Financial Incentives for Home-Based Health Monitoring: A Randomized Controlled Trial

ABSTRACTBACKGROUNDHome wireless device monitoring could play an important role in improving the health of patients with poorly controlled chronic diseases, but daily engagement rates among these patients may be low.OBJECTIVETo test the effectiveness of two different magnitudes of financial incentives for improving adherence to remote-monitoring regimens among patients with poorly controlled diabetes.DESIGNRandomized, controlled trial. (Clinicaltrials.gov Identifier: NCT01282957).PARTICIPANTSSeventy-five patients with a hemoglobin A1c greater than or equal to 7.5 % recruited from a Primary Care Medical Home practice at the University of Pennsylvania Health System.INTERVENTIONSTwelve weeks of daily home-monitoring of blood glucose, blood pressure, and weight (control group; n = 28); a lottery incentive with expected daily value of $2.80 (n = 26) for daily monitoring; and a lottery incentive with expected daily value of $1.40 (n = 21) for daily monitoring.MAIN MEASURESDaily use of three home-monitoring devices during the three-month intervention (primary outcome) and during the three-month follow-up period and change in A1c over the intervention period (secondary outcomes).KEY RESULTSIncentive arm participants used devices on a higher proportion of days relative to control (81 % low incentive vs. 58 %, P = 0.007; 77 % high incentive vs. 58 %, P = 0.02) during the three-month intervention period. There was no difference in adherence between the two incentive arms (P = 0.58). When incentives were removed, adherence in the high incentive arm declined while remaining relatively high in the low incentive arm. In month 6, the low incentive arm had an adherence rate of 62 % compared to 35 % in the high incentive arm (P = 0.015) and 27 % in the control group (P = 0.002).CONCLUSIONSA daily lottery incentive worth $1.40 per day improved monitoring rates relative to control and had significantly better efficacy once incentives were removed than a higher incentive.

[1]  D. Asch,et al.  On the Way to Health. , 2012, LDI issue brief.

[2]  E. Deci,et al.  A meta-analytic review of experiments examining the effects of extrinsic rewards on intrinsic motivation. , 1999, Psychological bulletin.

[3]  Sally Wells,et al.  Compliance and effectiveness of 1 year's home telemonitoring. The report of a pilot study of patients with chronic heart failure , 2001, European journal of heart failure.

[4]  D. Asch,et al.  Automated hovering in health care--watching over the 5000 hours. , 2012, The New England journal of medicine.

[5]  H. Ward,et al.  Predictive Validity of a Medication Adherence Measure in an Outpatient Setting , 2008, Journal of clinical hypertension.

[6]  R. Nisbett,et al.  Undermining children's intrinsic interest with extrinsic reward: A test of the "overjustification" hypothesis. , 1973 .

[7]  G. Chapman,et al.  Emotions and preventive health behavior: worry, regret, and influenza vaccination. , 2006, Health psychology : official journal of the Division of Health Psychology, American Psychological Association.

[8]  G. Mertes,et al.  Meal-related structured self-monitoring of blood glucose: effect on diabetes control in non-insulin-treated type 2 diabetic patients. , 2002, Diabetes care.

[9]  K Y Liang,et al.  Longitudinal data analysis for discrete and continuous outcomes. , 1986, Biometrics.

[10]  Mark Speechley,et al.  Health Technologies for Monitoring and Managing Diabetes: A Systematic Review , 2009, Journal of diabetes science and technology.

[11]  John Gibson,et al.  Eight Questions About Brain Drain , 2011, SSRN Electronic Journal.

[12]  Leslie K. John,et al.  Financial Incentives for Extended Weight Loss: A Randomized, Controlled Trial , 2011, Journal of General Internal Medicine.

[13]  A. Tversky,et al.  Prospect theory: analysis of decision under risk , 1979 .

[14]  U. Gneezy,et al.  Journal of Economic Perspectives—Volume 25, Number 4—Fall 2011—Pages 191–210 When and Why Incentives (Don’t) Work to Modify Behavior , 2022 .

[15]  R. Eisenberger,et al.  Detrimental effects of reward. Reality or myth? , 1996, The American psychologist.

[16]  Terence Connolly,et al.  Regret in economic and psychological theories of choice , 2006 .

[17]  Edward L. Deci,et al.  Intrinsic Motivation and Self-Determination in Human Behavior , 1975, Perspectives in Social Psychology.

[18]  Kevin G Volpp,et al.  A test of financial incentives to improve warfarin adherence , 2008, BMC health services research.

[19]  S. Zeger,et al.  Longitudinal data analysis using generalized linear models , 1986 .

[20]  Kevin G Volpp,et al.  Financial incentive-based approaches for weight loss: a randomized trial. , 2008, JAMA.

[21]  Jingsan Zhu,et al.  Individual- Versus Group-Based Financial Incentives for Weight Loss , 2013, Annals of Internal Medicine.

[22]  C. Brensinger,et al.  Randomized trial of lottery-based incentives to improve warfarin adherence. , 2012, American heart journal.

[23]  A. Tversky,et al.  Prospect theory: an analysis of decision under risk — Source link , 2007 .

[24]  M. Davidson,et al.  The effect of self monitoring of blood glucose concentrations on glycated hemoglobin levels in diabetic patients not taking insulin: a blinded, randomized trial. , 2005, The American journal of medicine.

[25]  M. Walsh,et al.  Randomized trial of a daily electronic home monitoring system in patients with advanced heart failure: the Weight Monitoring in Heart Failure (WHARF) trial. , 2003, American heart journal.

[26]  Marcel Zeelenberg,et al.  Consequences of regret aversion in real life : The case of the Dutch postcode lottery , 2004 .