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BMC Health Services Research
Published in: BMC Health Services Research 1/2015

Open Access 01-06-2015 | Study protocol

The wellness incentives and navigation project: design and methods

Authors: Elizabeth Shenkman, Keith Muller, Bruce Vogel, Sara Jo Nixon, Alexander C. Wagenaar, Kimberly Case, Yi Guo, Martin Wegman, Jessie Aric, Dena Stoner

Published in: BMC Health Services Research | Issue 1/2015

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Abstract

Background

About 35 % of non-elderly U.S. adult Medicaid enrollees have a behavioral health condition, such as anxiety, mood disorders, substance use disorders, and/or serious mental illness. Individuals with serious mental illness, in particular, have mortality rates that are 2 to 3 times higher as the general population, which are due to multiple factors including inactivity, poor nutrition, and tobacco use. 61 % of Medicaid beneficiaries with behavioral health conditions also have multiple other co-occurring chronic physical health conditions, which further contributes to morbidity and mortality. The Wellness Incentives and Navigation (WIN) project is one of 10 projects under the Centers for Medicare and Medicaid Services “Medicaid Incentives for the Prevention of Chronic Diseases” Initiative, to “test the effectiveness of providing incentives directly to Medicaid beneficiaries of all ages who participate in prevention programs, and change their health risks and outcomes by adopting healthy behaviors.”

Methods/Design

WIN is a three-year randomized pragmatic clinical trial designed to examine the comparative effectiveness of the combined use of personal navigators, motivational interviewing, and a flexible wellness account on cardiovascular risk reduction among individuals in Medicaid with co-occurring physical and mental health conditions or serious mental illness alone relative to the usual care provided within Medicaid Managed Care. 1250 individuals, identified through Medicaid claims data, were recruited and randomly assigned to an intervention group or control group with outcomes tracked annually. A comparison group was also recruited to help assess the study’s internal validity.

Discussion

The primary outcomes are physical and mental health related quality-of-life as measured by the SF-12, and BMI, blood pressure, LDL-C, and Hba1c results for those who are diabetic measured clinically. The purpose of this paper is to present the unique design of the WIN trial prior to results becoming available in hopes of assisting other researchers in conducting community-based randomized pragmatic trials. Outcomes will be assessed through the linkage of patient reported outcomes, health care claims, and electronic health record data.

