Abstract:
BACKGROUND:Many employers offer worksite wellness programs, including financial incentives to achieve goals. Evidence supporting such programs is sparse. OBJECTIVE:To assess whether diabetes and cardiovascular risk factor control in employees improved with financial incentives for participation in disease management and for attaining goals. DESIGN:Retrospective cohort study using insurance claims linked with electronic medical record data from January 2008-December 2012. PARTICIPANTS:Employee patients with diabetes covered by the organization's self-funded insurance and propensity-matched non-employee patient comparison group with diabetes and commercial insurance. INTERVENTION:Financial incentives for employer-sponsored disease management program participation and achieving goals. MAIN MEASURES:Change in glycosylated hemoglobin (HbA1c), low-density lipoprotein (LDL), systolic blood pressure (SBP), and weight. RESULTS:A total of 1092 employees with diabetes were matched to non-employee patients. With increasing incentives, employee program participation increased (7 % in 2009 to 50 % in 2012, p < 0.001). Longitudinal mixed modeling demonstrated improved diabetes and cardiovascular risk factor control in employees vs. non-employees [HbA1c yearly change -0.05 employees vs. 0.00 non-employees, difference in change (DIC) p <0.001]. In their first participation year, employees had larger declines in HbA1c and weight vs. non-employees (0.33 vs. 0.14, DIC p = 0.04) and (2.3 kg vs. 0.1 kg, DIC p < 0.001), respectively. Analysis of employee cohorts corresponding with incentive offerings showed that fixed incentives (years 1 and 2) or incentives tied to goals (years 3 and 4) were not significantly associated with HbA1c reductions compared to non-employees. For each employee cohort offered incentives, SBP and LDL also did not significantly differ in employees compared with non-employees (DIC p > 0.05). CONCLUSIONS:Financial incentives were associated with employee participation in disease management and improved cardiovascular risk factors over 5 years. Improvements occurred primarily in the first year of participation. The relative impact of specific incentives could not be discerned.
journal_name
J Gen Intern Medjournal_title
Journal of general internal medicineauthors
Misra-Hebert AD,Hu B,Taksler G,Zimmerman R,Rothberg MBdoi
10.1007/s11606-016-3686-2subject
Has Abstractpub_date
2016-08-01 00:00:00pages
871-7issue
8eissn
0884-8734issn
1525-1497pii
10.1007/s11606-016-3686-2journal_volume
31pub_type
杂志文章abstract:OBJECTIVE:Our goal was to establish whether psychosocial risk factors for nonadherence, previously identified as negative predictors of warfarin prescribing, are predictors of adverse events for patients with nonvalvular atrial fibrillation receiving warfarin. DESIGN:Retrospective cohort analysis. SETTING:Ohio Medica...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1111/j.1525-1497.2005.0242.x
更新日期:2005-12-01 00:00:00
abstract:BACKGROUND:Stigma is associated with depression treatment, however, whether stigma differs between depression treatment modalities is not known, nor have racial differences in depression treatment stigma been fully explored. OBJECTIVE:To measure stigma for four depression treatments and estimate its association with t...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-007-0276-3
更新日期:2007-09-01 00:00:00
abstract:BACKGROUND:Many physicians and professional leaders agree that community participation is an important professional role for physicians. Volunteerism has also received increasing attention in the national agenda for social change. Yet little is known about physicians' community volunteer activities. OBJECTIVE:To measu...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-008-0811-x
更新日期:2008-12-01 00:00:00
abstract::The clinical features and distinguishing characteristics of the less common causes of chronic airflow obstruction have been reviewed. Clearly, the majority of patients have cigarette-induced chronic bronchitis and/or emphysema. However, for those patients with chronic airflow obstruction who are younger than 40 years ...
journal_title:Journal of general internal medicine
pub_type: 杂志文章,评审
doi:10.1007/BF02599641
更新日期:1993-10-01 00:00:00
abstract:BACKGROUND:Mentorship is perceived to play a significant role in the career development and productivity of academic clinicians, but little is known about the characteristics of mentorship. This knowledge would be useful for those developing mentorship programs. OBJECTIVE:To complete a systematic review of the qualita...
