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Authors
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Director, Fostering Improvement in End-of-Life Decision Science (FIELDS) Program; Deputy Director, Center for Health Incentives and Behavioral Economics, Leonard Davis Institute of Health EconomicsScott Halpern, MD, PhD
Director, Fostering Improvement in End-of-Life Decision Science (FIELDS) Program; Deputy Director, Center for Health Incentives and Behavioral Economics, Leonard Davis Institute of Health EconomicsDirector, Fostering Improvement in End-of-Life Decision Science (FIELDS) Program; Deputy Director, Center for Health Incentives and Behavioral Economics, Leonard Davis Institute of Health Economics
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Faculty at the University of PennsylvaniaBenjamin French, PhD
Faculty at the University of PennsylvaniaFaculty at the University of Pennsylvania
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Statistician specializing in causal inference and applications to the health sciencesDylan Small, Ph.D
Statistician specializing in causal inference and applications to the health sciencesStatistician specializing in causal inference and applications to the health sciences
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Medical Student at .Kathryn Saulsgiver, PhD
Medical Student at .Medical Student at .
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Doctoral student in epidemiology at the University of PennsylvaniaMichael Harhay
Doctoral student in epidemiology at the University of PennsylvaniaDoctoral student in epidemiology at the University of Pennsylvania
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Professor, Perelman School of Medicine and the Wharton School, University of PennsylvaniaDavid Asch, MD
Professor, Perelman School of Medicine and the Wharton School, University of PennsylvaniaProfessor, Perelman School of Medicine and the Wharton School, University of Pennsylvania
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Developing and testing innovative ways of applying insights from behavioral economics in improving patient health behavior and affecting provider performanceKevin Volpp, M.D., Ph.D
Developing and testing innovative ways of applying insights from behavioral economics in improving patient health behavior and affecting provider performanceDeveloping and testing innovative ways of applying insights from behavioral economics in improving patient health behavior and affecting provider performance
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Experts
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Associate Editor of the Journal of Lipid ResearchGodfrey Getz, MD
Associate Editor of the Journal of Lipid ResearchAssociate Editor of the Journal of Lipid Research
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Dancing Doctor, Informatics, Public Health, Predictive Analytics, Positive Deviance, InnovationJay Bhatt, DO, MPH, MPA, FACP
Dancing Doctor, Informatics, Public Health, Predictive Analytics, Positive Deviance, InnovationDancing Doctor, Informatics, Public Health, Predictive Analytics, Positive Deviance, Innovation
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General internist with extensive experience improving the care of vulnerable patients with chronic diseaseMarshall Chin, MD, MPH
General internist with extensive experience improving the care of vulnerable patients with chronic diseaseGeneral internist with extensive experience improving the care of vulnerable patients with chronic disease
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General internist studying clinical and health care policy issues at the intersection of diabetes, aging, and health economicsElbert Huang, MD
General internist studying clinical and health care policy issues at the intersection of diabetes, aging, and health economicsGeneral internist studying clinical and health care policy issues at the intersection of diabetes, aging, and health economics
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Senior Investigator at the Group Health Research InstituteDavid Grossman, MD, MPH
Senior Investigator at the Group Health Research InstituteSenior Investigator at the Group Health Research Institute
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Focusing on on improving patient-centered education for underserved patients through novel interventionsValerie Press, MD, MPH
Focusing on on improving patient-centered education for underserved patients through novel interventionsFocusing on on improving patient-centered education for underserved patients through novel interventions
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Associate Senior Medical Officer at CareMore Health SystemJohn Farag, MD
Associate Senior Medical Officer at CareMore Health SystemAssociate Senior Medical Officer at CareMore Health System
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Lead Moderators
