A Randomized Controlled Trial of Financial Incentives for Medicaid Beneficiaries with Diabetes

Fernandes, Ritabelle; Chinn, Chuan C; Li, Dongmei; Frankland, Timothy B.; Wang, Christina Mb; Smith, Myra D; Ozaki, Rebecca Rude

doi:10.7812/tpp/17-080

Cited by 11 publications

(21 citation statements)

References 21 publications

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“…The authors of 34 studies that included adults over a wider age range were contacted, and five replied with study information. The majority of studies (123) were published after 2012 . Five studies were conducted in Europe , five in North America , two in Australia and one in the Western Pacific region .…”

Section: Resultsmentioning

confidence: 99%

“…The majority of studies (123) were published after 2012 . Five studies were conducted in Europe , five in North America , two in Australia and one in the Western Pacific region . Most studies were conducted in type 1 diabetes (eight studies) , three studies included both type 1 and 2 diabetes , and two studies included only type 2 diabetes .…”

Section: Resultsmentioning

confidence: 99%

“…Five studies were conducted in Europe , five in North America , two in Australia and one in the Western Pacific region . Most studies were conducted in type 1 diabetes (eight studies) , three studies included both type 1 and 2 diabetes , and two studies included only type 2 diabetes . Ten studies were conducted in tertiary diabetes clinics , two in the community and one in primary care .…”

Section: Resultsmentioning

confidence: 99%

“…). Random sequence generation was assessed as high risk of bias in four studies using subgroup data . Detection bias was assessed as high risk of bias in one study that used self‐reported insulin injection frequency as the primary outcome .…”

Section: Resultsmentioning

confidence: 99%

“…The majority of interventions were delivered individually (10 interventions) and three were carried out in groups or were mixed . Communication methods were varied, with five interventions using in‐person communication , three using mobile health technology and five using telemedicine . Each intervention employed one to five behavioural change techniques from 12 different domains (Table ).…”

Section: Resultsmentioning

confidence: 99%

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Effectiveness of self‐management interventions in young adults with type 1 and 2 diabetes: a systematic review and meta‐analysis

Wong

Smith²,

Chua³

et al. 2019

Diabet. Med.

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Aim Diabetes in young adulthood has been associated with poor outcomes. Self-management is fundamental to good diabetes care, and self-management interventions have been found to improve outcomes in older adults. We performed a systematic review and meta-analysis to assess the effectiveness of self-management interventions in young adults (aged 15-39 years) with type 1 or type 2 diabetes.Methods We searched five databases and two clinical trial registries from 2003 to February 2019, without language restrictions. We included randomized controlled trials (RCTs) comparing the effectiveness of self-management interventions with usual care or enhanced usual care in young adults. Outcomes of interest included clinical outcomes, psychological health, self-care behaviours, diabetes knowledge and self-efficacy. Pairwise meta-analysis was conducted using a random effects model and quality of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) criteria. We followed Cochrane gold standard systematic review methodology and reported this systematic review according to PRISMA guidelines. The protocol was registered with PROSEPRO (CRD42018110868). ResultsIn total, 13 studies (1002 participants) were included. Meta-analysis showed no difference between selfmanagement interventions and controls in post-intervention HbA 1c levels, BMI, depression, diabetes-related distress, overall self-care, diabetes knowledge and self-efficacy. Quality of evidence ranged from very low to moderate due to study limitations, inconsistency and imprecision.Conclusions Current self-management interventions did not improve outcomes in young adults with diabetes. Our findings, which contrast with those from systematic reviews in older adults, highlight the need for the development of more effective interventions for young adults with diabetes. Diabet. Med. 37, 229-241 (2020) Self-management is a cornerstone of diabetes care. Yet, many have difficulties accomplishing the complex regimen of self-care behaviours, including healthy eating, regular exercise, taking medications as prescribed, managing negative emotions and making regular clinic visits [8]. Additionally, up to 18% of young adults with type 1 diabetes and 30% with type 2 experience moderate to severe depressive symptoms [9], highlighting the need for self-management interventions to facilitate healthy behaviours and achieve optimal diabetes outcomes, while supporting psychological well-being. Self-management interventions form a diverse group, and differ in their method of delivery, mode of communication and intensity [10]. Self-management interventions also incorporate a variety of behavioural change techniques for self-care. The BCT Taxonomy v1

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 3 more Smart Citations

Effectiveness of self‐management interventions in young adults with type 1 and 2 diabetes: a systematic review and meta‐analysis

Wong

Smith²,

Chua³

et al. 2019

Diabet. Med.