journal_title:Journal of general internal medicine
pub_type: 杂志文章,评审
doi:10.1007/s11606-009-1165-8
更新日期:2010-01-01 00:00:00
abstract:BACKGROUND:The case presentation is a fundamental activity used in both patient care and trainee education, partly due to feedback from supervisor to trainee. Although feedback in medical education is well studied, prior studies have not focused on the perceptions of feedback by Internal Medicine supervisors and traine...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-019-05134-z
更新日期:2019-10-01 00:00:00
abstract:BACKGROUND:Lack of regular physical activity is highly prevalent in U.S. adults and significantly increases mortality risk. OBJECTIVE:To examine the clinical impact of a newly implemented program ("Exercise as a Vital Sign" [EVS]) designed to systematically ascertain patient-reported exercise levels at the beginning o...
journal_title:Journal of general internal medicine
pub_type: 杂志文章,多中心研究
doi:10.1007/s11606-013-2693-9
更新日期:2014-02-01 00:00:00
abstract:BACKGROUND:Conflicting data exists regarding the effect of continuity on diabetes care. Resident physicians frequently treat patients with diabetes in their continuity clinics; however, maintaining continuity in a resident clinic can be very challenging. OBJECTIVE:To determine if resident continuity is associated with...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-008-0654-5
更新日期:2008-07-01 00:00:00
abstract::I have discussed the pharmacokinetics, efficacies, and side effects of the various nonnarcotic drugs available for the treatment of patients who have headache. Sumatriptan, the newest one, is expensive but may be cost-effective for those who have failed traditional migraine treatment, who visit the ER frequently, who ...
journal_title:Journal of general internal medicine
pub_type: 杂志文章,评审
doi:10.1007/BF02599185
更新日期:1994-06-01 00:00:00
abstract:OBJECTIVE:To examine in-depth the lives of women whose partners attempted to kill them, and to identify patterns that may aid in the clinician's ability to predict, prevent, or counsel about femicide or attempted femicide. DESIGN:Qualitative analysis of 30 in-depth interviews. SETTING:Six U.S. cities. PARTICIPANTS:T...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1046/j.1525-1497.2003.21202.x
更新日期:2003-10-01 00:00:00
abstract:BACKGROUND:Patients with limited English proficiency (LEP) may be at risk for medical errors and worse health outcomes. Language concordance between patient and provider has been shown to improve health outcomes for Spanish-speaking patients. Nearly 40 % of Hispanics, a growing population in the United States, are cate...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-015-3309-3
更新日期:2015-10-01 00:00:00
abstract:BACKGROUND:Concern about the link between clinical supervision and safe, quality health care has led to widespread increases in the supervision of medical trainees. The effects of increased supervision on patient care and trainee education are not known, primarily because the current multifacted and poorly operationali...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-007-0179-3
更新日期:2007-08-01 00:00:00
abstract:OBJECTIVES:To assess the prevalence and persistence of depression in patients with acute myocardial infarction (AMI) and the relationship between assessment modality and prevalence. DATA SOURCES:MEDLINE, Cochrane, CINAHL, PsycINFO, and EMBASE. REVIEW METHODS:A comprehensive search was conducted in March 2004 to ident...
journal_title:Journal of general internal medicine
pub_type: 杂志文章,评审
doi:10.1111/j.1525-1497.2005.00269.x
更新日期:2006-01-01 00:00:00
abstract:PURPOSE:Anxiety is thought to affect test performance. Studies have shown that students with low levels of test anxiety achieve higher scores on multiple choice question (MCQ) examinations than those with high anxiety levels. Female students have been shown to have higher test anxiety levels than male students. Standar...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1111/j.1525-1497.2006.00419.x
更新日期:2006-05-01 00:00:00
abstract:OBJECTIVE:African-American (black) and white individuals have been shown to differ in their desire for life-sustaining treatments and their use of living wills for end-of-life care, but the reasons for these differences are unclear. This study was designed to test the hypothesis that these ethnic differences exist beca...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/BF02600155
更新日期:1996-11-01 00:00:00
abstract:BACKGROUND:Physician opinion can influence the prospects for health care reform, yet there are few recent data on physician views on reform proposals or access to medical care in the United States. OBJECTIVE:To assess physician views on financing options for expanding health care coverage and on access to health care....
