We propose to implement 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. We 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. Using a mixed methods approach, we will compare outcomes among patients who receive one of two levels of incentives ($25, $50) versus those who receive usual care. Patients will be interviewed at enrollment and at the end of the study (12 months following their enrollment) for their feedback on the incentives, their health status, and their experience with the health care system. We will also objectively assess their utilization through the analysis of medical claims. All hypotheses test the $50 and $25 experimental groups against each other and the control group.
Our specific aims are to:
Aim 1. Enroll low-income, uninsured adults in an RCT to test the impact of incentives on visiting a primary care provider (PCP) within 6 months of enrollment and to measure health care utilization 12 months following study enrollment. H1: The likelihood of a PCP visit is highest in the experimental groups. H1a: Time delay to a PCP visit is shortest in the experimental groups. H1b: The average number of PCP visits is higher in the experimental groups. H2: The use of preventive care (drawing from HEDIS measures) is higher in the experimental groups. H3: The number of total ED, non-emergent ED, inpatient and outpatient visits is lower in the experimental groups. H4: The number of pharmaceuticals used is lower in the experimental groups. H5: Total cost of health care utilization will be lower in the experimental groups. H6: The experimental groups will be more likely to re-enroll in the Virginia Coordinated Care program.
Aim 2. Administer semi-structured interviews at pre-randomization and study completion to qualitatively explore the effects of incentives. H1: Satisfaction with health care services will be higher in the experimental groups. H2: Self-reported health status will be higher in the experimental groups. H3: Incentives will be the primary motivator for patients in the experimental groups to seek primary care.

Public Health Relevance

We propose to implement 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.

Agency
National Institute of Health (NIH)
Institute
Agency for Healthcare Research and Quality (AHRQ)
Type
Research Project (R01)
Project #
1R01HS022534-01
Application #
8612264
Study Section
Health Care Quality and Effectiveness Research (HQER)
Program Officer
Hagan, Michael
Project Start
2013-09-30
Project End
2017-09-29
Budget Start
2013-09-30
Budget End
2017-09-29
Support Year
1
Fiscal Year
2013
Total Cost
Indirect Cost
Name
Virginia Commonwealth University
Department
Miscellaneous
Type
Schools of Medicine
DUNS #
105300446
City
Richmond
State
VA
Country
United States
Zip Code
23298