Incentives for Primary Care Use in a Safety Net Setting

NCT ID: NCT02922855

Last Updated: 2018-06-12

Basic Information

• Recruitment Status: COMPLETED
• Clinical Phase: NA
• Total Enrollment: 1228 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2014-01-31
• Study Completion Date: 2016-11-08

Brief Summary

A randomized controlled trial (RCT) of incentives for an initial primary care visit within 6 months of enrollment in a health care coverage program. Study subjects are drawn from a low-income adult population that gains coverage and access to community-based primary care services under a program administered by an academic safety-net hospital. The investigators will offer financial incentives to encourage an initial primary care visit within 6 months of enrollment and evaluate whether the primary care visit altered subsequent health seeking behavior and influenced patient satisfaction and other outcomes such as self-reported health status.

Detailed Description

A randomized controlled trial (RCT) of incentives for an initial primary care visit within 6 months of enrollment in a health care coverage program. Study subjects are drawn from a low-income adult population that gains coverage and access to community-based primary care services under a program administered by an academic safety-net hospital. The investigators will offer financial incentives to encourage an initial primary care visit within 6 months of enrollment and evaluate whether the primary care visit altered subsequent health seeking behavior and influenced patient satisfaction and other outcomes such as self-reported health status.

Incentives should steer patients in their decision to seek primary care, reduce barriers to care, and ultimately improve patient health and reduce utilization and costs through their relationship with a PCP. This study is the first of its kind to incentivize low-income patients. This population has the greatest need for health care and exerts the greatest pressure on the United States' safety net system. Furthermore, the safety net population is the target of policies such as Medicaid eligibility expansions, yet urban safety net patients are largely understudied. These patients are rarely given the opportunity to participate in research, and when they are the subjects of measures to reduce health care utilization, they are the subject of policies using negative incentives such as those that introduce cost sharing for using ED services.1 Alternatively, safety net providers invest in case management systems to reduce utilization. The proposed study is a departure from prior measures to reduce utilization among low-income patients by focusing on patients and using positive incentives. The study borrows from the principles of behavioral economics to motivate patients towards primary care utilization. Once in the primary care system, The investigators will test whether primary care contact reduces more expensive forms (e.g., inpatient, ED) of health care.

The investigators will compare outcomes of patients assigned in the highest incentive group ($50) to patients assigned to the modest incentive group ($25) and to patients assigned to usual care (no incentive, but assignment to a PCP). The investigators will also compare incentive patients ($50, $25) to a contemporaneous group of patients that enroll in the safety net clinic at the same time.

Conditions

Health Care Utilization; Primary Care Physician; Uninsured

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: PARALLEL
• Primary Study Purpose: HEALTH_SERVICES_RESEARCH
• Blinding Strategy: SINGLE

Study Groups

Contemporaneous Control

This group is our 'usual care' control group. They were not contacted for an interview and were not offered an incentive to visit their primary care physician.

Group Type: NO_INTERVENTION

No interventions assigned to this group

$0 group

This group completed a baseline interview but was not offered any incentive if they visited their primary care physician.

Group Type: ACTIVE_COMPARATOR

0 dollars group

Intervention Type: BEHAVIORAL

Those assigned to the $0 group will not receive an incentive for visiting their PCP.

$25 group

This group completed a baseline interview and was offered $25 they visited their primary care physician within 6 months.

Group Type: EXPERIMENTAL

25 dollars group

Intervention Type: BEHAVIORAL

Those assigned to the $25 group will receive $25 if they visit their PCP within 6 months of study enrollment.

$50 group

This group completed a baseline interview and was offered $50 they visited their primary care physician within 6 months.

Group Type: EXPERIMENTAL

50 dollars group

Intervention Type: BEHAVIORAL

Those assigned to the $50 group will receive $50 if they visit their PCP within 6 months of study enrollment.

Interventions

0 dollars group

Those assigned to the $0 group will not receive an incentive for visiting their PCP.

Intervention Type: BEHAVIORAL

50 dollars group

Those assigned to the $50 group will receive $50 if they visit their PCP within 6 months of study enrollment.

Intervention Type: BEHAVIORAL

25 dollars group

Those assigned to the $25 group will receive $25 if they visit their PCP within 6 months of study enrollment.

Intervention Type: BEHAVIORAL

Eligibility Criteria

Inclusion Criteria

• Adults between ages 21-64 years
• No prior enrollment in VCC for the past 12 months
• English or Spanish speaking, and
• Can be contacted by mail and telephone (preferably) or willing to be interviewed in person.

Exclusion Criteria

• Unable to be contacted by phone/mail
• Cannot provide consent
• No longer located in catchment area

• Minimum Eligible Age: 21 Years
• Maximum Eligible Age: 64 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

Agency for Healthcare Research and Quality (AHRQ)

FED

Sponsor Role: collaborator

Virginia Commonwealth University

OTHER

Sponsor Role: lead

Responsible Party

Responsibility Role: SPONSOR

Principal Investigators

Cathy Bradley, Phd

Role: PRINCIPAL_INVESTIGATOR

PI

Other Identifiers

1R01HS022534

Identifier Type: AHRQ

Identifier Source: secondary_id

View Link

HM20000002

Identifier Type: -

Identifier Source: org_study_id