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Principal at Longwood Fund | Hospitalist at Massachusetts General HospitalShaan Gandhi, MD, DPhil, MBA
Principal at Longwood Fund | Hospitalist at Massachusetts General HospitalPrincipal at Longwood Fund | Hospitalist at Massachusetts General Hospital
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Moderators
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Hospitalist At Thomas Jefferson University and Medical Liaison at Jefferson's Digital Innovation and Consumer Experience (DICE) group, Leader, Entrepreneur, Sports and Food JunkieTejal Naik, MD
Hospitalist At Thomas Jefferson University and Medical Liaison at Jefferson's Digital Innovation and Consumer Experience (DICE) group, Leader, Entrepreneur, Sports and Food JunkieHospitalist At Thomas Jefferson University and Medical Liaison at Jefferson's Digital Innovation and Consumer Experience (DICE) group, Leader, Entrepreneur, Sports and Food Junkie
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MD/PhD candidate at Harvard Medical School and MITRachel Wolfson
MD/PhD candidate at Harvard Medical School and MITMD/PhD candidate at Harvard Medical School and MIT
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Co-Founder of Salubris AnalyticsJesus Trevino
Co-Founder of Salubris AnalyticsCo-Founder of Salubris Analytics
About the Discussion
@NEJM Ask the Authors and Experts: Randomized Trial of Four Financial-Incentive Programs for Smoking Cessation
Original Article
Randomized Trial of Four Financial-Incentive Programs for Smoking Cessation
Background
Financial incentives promote many health behaviors, but effective ways to deliver health incentives remain uncertain.
Methods
We randomly assigned CVS Caremark employees and their relatives and friends to one of four incentive programs or to usual care for smoking cessation. Two of the incentive programs targeted individuals, and two targeted groups of six participants. One of the individual-oriented programs and one of the group-oriented programs entailed rewards of approximately $800 for smoking cessation; the others entailed refundable deposits of $150 plus $650 in reward payments for successful participants. Usual care included informational resources and free smoking-cessation aids.
Results
Overall, 2538 participants were enrolled. Of those assigned to reward-based programs, 90.0% accepted the assignment, as compared with 13.7% of those assigned to deposit-based programs (P<0.001). In intention-to-treat analyses, rates of sustained abstinence from smoking through 6 months were higher with each of the four incentive programs (range, 9.4 to 16.0%) than with usual care (6.0%) (P<0.05 for all comparisons); the superiority of reward-based programs was sustained through 12 months. Group-oriented and individual-oriented programs were associated with similar 6-month abstinence rates (13.7% and 12.1%, respectively; P = 0.29). Reward-based programs were associated with higher abstinence rates than deposit-based programs (15.7% vs. 10.2%, P<0.001). However, in instrumental-variable analyses that accounted for differential acceptance, the rate of abstinence at 6 months was 13.2 percentage points (95% confidence interval, 3.1 to 22.8) higher in the deposit-based programs than in the reward-based programs among the estimated 13.7% of the participants who would accept participation in either type of program.
Conclusions
Reward-based programs were much more commonly accepted than deposit-based programs, leading to higher rates of sustained abstinence from smoking. Group-oriented incentive programs were no more effective than individual-oriented pro-grams. (Funded by the National Institutes of Health and CVS Caremark; Clinical-Trials.gov number, NCT01526265.)
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Authors
-
Director, Fostering Improvement in End-of-Life Decision Science (FIELDS) Program; Deputy Director, Center for Health Incentives and Behavioral Economics, Leonard Davis Institute of Health EconomicsScott Halpern, MD, PhD
Director, Fostering Improvement in End-of-Life Decision Science (FIELDS) Program; Deputy Director, Center for Health Incentives and Behavioral Economics, Leonard Davis Institute of Health Economics
Director, Fostering Improvement in End-of-Life Decision Science (FIELDS) Program; Deputy Director, Center for Health Incentives and Behavioral Economics, Leonard Davis Institute of Health Economics
-
Faculty at the University of PennsylvaniaBenjamin French, PhD
Faculty at the University of Pennsylvania
Faculty at the University of Pennsylvania
-
Statistician specializing in causal inference and applications to the health sciencesDylan Small, Ph.D
Statistician specializing in causal inference and applications to the health sciences
Statistician specializing in causal inference and applications to the health sciences
-
Medical Student at .Kathryn Saulsgiver, PhD
Medical Student at .
