Moderating Effects of Patient Characteristics on the Impact of Financial Incentives

摘要

While financial incentives to providers or patients are increasingly common as a quality improvement strategy, their impact on patient subgroups and healthcare 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 (odds ratio = 0.98 [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 [0.03, 0.70] and 0.09 [0.01, 0.93]), respectively. These findings suggest some differential response to incentives, particularly in the form of targeted medication changes.