Financial incentives for home-based health monitoring: a randomized controlled trial

Abstract

Background: Home 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.

Objective: To test the effectiveness of two different magnitudes of financial incentives for improving adherence to remote-monitoring regimens among patients with poorly controlled diabetes.

Design: Randomized, controlled trial. (Clinicaltrials.gov Identifier: NCT01282957).

Participants: Seventy-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.

Interventions: Twelve 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 measures: Daily 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 results: Incentive 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).

Conclusions: A 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.

Figure 1

Study flow diagram.

Figure 2

Monthly adherence rate (all device use) by arm. Error bars indicate 95 % CIs.

Figure 3

Weekly “no device use” rate by arm. “No-use rate” shows the percentage of participants not using any devices in a given week.

Figure 4

Box Plot of A1c changes from baseline to end of intervention period. Plots show mean change (and associated 95 % CIs) in A1c level between enrollment and the end of the intervention period by arm.