Trial Registration

NCT02440906
Literature
1.
2.
Foley DL, Mackinnon A, Morgan VA, Watts GF, Shaw JE, Magliano DJ, et al. Cardiovascular risk factor associations in adults with psychosis and adults in a national comparator sample. Aust. N. Z. J. Psychiatry. 2015;0004867414565476
3.
4.
Finkelstein EA, Brown DS, Brown DR, Buchner DM. A randomized study of financial incentives to increase physical activity among sedentary older adults. Prev Med. 2008;47:182–7.CrossRefPubMed
5.
Martino S, Carroll KM, Nich C, Rounsaville BJ. A randomized controlled pilot study of motivational interviewing for patients with psychotic and drug use disorders. Addiction. 2006;101:1479–92.CrossRefPubMed
6.
7.
Hibbard JH, Greene J, Overton V. Patients With Lower Activation Associated With Higher Costs; Delivery Systems Should Know Their Patients’ “Scores.”. Health Aff (Millwood). 2013;32:216–22.CrossRef
8.
Salyers MP, Matthias MS, Spann CL, Lydick JM, Rollins AL, Frankel RM. The Role of Patient Activation in Psychiatric Visits. Psychiatr Serv. 2009;60:1535–9.CrossRefPubMedPubMedCentral
9.
Greene J, Hibbard JH. Why Does Patient Activation Matter? An Examination of the Relationships Between Patient Activation and Health-Related Outcomes. J Gen Intern Med. 2011;27:520–6.CrossRefPubMedCentral
10.
Hibbard JH, Mahoney E. Toward a theory of patient and consumer activation. Patient Educ Couns. 2010;78:377–81.CrossRefPubMed
11.
Alexander J, Hearld L, Mittler JN. Patient–Physician Role Relationships and Patient Activation The Moderating Effects of Race and Ethnicity. Med Care Res Rev. 2014;71:472–95.CrossRefPubMed
12.
Rollnick S, Miller WR, Butler C. Motivational Interviewing in Health Care: Helping Patients Change Behavior. New York: Guilford Press; 2008.
13.
Linden A, Butterworth SW, Prochaska JO. Motivational interviewing-based health coaching as a chronic care intervention. J Eval Clin Pract. 2010;16:166–74.CrossRefPubMed
14.
Martins RK, McNeil DW. Review of Motivational Interviewing in promoting health behaviors. Clin Psychol Rev. 2009;29:283–93.CrossRefPubMed
15.
Volpp KG, Troxel AB, Pauly MV, Glick HA, Puig A, Asch DA, et al. A randomized, controlled trial of financial incentives for smoking cessation. N Engl J Med. 2009;360:699–709.CrossRefPubMed
16.
Volpp KG, John LK, Troxel AB, Norton L, Fassbender J, Loewenstein G. Financial incentive-based approaches for weight loss: a randomized trial. JAMA J Am Med Assoc. 2008;300:2631–7.CrossRef
17.
Sutherland K, Christianson JB, Leatherman S. Impact of Targeted Financial Incentives on Personal Health Behavior A Review of the Literature. Med Care Res Rev. 2008;65:36S–78S.CrossRefPubMed
18.
Blumenthal KJ, Saulsgiver KA, Norton L, Troxel AB, Anarella JP, Gesten FC, et al. Medicaid Incentive Programs To Encourage Healthy Behavior Show Mixed Results To Date And Should Be Studied And Improved. Health Aff (Millwood). 2013;32:497–507.CrossRef
19.
Keller PA, Harlam B, Loewenstein G, Volpp KG. Enhanced active choice: A new method to motivate behavior change. J Consum Psychol. 2011;21:376–83.CrossRef
20.
Marteau TM, Ashcroft RE, Oliver A. Using financial incentives to achieve healthy behaviour. BMJ. 2009;338:b1415.CrossRefPubMed
21.
Lagarde M, Haines A, Palmer N. Conditional cash transfers for improving uptake of health interventions in low- and middle-income countries: A systematic review. JAMA. 2007;298:1900–10.CrossRefPubMed
22.
23.
Benjamin AE. Consumer-Directed Services At Home: A New Model For Persons With Disabilities. Health Aff (Millwood). 2001;20:80–95.CrossRef
24.
Miller WR, Rollnick S. Motivational Interviewing: Helping People Change. New York: Guilford Press; 2012.
25.
Lepage M, Bodnar M, Bowie CR. Neurocognition: Clinical and Functional Outcomes in Schizophrenia. Can J Psychiatry Rev Can Psychiatr. 2014;59:5–12.
26.
Larøi F, Canlaire J, Mourad H, Van Der Linden M. Relations between a computerized shopping task and cognitive tests in a group of persons diagnosed with schizophrenia compared with healthy controls. J Int Neuropsychol Soc. 2010;16:180–9.CrossRefPubMed
27.
Rempfer MV, Hamera EK, Brown CE, Cromwell RL. The relations between cognition and the independent living skill of shopping in people with schizophrenia. Psychiatry Res. 2003;117:103–12.CrossRefPubMed
28.
Čukić I, Weiss A. Personality and diabetes mellitus incidence in a national sample. J Psychosom Res. 2014;77:163–8.CrossRefPubMed
29.
