; Participation in outpatient cardiac rehabilitation (CR) decreases morbidity and mortality for patients hospitalized with myocardial infarction, coronary bypass surgery or percutaneous revascularization. Unfortunately, only 10-35% of patients for whom CR is indicated choose to participate. Lower socioeconomic status (SES) and Medicaid coverage are robust predictors of CR non-participation. There is growing recognition of the need to increase CR among economically disadvantaged patients, but there are no evidence-based interventions available for doing so. In the present study we propose to examine the efficacy of using financial incentives for increasing CR participation among low-income patients. Financial incentives have been highly effective in altering other health behaviors among disadvantaged populations (e.g., smoking during pregnancy, weight loss). For this study we will randomize 130 CR-eligibie low-income patients to a treatment condition where they receive financial incentives contingent on initiation of and continued attendance at CR sessions or to a "usual-care" condition. Participants in both treatment conditions will complete pre- and post-treatment assessments. Treatment conditions will be compared on attendance at CR and end-of-intervention improvements in fitness, decision making and health-related quality of life. Cost effectiveness of the treatment conditions will also be examined by comparing the costs of the incentive intervention and usual care conditions with their effects on increasing CR initiation and adherence. Furthermore, we will model the value of the intervention based on increases in participation rates, intervention costs, long-term medical costs and health outcomes after a coronary event. Should this intervention be efficacious and cost-effective, it has the potential to substantially increase CR participation and significantly improve health outcomes among low-income cardiac patients.

Public Health Relevance

The proposed trial will make a substantive contribution to our understanding of the health and economic benefits of increasing participation in cardiac rehabilitation (CR) in an underserved population and thereby also reduce health disparities. This intervention will result in significant health gains in a population with historically abysmal CR rates who are also disproportionately at high risk for further health issues after their cardiac event.

Agency
National Institute of Health (NIH)
Type
Exploratory Grants (P20)
Project #
5P20GM103644-02
Application #
8734447
Study Section
Special Emphasis Panel (ZGM1)
Project Start
Project End
Budget Start
Budget End
Support Year
2
Fiscal Year
2014
Total Cost
Indirect Cost
Name
University of Vermont & St Agric College
Department
Type
DUNS #
City
Burlington
State
VT
Country
United States
Zip Code
Rohsenow, Damaris J; Tidey, Jennifer W; Kahler, Christopher W et al. (2015) Intolerance for withdrawal discomfort and motivation predict voucher-based smoking treatment outcomes for smokers with substance use disorders. Addict Behav 43:18-24
Harvey, Jean R; Ogden, Doris E (2014) Obesity treatment in disadvantaged population groups: where do we stand and what can we do? Prev Med 68:71-5
Higgins, Stephen T; Washio, Yukiko; Lopez, Alexa A et al. (2014) Examining two different schedules of financial incentives for smoking cessation among pregnant women. Prev Med 68:51-7
Rengo, Jason L; Savage, Patrick D; Toth, Michael J et al. (2014) Statin therapy does not attenuate exercise training response in cardiac rehabilitation. J Am Coll Cardiol 63:2050-1
Bradstreet, Matthew P; Higgins, Stephen T; McClernon, F Joseph et al. (2014) Examining the effects of initial smoking abstinence on response to smoking-related stimuli and response inhibition in a human laboratory model. Psychopharmacology (Berl) 231:2145-58
Ades, Philip A (2014) A controversial step forward: A commentary on the 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults. Coron Artery Dis 25:360-3
Patrick, Mollie E; Dunn, Kelly E; Badger, Gary J et al. (2014) Spontaneous reductions in smoking during double-blind buprenorphine detoxification. Addict Behav 39:1353-6
Hand, Dennis J; Heil, Sarah H; Sigmon, Stacey C et al. (2014) Improving medicaid health incentives programs: lessons from substance abuse treatment research. Prev Med 63:87-9
White, Thomas J; Redner, Ryan; Skelly, Joan M et al. (2014) Examining educational attainment, prepregnancy smoking rate, and delay discounting as predictors of spontaneous quitting among pregnant smokers. Exp Clin Psychopharmacol 22:384-91
Peel, Amanda B; Thomas, Samantha M; Dittus, Kim et al. (2014) Cardiorespiratory fitness in breast cancer patients: a call for normative values. J Am Heart Assoc 3:e000432

Showing the most recent 10 out of 15 publications