141st APHA Annual Meeting and Exposition

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285540
Testing the use of novel patient financial incentives to improve breast cancer screening rates


Tuesday, November 5, 2013

Dominic Hodgkin, PhD, Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, Waltham, MA
Elizabeth Merrick, Ph.D., MSW, Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, Waltham, MA
Constance M. Horgan, ScD, Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, Waltham, MA
Laura S. Lorenz, PhD, Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, Waltham, MA
Grant Ritter, PhD, Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, Waltham, MA
Lee Panas, MS, Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, Waltham, MA
Paul Kasuba, M.D., Tufts Health Plan, Watertown, MA
Debra Poskanzer, M.D., Director of Clinical Quality Improvement and Medical Affairs, Tufts Health Plan, Watertown, MA
Renee Altman Nefussy, Quality and Health Informatics, Tufts Health Plan, Watertown, MA
Elizabeth Goheen, Quality and Health Informatics, Tufts Health Plan, Watertown, MA
Background. Screening for breast cancer with routine mammography can save lives, but many women do not obtain the screening. Financial incentives for patients hold promise as a way to improve screening rates. This study tested three types of modest financial incentives including a novel patient-choice option that we term “person-centered incentives.”

Methods. The study setting was Tufts Health Plan, a large New England-based health plan. The sample (n=4,700) was randomly selected from the population of privately insured women aged 42-69, who had not received screening mammography in the prior 30 months and were deemed eligible for screening. This was a randomized controlled trial with three intervention conditions, each with a reminder letter plus incentive: $15 gift card; entry into drawing to win $250 gift card; or member's choice of either $15 gift card or drawing. Controls received a reminder letter only. The dependent variable was a binary measure of mammography receipt within the 4-month study intervention period. The mammography measure was defined per HEDIS performance measure specifications. We conducted bivariate and logistic regression analyses.

Results. We report on the proportion of individuals who obtained a mammogram in each of the groups, and test the significance of differences. We identify whether there was an intervention impact after controlling for any demographic or health differences that occurred despite randomization. We also found that most individuals offered a choice of incentive did not report a preference, but among those who did, the $15 gift card was selected more often than the drawing.

Conclusions: This randomized controlled trial tested three types of financial incentives for routine mammography including one incorporating patient choice. Both preferences and effects on screening rates were determined. “Person-centered incentives” that incorporate patient preferences and values through offering choice are worthy of continued examination in a variety of populations and contexts.

Learning Areas:

Conduct evaluation related to programs, research, and other areas of practice
Social and behavioral sciences

Learning Objectives:
Identify the impact of several types of financial incentives on screening mammography rates. Describe “person-centered incentives” and why they could be effective.

Keyword(s): Cancer Screening, Behavioral Research

Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: N/A

Qualified on the content I am responsible for because: I have been an investigator on several studies of how economic incentives affect health care utilization. Among my scientific interests has been the use of financial incentives to encourage healthy behaviors.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

Back to: 4272.0: Health issues of veterans, women, and other special populations poster session