Aditi Sen, PhD
George Loewenstein, PhD
Kevin Volpp, MD, PhD
National Institute on Aging
Cost-effective approaches are needed to manage the health of patients with chronic conditions. Remote monitoring using wireless devices could play an essential role in improving population health, but its utility depends on patient adherence.
A team of researchers from the University of Pennsylvania leveraged Way to Health to test the effect of lottery-based financial incentives to improve adherence to remote-monitoring regimens among patients with poorly controlled diabetes.
The team conducted a six-month randomized controlled trial consisting of a three-month intervention period and a three-month follow-up period. Enrolled patients received a glucometer, digital blood pressure monitor, and digital scale for daily home monitoring, and a device to automatically send readings to the study website.
Participants were assigned to one of three study arms with varying incentives. Participants in the high- and low-incentive groups who used all three biometric devices and transmitted their results on time were eligible to win a reward from a daily lottery.
- High-incentive group: Participants were entered into a lottery with an expected average daily reward of $2.80
- Low-incentive group: Participants were entered into a lottery with an expected average daily reward of $1.40
- Control group: Participants were not offered incentives
Participants in the incentive arms used biometric devices significantly more than participants in the control group during the three-month intervention.
There was no significant difference in adherence between the two incentive arms during the intervention period. However, after incentives were removed, adherence declined in the high-incentive arm but remained relatively high in the low-incentive arm. These results indicate that low-incentive daily lotteries can encourage sustained adherence to remote monitoring regimens.