; 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)
Institute
National Institute of General Medical Sciences (NIGMS)
Type
Exploratory Grants (P20)
Project #
5P20GM103644-02
Application #
8734447
Study Section
Special Emphasis Panel (ZGM1)
Project Start
Project End
Budget Start
2014-08-01
Budget End
2015-07-31
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
D'Alberto, Nicholas; Chaarani, Bader; Orr, Catherine A et al. (2018) Individual differences in stop-related activity are inflated by the adaptive algorithm in the stop signal task. Hum Brain Mapp 39:3263-3276
Villanti, Andrea C; Niaura, Raymond S; Abrams, David B et al. (2018) Preventing Smoking Progression in Young Adults: the Concept of Prevescalation. Prev Sci :
Gaalema, Diann E; Leventhal, Adam M; Priest, Jeffrey S et al. (2018) Understanding individual differences in vulnerability to cigarette smoking is enhanced by attention to the intersection of common risk factors. Prev Med 117:38-42
Ahern, Thomas P; Veres, Katalin; Jiang, Tammy et al. (2018) Adjustment disorder and type-specific cancer incidence: a Danish cohort study. Acta Oncol 57:1367-1372
Fujii, Mayo H; Hodges, Ashley C; Russell, Ruby L et al. (2018) Post-Discharge Opioid Prescribing and Use after Common Surgical Procedure. J Am Coll Surg 226:1004-1012
Ganz, Ollie; Johnson, Amanda L; Cohn, Amy M et al. (2018) Tobacco harm perceptions and use among sexual and gender minorities: findings from a national sample of young adults in the United States. Addict Behav 81:104-108
Phillips, Julie K; Skelly, Joan M; King, Sarah E et al. (2018) Associations of maternal obesity and smoking status with perinatal outcomes. J Matern Fetal Neonatal Med 31:1620-1626
Gaalema, Diann E; Pericot-Valverde, Irene; Bunn, Janice Y et al. (2018) Tobacco use in cardiac patients: Perceptions, use, and changes after a recent myocardial infarction among US adults in the PATH study (2013-2015). Prev Med 117:76-82
Lopez, Alexa A; Redner, Ryan; Kurti, Allison N et al. (2018) Tobacco and nicotine delivery product use in a U.S. national sample of women of reproductive age. Prev Med 117:61-68
Higgins, Tara M; Dougherty, Anne K; Badger, Gary J et al. (2018) Comparing long-acting reversible contraception insertion rates in women with Medicaid vs. private insurance in a clinic with a two-visit protocol. Contraception 97:76-78

Showing the most recent 10 out of 141 publications