43 to 2.40). Similar results were seen in subgroups of patients at high risk for coronary heart disease, high medication users, and elderly veterans. Conclusion— The copayment increase adversely affected lipid-lowering medication adherence among veterans, including those at high coronary heart disease risk.

The Role of Behavioral Economic Incentive Design and Demographic Characteristics in Financial Incentive-Based Approaches to Changing Health Behaviors: A Meta-Analysis

BACKGROUND Data on the effectiveness of employer-sponsored financial incentives for employee weight loss are limited. OBJECTIVE To test the effectiveness of 2 financial incentive designs for promoting weight loss among obese employees. DESIGN Randomized, controlled trial. (ClinicalTrials.gov: NCT01208350) SETTING Childrens Hospital of Philadelphia. PARTICIPANTS 105 employees with a body mass index between 30 and 40 kg/m2. INTERVENTION 24 weeks of monthly weigh-ins (control group; n = 35); individual incentive, designed as

Cost of Joint Replacement Using Bundled Payment Models

100 per person per month for meeting or exceeding weight-loss goals (n = 35); and group incentive, designed as

The patient-centered medical home: an evaluation of a single private payer demonstration in New Jersey.

500 per month split among participants within groups of 5 who met or exceeded weight-loss goals (n = 35). MEASUREMENTS Weight loss after 24 weeks (primary outcome) and 36 weeks and changes in behavioral mediators of weight loss (secondary outcomes). RESULTS Group-incentive participants lost more weight than control participants (mean between-group difference, 4.4 kg [95% CI, 2.0 to 6.7 kg]; P < 0.001) and individual-incentive participants (mean between-group difference, 3.2 kg [CI, 0.9 to 5.5 kg]; P = 0.008). Twelve weeks after incentives ended and after adjustment for 3-group comparisons, group-incentive participants maintained greater weight loss than control group participants (mean between-group difference, 2.9 kg [CI, 0.5 to 5.3 kg]; P = 0.016) but not greater than individual-incentive participants (mean between-group difference, 2.7 kg [CI, 0.4 to 5.0 kg]; P = 0.024). LIMITATION Single employer and short follow-up. CONCLUSION A group-based financial incentive was more effective than an individual incentive and monthly weigh-ins at promoting weight loss among obese employees at 24 weeks. PRIMARY FUNDING SOURCE National Institute on Aging.