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Quality improvement strategies for diabetes care: Effects on outcomes for adults living with diabetes

Yogasingam

Konnyu

Lépine

et al. 2023

Cochrane Database of Systematic Reviews

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Background There is a large body of evidence evaluating quality improvement (QI) programmes to improve care for adults living with diabetes. These programmes are often comprised of multiple QI strategies, which may be implemented in various combinations. Decision‐makers planning to implement or evaluate a new QI programme, or both, need reliable evidence on the relative effectiveness of different QI strategies (individually and in combination) for different patient populations. Objectives To update existing systematic reviews of diabetes QI programmes and apply novel meta‐analytical techniques to estimate the effectiveness of QI strategies (individually and in combination) on diabetes quality of care. Search methods We searched databases (CENTRAL, MEDLINE, Embase and CINAHL) and trials registers (ClinicalTrials.gov and WHO ICTRP) to 4 June 2019. We conducted a top‐up search to 23 September 2021; we screened these search results and 42 studies meeting our eligibility criteria are available in the awaiting classification section. Selection criteria We included randomised trials that assessed a QI programme to improve care in outpatient settings for people living with diabetes. QI programmes needed to evaluate at least one system‐ or provider‐targeted QI strategy alone or in combination with a patient‐targeted strategy. ‐ System‐targeted: case management (CM); team changes (TC); electronic patient registry (EPR); facilitated relay of clinical information (FR); continuous quality improvement (CQI). ‐ Provider‐targeted: audit and feedback (AF); clinician education (CE); clinician reminders (CR); financial incentives (FI). ‐ Patient‐targeted: patient education (PE); promotion of self‐management (PSM); patient reminders (PR). Patient‐targeted QI strategies needed to occur with a minimum of one provider or system‐targeted strategy. Data collection and analysis We dual‐screened search results and abstracted data on study design, study population and QI strategies. We assessed the impact of the programmes on 13 measures of diabetes care, including: glycaemic control (e.g. mean glycated haemoglobin (HbA1c)); cardiovascular risk factor management (e.g. mean systolic blood pressure (SBP), low‐density lipoprotein cholesterol (LDL‐C), proportion of people living with diabetes that quit smoking or receiving cardiovascular medications); and screening/prevention of microvascular complications (e.g. proportion of patients receiving retinopathy or foot screening); and harms (e.g. proportion of patients experiencing adverse hypoglycaemia or hyperglycaemia). We modelled the association of each QI strategy with outcomes using a series of hierarchical multivariable meta‐regression models in a Bayesian framework. The previous version of this review identified that different strategies were more or less effective depending on baseline levels of outco...

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Process- and Outcome-Based Financial Incentives to Improve Self-Management and Glycemic Control in People with Type 2 Diabetes in Singapore: A Randomized Controlled Trial

Bilger

Mitesh

Tan

et al. 2021

Patient

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Background Sub-optimally controlled diabetes increases risks for adverse and costly complications. Self-management including glucose monitoring, medication adherence, and exercise are key for optimal glycemic control, yet, poor self-management remains common. Objective The main objective of the Trial to Incentivize Adherence for Diabetes (TRIAD) study was to determine the effectiveness of financial incentives in improving glycemic control among type 2 diabetes patients in Singapore, and to test whether process-based incentives tied to glucose monitoring, medication adherence, and physical activity are more effective than outcome-based incentives tied to achieving normal glucose readings. Methods TRIAD is a randomized, controlled, multi-center superiority trial. A total of 240 participants who had at least one recent glycated hemoglobin (HbA1c) being 8.0% or more and on oral diabetes medication were recruited from two polyclinics. They were block-randomized (blocking factor: current vs. new glucometer users) into the usual care plus (UC +) arm, process-based incentive arm, and outcome-based incentive arm in a 2:3:3 ratio. The primary outcome was the mean change in HbA1c at month 6 and was linearly regressed on binary variables indicating the intervention arms, baseline HbA1c levels, a binary variable indicating titration change, and other baseline characteristics.Results Our findings show that the combined incentive arms trended toward better HbA1c than UC + , but the difference is estimated with great uncertainty (difference − 0.31; 95% confidence interval [CI] − 0.67 to 0.06). Lending credibility to this result, the proportion of participants who reduced their HbA1c is higher in the combined incentive arms relative to UC + (0.18; 95% CI 0.04, 0.31). We found a small improvement in process-relative to outcome-based incentives, but this was again estimated with great uncertainty (difference − 0.05; 95% CI − 0.42 to 0.31). Consistent with this improvement, processbased incentives were more effective at improving weekly medication adherent days (0.64; 95% CI − 0.04 to 1.32), weekly physically active days (1.37; 95% CI 0.60-2.13), and quality of life (0.04; 95% CI 0.0-0.07) than outcome-based incentives. Conclusion This study suggests that both incentive types may be part of a successful self-management strategy. Processbased incentives can improve adherence to intermediary outcomes, while outcome-based incentives focus on glycemic control and are simpler to administer.

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A Randomized Controlled Trial of Financial Incentives for Medicaid Beneficiaries with Diabetes

Abstract: Overall, this study found no conclusive evidence that financial incentives alone had beneficial effects on improving standards of medical care in diabetes.

Cited by 11 publications

References 21 publications

Effectiveness of self‐management interventions in young adults with type 1 and 2 diabetes: a systematic review and meta‐analysis

Effectiveness of self‐management interventions in young adults with type 1 and 2 diabetes: a systematic review and meta‐analysis

Quality improvement strategies for diabetes care: Effects on outcomes for adults living with diabetes

Process- and Outcome-Based Financial Incentives to Improve Self-Management and Glycemic Control in People with Type 2 Diabetes in Singapore: A Randomized Controlled Trial

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