Financial Incentives to Promote Cardiac Rehabilitation Participation and Adherence Among Medicaid Patients

Overview

Journal Prev Med

Specialty Public Health

Date 2016 Feb 20

PMID 26892911

Citations 24

Authors

Diann E Gaalema

Patrick D Savage

Jason L Rengo

Alexander Y Cutler

Stephen T Higgins

Philip A Ades

Affiliations

Soon will be listed here.

Abstract

Purpose: Cardiac rehabilitation (CR) improves medical outcomes after myocardial infarction or coronary revascularization. Lower socioeconomic status (SES) patients are less likely to participate in and complete CR. The aim of this study was to test whether financial incentives may increase participation and adherence to CR among lower-SES patients.

Methods: Patients eligible to participate in CR with Medicaid insurance coverage were approached for inclusion. Patients were placed on an escalating incentive schedule of financial incentives contingent upon CR attendance. CR participation was compared to a usual care group of 101 Medicaid patients eligible for CR in the 18months prior to the study. Attendance (participating in ≥one CR sessions) and adherence (sessions completed out of 36) were compared between groups. The study was conducted in Vermont, USA, 2013-2015.

Results: Of 13 patients approached to be in the study and receive incentives, 10 (77%) agreed to participate. All 10 patients completed at least one session of CR, significantly greater than the 25/101 (25%) in the control condition (p<0.001). Of patients in both groups who attended at least one session of CR, adherence was higher in the intervention group (average of 31.1 sessions completed vs. 13.6 in the control group, p<0.001). CR completion rates were also higher during the intervention with 8 of 10 (80%) intervention patients completing all 36 sessions compared to only 2 of 25 (8%) control patients (p<0.001).

Conclusions: Financial incentives may be an efficacious strategy for increasing CR participation and adherence among Medicaid patients.

Citing Articles

Lower-Socioeconomic Status Patients Have Extremely High-Risk Factor Profiles on Entry to Cardiac Rehabilitation.

Khadanga S, Savage P, Ades P, Yant B, Anair B, Kromer L J Cardiopulm Rehabil Prev. 2023; 44(1):26-32.

PMID: 37820180 PMC: 10843557. DOI: 10.1097/HCR.0000000000000826.

Encouraging adherence in adolescents with asthma using financial incentives: An RCT.

De Keyser H, Brinton J, Bothwell S, Camacho M, Kempe A, Szefler S Pediatr Pulmonol. 2023; 58(10):2823-2831.

PMID: 37449768 PMC: 10538420. DOI: 10.1002/ppul.26594.

Self-Reported Executive Function in Hospitalized Cardiac Patients and Associations With Patient Characteristics and Cardiac Rehabilitation Attendance.

Katz B, Khadanga S, Middleton W, Mahoney K, Savage P, DeSarno M J Cardiopulm Rehabil Prev. 2023; 43(6):433-437.

PMID: 36857090 PMC: 10474250. DOI: 10.1097/HCR.0000000000000785.

A New Era in Cardiac Rehabilitation Delivery: Research Gaps, Questions, Strategies, and Priorities.

Beatty A, Beckie T, Dodson J, Goldstein C, Hughes J, Kraus W Circulation. 2023; 147(3):254-266.

PMID: 36649394 PMC: 9988237. DOI: 10.1161/CIRCULATIONAHA.122.061046.

Improving cardiac rehabilitation patient adherence via personalized interventions.

Aharon K, Gershfeld-Litvin A, Amir O, Nabutovsky I, Klempfner R PLoS One. 2022; 17(8):e0273815.

PMID: 36037232 PMC: 9423647. DOI: 10.1371/journal.pone.0273815.

References

Lawler P, Filion K, Eisenberg M . Efficacy of exercise-based cardiac rehabilitation post-myocardial infarction: a systematic review and meta-analysis of randomized controlled trials. Am Heart J. 2011; 162(4):571-584.e2. DOI: 10.1016/j.ahj.2011.07.017. View

Savage P, Antkowiak M, Ades P . Failure to improve cardiopulmonary fitness in cardiac rehabilitation. J Cardiopulm Rehabil Prev. 2009; 29(5):284-91. DOI: 10.1097/HCR.0b013e3181b4c8bd. View

Suaya J, Shepard D, Normand S, Ades P, Prottas J, Stason W . Use of cardiac rehabilitation by Medicare beneficiaries after myocardial infarction or coronary bypass surgery. Circulation. 2007; 116(15):1653-62. DOI: 10.1161/CIRCULATIONAHA.107.701466. View

Kind A, Jencks S, Brock J, Yu M, Bartels C, Ehlenbach W . Neighborhood socioeconomic disadvantage and 30-day rehospitalization: a retrospective cohort study. Ann Intern Med. 2014; 161(11):765-74. PMC: 4251560. DOI: 10.7326/M13-2946. View

