Patients with diabetes mellitus have increased cardiovascular risk and although comparative effectiveness research from a meta-analysis demonstrates the efficacy of statin drugs in reducing this risk, many studies have documented limited initiation and adherence, despite current guideline recommendations of statin drugs for nearly all patients with diabetes. Patient decision aids have been found to improve patient knowledge;reduce decisional conflict from feeling uninformed or unclear about personal values;reduce passive decision making;and reduce indecision post-intervention. Value-based insurance to eliminate economic barriers (e.g., drug copayments has been found to enhance drug utilization), and providing economic incentives has been found to promote behavior change. Objective: to increase lipid process and outcomes measures in patients with diabetes to improve their quality of care while helping to restrain growth in health care costs by incorporating findings from comparative effectiveness research (CER) studies.
Aims : 1) to demonstrate in a randomized factorial design that patient-directed financial process and outcome incentives and/or individualized decision aids compared with usual care increase the proportion of primary care patients with diabetes mellitus who have their cholesterol checked (process) and have LDL levels that achieve recommended goals (outcome);2) to understand the mediators and moderators of behavior change in response to decision aids and to financial incentives in order to bring about meaningful improvements in clinical practice that improve both quality of care process and outcome measures and identify additional research questions and issues related to statin adherence that could be explored in an expanded study and guide design of study interventions;and 3) to determine the comparative cost-effectiveness of combined financial incentives and decision aids, financial incentives alone, decision aids alone and usual care. In sum, this project will 1) demonstrate that consumer incentives or decision support tools to inform patients about their cardiovascular risk and the potential benefit from statins can bring about meaningful improvements in clinical practice that improve both quality of care process and outcome measures;2) provide a fundamental understanding of the factors that mediate and moderate behavior change in patients related to financial incentives and decision aids (information) that can bring about meaningful improvements in clinical practice that improve both quality of care process and outcome measures and 3) evaluate the short- and long-term health and economic outcomes of the interventions from the perspective of society, hospital, payer, and patient. Future Directions: Our findings would advance knowledge on how decision aids and/or financial incentives will improve the financial and health outcomes associated with their utilization and will establish the viability and feasibility of pursuing additional research efforts with these interventions on a larger scale.

Public Health Relevance

Treatment with statin medications reduces heart attacks in adult patients with diabetes, yet many diabetic individuals do not take or stop taking them. This study will examine whether personalized risk and benefit information in combination with economic incentives for each separately will be effective and result in more patients having cholesterol testing and achieving a lowered cholesterol.

National Institute of Health (NIH)
National Institute on Aging (NIA)
Exploratory/Developmental Grants (R21)
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Special Emphasis Panel (ZRG1-HDM-G (50))
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Baker, Colin S
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Tufts University
United States
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