Martin Tobi

Chronic Epstein-Barr Virus Disease: A Workshop Held by the National Institute of Allergy and Infectious Diseases.

Excerpt Recent studies have focused on patients with chronic fatigue accompanied by other nonspecific symptoms and elevated antibody titers to selected Epstein-Barr viral antigens, but without a cl...

Financial incentives for completion of fecal occult blood tests among veterans: a 2-stage, pragmatic, cluster, randomized, controlled trial.

Across the Veterans Health Administration (VHA), the most commonly used colorectal cancer (CRC) screening method is the fecal occult blood test (FOBT) (1). This test reduces mortality from CRC (2, 3) and is cheaper and perhaps more convenient for patients than other CRC screening methods. However, rates of completion of prescribed FOBTs are often low (4, 5) because of poor patient adherence (69), which can delay diagnosis of CRC (10, 11). A promising tool for improving rates of FOBT completion is financial incentives (12, 13), which capitalize on insights from behavioral economics that suggest patients overweight near-term costs and benefits (14). When prescribed FOBTs, patients may forgo completion because the tests confer a certain and immediate disutility in return for the uncertain and distant benefit of early detection of CRC for a few patients who screen positive and no tangible benefit for most patients who screen negative. This overweighting of tangible, short-term costs and benefits might be leveraged to promote FOBT completion by providing an immediate financial reward for this behavior, yet this approach remains untested. The goal of this pilot study was to identify the dose and design of modest financial incentives that could increase rates of initial completion of prescribed FOBTs among VHA primary care patients. We used cluster randomization for practical reasons and to minimize contamination across patients, and we used a pragmatic design (15) to test incentives in a real-world clinical setting. Methods Design Overview We conducted a 2-stage parallel-design, pragmatic cluster randomized, controlled trial in the primary care clinic of the Philadelphia Veterans Affairs Medical Center (PVAMC) between 14 February 2012 and 9 October 2012. The clusters were clinic calendar days. In stage 1, 40 clusters of all 713 patients who were prescribed an FOBT (Figure 1) were assigned to usual care or to receipt of

Isolated gastrointestinal spider nevi: potential clinical significance.

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Abstract 4519: Preliminary data of a stool test for lung cancer from a prospective study

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Abstract 3689: Jak3 mutations in colorectal neoplasia- Preliminary data on a not so silent minority

20 incentives for completing their FOBT within 30 days. In stage 2, 48 clusters of all 836 patients who were prescribed an FOBT (Figure 2) were assigned to usual care or receipt of incentives of

Abstract 3714: Detroit African Americans (AA) are overrepresented among patients with large high-grade dysplastic (HGD) adenomas (LHiGDA) versus those with small HGD adenomas (ShiGDA)

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Su1831 Variation in Association of CRC in Prostate Cancer Patients Destined for Radiation Therapy Across Different Ethnic Groups

50, or entry into a

Delayed Gastric Emptying after Laparoscopic Anterior Highly Selective and Posterior Truncal Vagotomy

500 raffle for completing their FOBT within 30 days. Both stages included a usual care control group to account for temporal variation in FOBT completion. All incentives were disbursed as mailed paper vouchers that could be exchanged for cash at the PVAMC. The institutional review boards of the PVAMC and VA Ann Arbor Healthcare System approved the study. Need for patient consent was waived because the research involved no more than minimal risk and could not have been practicably carried out without the waiver. Figure 1. Study flow diagram: stage 1. FOBT = fecal occult blood test. Figure 2. Study flow diagram: stage 2. FOBT = fecal occult blood test. Setting and Participants The clinic calendar day clusters were eligible for randomization if they occurred during each study period. Because of the waiver of consent, all patients in each cluster who had a new FOBT order were included in the study. After each clinic day we recorded how many FOBT kits were distributed and stopped each stage once we reached our target sample size for each group. Randomization and Interventions The unit of randomization was the clinic calendar day. All patients in a given day were assigned to the same condition to minimize contamination. In each stage the allocation sequence was based on a permuted blocked randomization schedule with a fixed block size of 8 that was generated by a study investigator who had no contact with patients or access to patient data. Before each clinic day, the research coordinator inserted a brightly colored index card with the group assignment into all clinic FOBT kits. For patients randomly assigned to an incentive group, the card described the incentive they would receive if they completed and returned their FOBT within 30 days. For patients randomly assigned to the usual care control group, the card asked patients to complete and return their FOBT within 30 days. All investigators and analysts were blinded to group assignment until all data were collected. The research coordinator could not be blinded to group assignment because she stocked the clinic with study FOBTs before each clinic day and distributed financial incentives after FOBT completion. However, she had no contact with study participants before FOBT completion. Clinic staff and patients could not be blinded because the interventions were integrated into usual care, which entailed clinic staff briefly counseling patients about how to complete their FOBT. In stage 1, clusters of patients were randomly assigned to usual care or to receipt of

Chronic mononucleosis--a legitimate diagnosis.

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Sa1665 - Gp87 Colonic Expression Explains Some Observed Neoplastic Disparities in African Americans

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