Govil S, Weidner G, Merritt-Worden T, Ornish D . Socioeconomic status and improvements in lifestyle, coronary risk factors, and quality of life: the Multisite Cardiac Lifestyle Intervention Program. Am J Public Health. 2008; 99(7):1263-70. PMC: 2696652. DOI: 10.2105/AJPH.2007.132852. View

Roll J, Higgins S . A within-subject comparison of three different schedules of reinforcement of drug abstinence using cigarette smoking as an exemplar. Drug Alcohol Depend. 2000; 58(1-2):103-9. DOI: 10.1016/s0376-8716(99)00073-3. View

Daly J, Sindone A, Thompson D, Hancock K, Chang E, Davidson P . Barriers to participation in and adherence to cardiac rehabilitation programs: a critical literature review. Prog Cardiovasc Nurs. 2002; 17(1):8-17. DOI: 10.1111/j.0889-7204.2002.00614.x. View

Wenger N . Current status of cardiac rehabilitation. J Am Coll Cardiol. 2008; 51(17):1619-31. DOI: 10.1016/j.jacc.2008.01.030. View

Pack Q, Johnson L, Barr L, Daniels S, Wolter A, Squires R . Improving cardiac rehabilitation attendance and completion through quality improvement activities and a motivational program. J Cardiopulm Rehabil Prev. 2013; 33(3):153-9. PMC: 4760105. DOI: 10.1097/HCR.0b013e31828db386. View

10.

Albert M, Glynn R, Buring J, Ridker P . Impact of traditional and novel risk factors on the relationship between socioeconomic status and incident cardiovascular events. Circulation. 2006; 114(24):2619-26. DOI: 10.1161/CIRCULATIONAHA.106.660043. View

11.

Karmali K, Davies P, Taylor F, Beswick A, Martin N, Ebrahim S . Promoting patient uptake and adherence in cardiac rehabilitation. Cochrane Database Syst Rev. 2014; (6):CD007131. DOI: 10.1002/14651858.CD007131.pub3. View

12.

Lussier J, Heil S, Mongeon J, Badger G, Higgins S . A meta-analysis of voucher-based reinforcement therapy for substance use disorders. Addiction. 2006; 101(2):192-203. DOI: 10.1111/j.1360-0443.2006.01311.x. View

13.

Meredith S, Jarvis B, Raiff B, Rojewski A, Kurti A, Cassidy R . The ABCs of incentive-based treatment in health care: a behavior analytic framework to inform research and practice. Psychol Res Behav Manag. 2014; 7:103-14. PMC: 3964160. DOI: 10.2147/PRBM.S59792. View

14.

Harlan 3rd W, SANDLER S, Lee K, Lam L, Mark D . Importance of baseline functional and socioeconomic factors for participation in cardiac rehabilitation. Am J Cardiol. 1995; 76(1):36-9. DOI: 10.1016/s0002-9149(99)80797-8. View

15.

Neubeck L, Freedman S, Clark A, Briffa T, Bauman A, Redfern J . Participating in cardiac rehabilitation: a systematic review and meta-synthesis of qualitative data. Eur J Prev Cardiol. 2012; 19(3):494-503. DOI: 10.1177/1741826711409326. View

16.

Oberg E, Fitzpatrick A, Lafferty W, LoGerfo J . Secondary prevention of myocardial infarction with nonpharmacologic strategies in a Medicaid cohort. Prev Chronic Dis. 2009; 6(2):A52. PMC: 2687858. View

17.

Lumley J, Chamberlain C, Dowswell T, Oliver S, Oakley L, Watson L . Interventions for promoting smoking cessation during pregnancy. Cochrane Database Syst Rev. 2009; (3):CD001055. PMC: 4090746. DOI: 10.1002/14651858.CD001055.pub3. View

18.

Alter D, Chong A, Austin P, Mustard C, Iron K, Williams J . Socioeconomic status and mortality after acute myocardial infarction. Ann Intern Med. 2006; 144(2):82-93. DOI: 10.7326/0003-4819-144-2-200601170-00005. View

19.

Bernheim S, Spertus J, Reid K, Bradley E, Desai R, Peterson E . Socioeconomic disparities in outcomes after acute myocardial infarction. Am Heart J. 2007; 153(2):313-9. DOI: 10.1016/j.ahj.2006.10.037. View

20.

Alter D, Franklin B, Ko D, Austin P, Lee D, Oh P . Socioeconomic status, functional recovery, and long-term mortality among patients surviving acute myocardial infarction. PLoS One. 2013; 8(6):e65130. PMC: 3670842. DOI: 10.1371/journal.pone.0065130. View