Moderating Effects of Patient Characteristics on the Impact of Financial Incentives

Abstract

While financial incentives to providers or patients are increasingly common as a quality improvement strategy, their impact on patient subgroups and health care disparities is unclear. To examine these patterns, we analyzed data from a randomized clinical trial of financial incentives to lower low-density lipoprotein (LDL) cholesterol levels in patients at risk for cardiovascular disease. Patients with higher baseline LDL experienced greater cholesterol reductions in the shared incentive arm (0.23 mg/dL per unit change in baseline LDL, 95% CI [-0.46, -0.00]) but were also less likely to have medication potency increases in the physician incentive arm ( OR = 0.98, 95% CI [0.97, 0.996]). Uninsured patients and those of race other than Black or White were less likely to have potency increases in the shared incentive arm ( OR = 0.15, 95% CI [0.03, 0.70] and OR = 0.09, 95% CI [0.01, 0.93], respectively). These findings suggest some differential response to incentives, particularly in the form of targeted medication changes.

Trial registration: ClinicalTrials.gov NCT01346189.

Keywords: cardiovascular disease; health economics; patient engagement; physician behavior; randomized trials.

Figures

Figure 1:. Predictions of LDL change for patient subgroups, by trial arm

Legend: Marginal predictions of LDL reduction (measured in mg/dL) for different patient subgroups, by trial arm, derived from the model with interactions between all patient characteristics and trial arms. Point estimates are presented along with 95% confidence intervals. Abbreviations: CAD, coronary artery disease; FRS, Framingham Risk Score; LDL, low-density lipoprotein SI conversion factor: To convert cholesterol to mmol/L, multiply values by 0.0259