Background Financial incentive designs to increase physical activity have not been well-examined. Objective To test the effectiveness of 3 methods to frame financial incentives to increase physical activity among overweight and obese adults. Design Randomized, controlled trial. (ClinicalTrials.gov: NCT 02030119) Setting University of Pennsylvania. Participants 281 adult employees (body mass index ≥27 kg/m2). Intervention 13-week intervention. Participants had a goal of 7000 steps per day and were randomly assigned to a control group with daily feedback or 1 of 3 financial incentive programs with daily feedback: a gain incentive ($1.40 given each day the goal was achieved), lottery incentive (daily eligibility [expected value approximately $1.40] if goal was achieved), or loss incentive ($42 allocated monthly upfront and $1.40 removed each day the goal was not achieved). Participants were followed for another 13 weeks with daily performance feedback but no incentives. Measurements Primary outcome was the mean proportion of participant-days that the 7000-step goal was achieved during the intervention. Secondary outcomes included the mean proportion of participant-days achieving the goal during follow-up and the mean daily steps during intervention and follow-up. Results The mean proportion of participant-days achieving the goal was 0.30 (95% CI, 0.22 to 0.37) in the control group, 0.35 (CI, 0.28 to 0.42) in the gain-incentive group, 0.36 (CI, 0.29 to 0.43) in the lottery-incentive group, and 0.45 (CI, 0.38 to 0.52) in the loss-incentive group. In adjusted analyses, only the loss-incentive group had a significantly greater mean proportion of participant-days achieving the goal than control (adjusted difference, 0.16 [CI, 0.06 to 0.26]; P = 0.001), but the adjusted difference in mean daily steps was not significant (861 [CI, 24 to 1746]; P = 0.056). During follow-up, daily steps decreased for all incentive groups and were not different from control. Limitation Single employer. Conclusion Financial incentives framed as a loss were most effective for achieving physical activity goals. Primary Funding Source National Institute on Aging.

Objective The incidence and incidence over time of cardiac arrest in hospitalized patients (IHCA) is unknown. We sought to estimate the event rate and temporal trends of adult inhospital cardiac arrest (IHCA) treated with a resuscitation response. Design Three approaches were used to estimate the IHCA event rate. First approach: Calculate the IHCA event rate at hospitals (n=433) in the Get With The Guidelines-Resuscitation (GWTG-R) registry, years 2003–2007 and multiply this by US annual bed-days. Second approach: Use the GWTG-R, IHCA event rate to develop a regression model (including hospital demographic, geographic, organizational factors) and use the model coefficients to calculate predicted event rates for acute care hospitals (n=5,445) responding to the American Hospital Association survey. Third approach: Classify acute care hospitals into groups based on academic, urban, bed size-and determine the average event rate for GWTG-R hospitals in each group and then use weighted averages to calculate the national IHCA rate. Annual event rates were calculated to estimate temporal trends. Setting GWTG-R registry Patients Adult IHCA with a resuscitation response Measurements and main results The mean adult treated IHCA event rate at GWTG-R hospitals was 0.92/1000 bed-days (IQR 0.58 to 1.2/1000). In hospitals (n=150) contributing data for all years of the study period, the event rate increased from 2003–2007. With 2.09 million annual US bed-days, we estimated 192,000 IHCA throughout the US annually. Based on the regression model, extrapolating GWTG-R hospitals to hospitals participating in the American Hospital Association survey projected 211,000 annual IHCA. Using weighted averages projected 209,000 annual US IHCA. Conclusions There are approximately 200,000 treated cardiac arrests among US hospitalized patients annually and this rate may be increasing. This is important for understanding the burden of IHCA and developing strategies to improve care for hospitalized patients.