title: 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.
  
  
  METHODS
  Randomized, controlled trial. (Clinicaltrials.gov Identifier: NCT01282957).
  
  
  METHODS
  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.
  
  
  METHODS
  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.
  
  
  METHODS
  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).
  
  
  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.
authors: Penn CMU Roybal P30 Center in Behavioral Economics and Health and Leonard Davis Institute Center for Health Incentives and Behavioral Economics, Philadelphia, PA, USA, Aditisen@wharton.upenn.edu.
authors: Aditi P
authors: AP
authors: Sen
authors: Taylor B
authors: TB
authors: Sewell
authors: E Brooks
authors: EB
authors: Riley
authors: Beth
authors: B
authors: Stearman
authors: Scarlett L
authors: SL
authors: Bellamy
authors: Michelle F
authors: MF
authors: Hu
authors: Yuanyuan
authors: Y
authors: Tao
authors: Jingsan
authors: J
authors: Zhu
authors: James D
authors: JD
authors: Park
authors: George
authors: G
authors: Loewenstein
authors: David A
authors: DA
authors: Asch
authors: Kevin G
authors: KG
authors: Volpp
mesh_terms: D000328:Adult; D001786:Blood Glucose / Q000502:physiology; D015190:Blood Glucose Self-Monitoring / Q000191:economics* / Q000592:standards; D001794:Blood Pressure / Q000502:physiology; D001835:Body Weight / Q000502:physiology; D003920:Diabetes Mellitus / Q000097:blood / Q000175:diagnosis / Q000191:economics; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009042:Motivation; D010349:Patient Compliance; D018802:Patient-Centered Care / Q000191:economics* / Q000592:standards
chemical_list: D001786:Blood Glucose