Financial incentives to promote cardiac rehabilitation participation and adherence among Medicaid patients

Gaalema, Diann E.; Savage, Patrick D.; Rengo, Jason L.; Cutler, Alexander; Higgins, Stephen T.; Ades, Philip A.

doi:10.1016/j.ypmed.2015.11.032

Cited by 40 publications

(33 citation statements)

References 23 publications

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“…11,26 To overcome these barriers, some experts have suggested the development of home-based CR programs 27 or financial incentives for patients who participate. 28 Our study has several limitations. First, it carries the inherent limitations of a cross-sectional study-namely, the limited ability to clearly establish temporality of associations and the inability to define associations of causality.…”

Section: Discussionmentioning

confidence: 91%

Trends and Predictors of Participation in Cardiac Rehabilitation Following Acute Myocardial Infarction: Data From the Behavioral Risk Factor Surveillance System

Peters

Keeley

2018

JAHA

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BackgroundParticipation in cardiac rehabilitation (CR) after acute myocardial infarction has been proven to significantly reduce morbidity and mortality. Historically, participation rates have been low, and although recent efforts have increased referral rates, current data on CR participation are limited.Methods and ResultsUtilizing data from the Behavioral Risk Factor Surveillance System conducted by Centers for Disease Control and Prevention, we performed a population‐based, cross‐sectional analysis of CR post‐acute myocardial infarction. Unadjusted participation from 2005 to 2015 was evaluated by univariable logistic regression. Multivariable logistic regression was performed with patient characteristic variables to determine adjusted trends and associations with participation in CR in more recent years from 2011 to 2015. Among the 32 792 survey respondents between 2005 and 2015, participation ranged from 35% in 2005 to 39% in 2009 (P=0.005) and from 38% in 2011 to 32% in 2015 (P=0.066). Between 2011 and 2015, participants were less likely to be female (odds ratio [OR] 0.763, 95% confidence interval [CI] 0.646‐0.903), black (OR 0.700, 95% CI 0.526‐0.931), uninsured (OR 0.528, 95% CI 0.372‐0.751), less educated (OR 0.471, 95% CI 0.367‐0.605), current smokers (OR 0.758, 95% CI 0.576‐0.999), and were more likely to be retired or self‐employed (OR 1.393, 95% CI 1.124‐1.726).ConclusionsOnly one third of patients participate in CR following acute myocardial infarction despite the known health benefits. Participants are less likely to be female, black, and uneducated. Future studies should focus on methods to maximize the proportion of CR referrals converted into CR participation.

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Section: Discussionmentioning

confidence: 91%

Trends and Predictors of Participation in Cardiac Rehabilitation Following Acute Myocardial Infarction: Data From the Behavioral Risk Factor Surveillance System

Peters

Keeley

2018

JAHA

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“…Very little investigation has been done thus far aimed at improving adherence with secondary prevention behaviors specifically in lower-SES populations. However, one promising approach that is currently being tested is the use of incentives, where objectively measured outcomes of behavior change, such as attendance at CR, are reinforced with gift cards, vouchers, or other financial incentives (60). …”

Section: Discussionmentioning

confidence: 99%

Effect of Socioeconomic Status on Propensity to Change Risk Behaviors Following Myocardial Infarction: Implications for Healthy Lifestyle Medicine

Gaalema

Elliott

Morford

et al. 2017

Progress in Cardiovascular Diseases

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Introduction Failure to change risk behaviors following myocardial infarction (MI) increases the likelihood of recurrent MI and death. Lower-socioeconomic status (SES) patients are more likely to engage in high-risk behaviors prior to MI. Less well known is whether propensity to change risk behaviors after MI also varies inversely with SES. Methods We performed a systematized literature review addressing changes in risk behaviors following MI as a function of SES. Results 2160 abstracts were reviewed and 44 met eligibility criteria. Behaviors included smoking cessation, cardiac rehabilitation (CR), medication adherence, diet, and physical activity (PA). For each behavior, lower-SES patients were less likely to change after MI. Overall, lower-SES patients were 2 to 4 times less likely to make needed behavior changes (OR's 0.25–0.56). Conclusion Lower-SES populations are less successful at changing risk behaviors post-MI. Increasing their participation in CR/secondary prevention programs, which address multiple risk behaviors, including increasing PA and exercise, should be a priority of healthy lifestyle medicine (HLM).

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“…46,47 Contemporary CR programs are encouraged to incrementally adopt and apply many of these strategies, eventually incorporating them as routine elements of daily operations. Other strategies to consider include record keeping by participants (eg, diaries, logs, step counts), matching program hours of operation to patient rather than to staff needs, and offering program content that is culturally and linguistically appropriate and considerate of age, sex, comorbidities, and coexisting disabilities.…”

Section: Increasing Adherence To Crmentioning

confidence: 99%

Increasing Cardiac Rehabilitation Participation From 20% to 70%: A Road Map From the Million Hearts Cardiac Rehabilitation Collaborative

Ades

Keteyian

Wright

et al. 2017

Mayo Clinic Proceedings

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335

287

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The primary aim of the Million Hearts initiative is to prevent 1 million cardiovascular events over 5 years. Concordant with the Million Hearts’ focus on achieving more than 70% performance in the “ABCS” of aspirin for those at risk, blood pressure control, cholesterol management, and smoking cessation, we outline the cardiovascular events that would be prevented and a road map to achieve more than 70% participation in cardiac rehabilitation (CR)/secondary prevention programs by the year 2022. Cardiac rehabilitation is a class Ia recommendation of the American Heart Association and the American College of Cardiology after myocardial infarction or coronary revascularization, promotes the ABCS along with lifestyle counseling and exercise, and is associated with decreased total mortality, cardiac mortality, and rehospitalizations. However, current participation rates for CR in the United States generally range from only 20% to 30%. This road map focuses on interventions, such as electronic medical record–based prompts and staffing liaisons that increase referrals of appropriate patients to CR, increase enrollment of appropriate individuals into CR, and increase adherence to longer-term CR. We also calculate that increasing CR participation from 20% to 70% would save 25,000 lives and prevent 180,000 hospitalizations annually in the United States.

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Financial incentives to promote cardiac rehabilitation participation and adherence among Medicaid patients

Cited by 40 publications

References 23 publications

Trends and Predictors of Participation in Cardiac Rehabilitation Following Acute Myocardial Infarction: Data From the Behavioral Risk Factor Surveillance System

Trends and Predictors of Participation in Cardiac Rehabilitation Following Acute Myocardial Infarction: Data From the Behavioral Risk Factor Surveillance System

Effect of Socioeconomic Status on Propensity to Change Risk Behaviors Following Myocardial Infarction: Implications for Healthy Lifestyle Medicine

Increasing Cardiac Rehabilitation Participation From 20% to 70%: A Road Map From the Million Hearts Cardiac Rehabilitation Collaborative

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