Holmes HM, Luo R, Hanlon JT, Elting LS, Suarez-Almazor M, Goodwin JS. Ethnic Disparities in Adherence to Antihypertensive Medications of Medicare Part D Beneficiaries. J Am Geriatr Soc. 2012;60:1298–303.CrossRefPubMedPubMedCentral
30.
Wen T, Attenello FJ, He S, Cen Y, Kim-Tenser MA, Sanossian N, et al. Racial and socioeconomic disparities in incidence of hospital-acquired complications following cerebrovascular procedures. Neurosurgery. 2014;75:43–50.CrossRefPubMed
31.
Willey JZ, Moon YP, Kahn E, Rodriguez CJ, Rundek T, Cheung K, et al. Population attributable risks of hypertension and diabetes for cardiovascular disease and stroke in the northern Manhattan study. J Am Heart Assoc. 2014;3:5.CrossRef
32.
Basu J, Friedman B, Burstin H. Preventable Hospitalization and Medicaid Managed Care: Does Race Matter? J Health Care Poor Underserved. 2006;17:101–15.CrossRefPubMed
33.
Hunt KA, Weber EJ, Showstack JA, Colby DC, Callaham ML. Characteristics of Frequent Users of Emergency Departments. Ann Emerg Med. 2006;48:1–8.CrossRefPubMed
34.
Zhang S, Cardarelli K, Shim R, Ye J, Booker KL, Rust G. Racial disparities in economic and clinical outcomes of pregnancy among Medicaid recipients. Matern Child Health J. 2013;17:1518–25.CrossRefPubMedPubMedCentral
35.
Thomas B. Health and health care disparities: the effect of social and environmental factors on individual and population health. Int J Environ Res Public Health. 2014;11:7492–507.CrossRefPubMedPubMedCentral
36.
37.
38.
39.
Riddle DL, Johnson RE, Jensen MP, Keefe FJ, Kroenke K, Bair MJ, et al. The Pragmatic-Explanatory Continuum Indicator Summary (PRECIS) instrument was useful for refining a randomized trial design: Experiences from an investigative team. J Clin Epidemiol. 2010;63:1271–5.CrossRefPubMedPubMedCentral
40.
Schwartz D, Lellouch J. Explanatory and Pragmatic Attitudes in Therapeutical Trials. J Clin Epidemiol. 2009;62:499–505.CrossRefPubMed
41.
Thorpe KE, Zwarenstein M, Oxman AD, Treweek S, Furberg CD, Altman DG, et al. A pragmatic–explanatory continuum indicator summary (PRECIS): a tool to help trial designers. J Clin Epidemiol. 2009;62:464–75.CrossRefPubMed
42.
Salyers MP, Bosworth HB, Swanson JW, Lamb-Pagone J, Osher FC. Reliability and Validity of the SF-12 Health Survey among People with Severe Mental Illness. Med Care. 2000;38:1141–50.CrossRefPubMed
43.
44.
Tolman AW, Kurtz MM. Neurocognitive Predictors of Objective and Subjective Quality of Life in Individuals With Schizophrenia: A Meta-Analytic Investigation. Schizophr Bull. 2012;38:304–15.CrossRefPubMed
45.
Alosco ML, Spitznagel MB, Cohen R, Raz N, Sweet LH, Josephson R, et al. Decreased physical activity predicts cognitive dysfunction and reduced cerebral blood flow in heart failure. J Neurol Sci. 2014;339:169–75.CrossRefPubMedPubMedCentral
46.
Kesse-Guyot E, Andreeva VA, Lassale C, Hercberg S, Galan P. Clustering of Midlife Lifestyle Behaviors and Subsequent Cognitive Function: A Longitudinal Study. Am J Public Health. 2014;104:e170–7.CrossRefPubMed
47.
Hall PA, Marteau TM. Executive function in the context of chronic disease prevention: Theory, research and practice. Prev Med. 2014;68:44–50.CrossRefPubMed
48.
Wilson RS, Bennett DA. Assessment of cognitive decline in old age with brief tests amenable to telephone administration. Neuroepidemiology. 2005;25:19–25.CrossRefPubMed
49.
Wilson RS, Leurgans SE, Foroud TM, Sweet RA, Graff-Radford N, Mayeux R, et al. Telephone assessment of cognitive function in the late-onset Alzheimer’s disease family study. Arch Neurol. 2010;67:855–61.CrossRefPubMedPubMedCentral
50.
Wechsler D. A Standardized Memory Scale for Clinical Use. J Psychol. 1945;19:87–95.CrossRef
51.
52.
53.
54.
Johnson JL, Muller KE, Slaughter JC, Gurka MJ, Gribbin MJ, Simpson SL. POWERLIB: SAS/IML Software for Computing Power in Multivariate Linear Models. J Stat Softw. 2009;30:5.CrossRef
55.
Muller KE, Fetterman BA. Regression and ANOVA: An Integrated Approach Using SAS Software. New York: SAS Institute; 2002.
56.
MacKinnon DP. Introduction to Statistical Mediation Analysis. Routledge; 2008
Metadata
Title
The wellness incentives and navigation project: design and methods
Authors
Elizabeth Shenkman
Keith Muller
Bruce Vogel
Sara Jo Nixon
Alexander C. Wagenaar
Kimberly Case
Yi Guo
Martin Wegman
Jessie Aric
Dena Stoner
Publication date
01-06-2015
Publisher
BioMed Central
Published in
BMC Health Services Research / Issue 1/2015
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/s12913-015-1245-x

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