Medical Student at .
-
Doctoral student in epidemiology at the University of PennsylvaniaMichael Harhay
Doctoral student in epidemiology at the University of Pennsylvania
Doctoral student in epidemiology at the University of Pennsylvania
-
Professor, Perelman School of Medicine and the Wharton School, University of PennsylvaniaDavid Asch, MD
Professor, Perelman School of Medicine and the Wharton School, University of Pennsylvania
Professor, Perelman School of Medicine and the Wharton School, University of Pennsylvania
-
Developing and testing innovative ways of applying insights from behavioral economics in improving patient health behavior and affecting provider performanceKevin Volpp, M.D., Ph.D
Developing and testing innovative ways of applying insights from behavioral economics in improving patient health behavior and affecting provider performance
Developing and testing innovative ways of applying insights from behavioral economics in improving patient health behavior and affecting provider performance
-
Experts
-
Associate Editor of the Journal of Lipid ResearchGodfrey Getz, MD
Associate Editor of the Journal of Lipid Research
Associate Editor of the Journal of Lipid Research
-
Dancing Doctor, Informatics, Public Health, Predictive Analytics, Positive Deviance, InnovationJay Bhatt, DO, MPH, MPA, FACP
Dancing Doctor, Informatics, Public Health, Predictive Analytics, Positive Deviance, Innovation
Dancing Doctor, Informatics, Public Health, Predictive Analytics, Positive Deviance, Innovation
-
General internist with extensive experience improving the care of vulnerable patients with chronic diseaseMarshall Chin, MD, MPH
General internist with extensive experience improving the care of vulnerable patients with chronic disease
General internist with extensive experience improving the care of vulnerable patients with chronic disease
-
General internist studying clinical and health care policy issues at the intersection of diabetes, aging, and health economicsElbert Huang, MD
General internist studying clinical and health care policy issues at the intersection of diabetes, aging, and health economics
General internist studying clinical and health care policy issues at the intersection of diabetes, aging, and health economics
-
Senior Investigator at the Group Health Research InstituteDavid Grossman, MD, MPH
Senior Investigator at the Group Health Research Institute
Senior Investigator at the Group Health Research Institute
-
Focusing on on improving patient-centered education for underserved patients through novel interventionsValerie Press, MD, MPH
Focusing on on improving patient-centered education for underserved patients through novel interventions
Focusing on on improving patient-centered education for underserved patients through novel interventions
-
Associate Senior Medical Officer at CareMore Health SystemJohn Farag, MD
Associate Senior Medical Officer at CareMore Health System
Associate Senior Medical Officer at CareMore Health System
-
Lead Moderators
-
Principal at Longwood Fund | Hospitalist at Massachusetts General HospitalShaan Gandhi, MD, DPhil, MBA
Principal at Longwood Fund | Hospitalist at Massachusetts General Hospital
Principal at Longwood Fund | Hospitalist at Massachusetts General Hospital
-
Moderators
-
Hospitalist At Thomas Jefferson University and Medical Liaison at Jefferson's Digital Innovation and Consumer Experience (DICE) group, Leader, Entrepreneur, Sports and Food JunkieTejal Naik, MD
Hospitalist At Thomas Jefferson University and Medical Liaison at Jefferson's Digital Innovation and Consumer Experience (DICE) group, Leader, Entrepreneur, Sports and Food Junkie
Hospitalist At Thomas Jefferson University and Medical Liaison at Jefferson's Digital Innovation and Consumer Experience (DICE) group, Leader, Entrepreneur, Sports and Food Junkie
-
MD/PhD candidate at Harvard Medical School and MITRachel Wolfson
MD/PhD candidate at Harvard Medical School and MIT
MD/PhD candidate at Harvard Medical School and MIT
-
Co-Founder of Salubris AnalyticsJesus Trevino
Co-Founder of Salubris Analytics
Co-Founder of Salubris Analytics