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-009-0916-x
更新日期:2009-04-01 00:00:00
abstract:MAIN RESULTS:Compared with younger patients, patients aged 50 years or older were less likely to have acquired HIV via intravenous drug use or homosexual contact (p = .0001). Older patients were more likely to have comorbid diseases (12% vs 4%; p = .0001), had more frequent neurologic findings on admission (19% vs 9%; ...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/BF02599026
更新日期:1996-10-01 00:00:00
abstract:BACKGROUND:Colorectal cancer (CRC) screening can be administered through tests with varied characteristics and is a preference-sensitive decision. OBJECTIVE:To assess patient experiences with a Maximum Differences Scaling (MDS) tool for eliciting values about CRC screening test characteristics and determine whether pa...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-010-1318-9
更新日期:2010-07-01 00:00:00
abstract:BACKGROUND:There are no life-tables quantifying the average life-spans of post-hospitalized heart failure populations across various strata of risk. OBJECTIVE:To quantify the life-expectancies (i.e., average life-spans) of heart failure patients at the time of hospital discharge according to age, gender, predictive 30...
journal_title:Journal of general internal medicine
pub_type: 杂志文章,随机对照试验
doi:10.1007/s11606-012-2072-y
更新日期:2012-09-01 00:00:00
abstract:BACKGROUND:African-American women have had higher rates of female sterilization compared to white women since its emergence as a contraceptive method. The reasons underlying this observed racial difference are unknown. OBJECTIVES:The goals of this study were to (1) explore what factors shape black and white women's de...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-008-0887-3
更新日期:2009-03-01 00:00:00
abstract:BACKGROUND:There is growing interest in developing systems to overcome barriers for acquiring and interpreting family health histories in primary care. OBJECTIVE:To examine the capacity of three different electronic portals to collect family history from patients and deposit valid data in an electronic health record (...
journal_title:Journal of general internal medicine
pub_type: 临床试验,杂志文章,多中心研究
doi:10.1007/s11606-013-2442-0
更新日期:2013-12-01 00:00:00
abstract::Research into health literacy and shared decision-making has largely developed along parallel, but distinct lines over the past two decades. There is little evidence that the concepts and related practice have intersected except in the most functional way, for example, to simplify shared decision-making tools by impro...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-020-05912-0
更新日期:2020-05-29 00:00:00
abstract:BACKGROUND:Approximately one in six adults in the United States (U.S.) binge drinks. The U.S. Preventive Services Task Force recommends that primary care physicians screen patients for such hazardous alcohol use, and when warranted, deliver a brief intervention. OBJECTIVE:We aimed to determine primary care residents' ...
journal_title:Journal of general internal medicine
pub_type: 杂志文章,多中心研究
doi:10.1007/s11606-015-3184-y
更新日期:2015-06-01 00:00:00
abstract:BACKGROUND:Process measures of healthcare quality are usually formulated as the number of patients who receive evidence-based treatment (numerator) divided by the number of patients in the target population (denominator). When the systems being evaluated can influence which patients are included in the denominator, it ...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-015-3558-1
更新日期:2016-04-01 00:00:00
abstract:BACKGROUND:Despite evidence-based guidelines, high-quality diabetes care is not always achieved. Identifying factors associated with the quality of management in primary care may inform service improvements, facilitating the tailoring of quality improvement interventions to practice needs and resources. METHODS:We sea...
journal_title:Journal of general internal medicine
pub_type: 杂志文章,评审
doi:10.1007/s11606-020-05676-7
更新日期:2020-06-01 00:00:00
abstract:OBJECTIVE:To determine whether a Bayesian method of lung scan (LS) reporting could influence the management of patients with suspected pulmonary embolism (PE). DESIGN:1) A descriptive study of the diagnostic process for suspected PE using the new reporting method; 2) a non-experimental evaluation of the reporting meth...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/BF02600392
更新日期:1990-07-01 00:00:00
abstract::General internal medicine (GIM) fellowships play an important role in the development of physician scientists and clinical educators, as well as leaders in academic medicine. Nevertheless, the challenges of developing another novel aspect to one's career, along with balancing coursework, research productivity, clinica...
journal_title:Journal of general internal medicine
pub_type: 社论
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更新日期:2020-12-01 00:00:00
abstract::To understand the effect that termination of an established physician-patient relationship has on patient attendance patterns in a medical clinic, appointment scheduling and patient attendance were measured for 210 patients before and after 11 senior resident physicians left the clinic. There was no significant change...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/BF02599811
更新日期:1986-03-01 00:00:00
abstract:BACKGROUND:Patients are often treated in hospital by physicians other than their regular community doctor. After they are discharged, their care is often returned to their regular community doctor and patients may not see the hospital physician. Transfer of information between physicians can be poor. We determined whet...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1111/j.1525-1497.2004.30082.x
更新日期:2004-06-01 00:00:00
abstract:BACKGROUND:High-quality communication about end-of-life care results in greater patient and family satisfaction. End-of-life discussions should occur early during the patient's disease trajectory and yet is often addressed only when patients become severely ill. As a result, end-of-life discussions are commonly initiat...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-019-05615-1
更新日期:2020-04-01 00:00:00