Financial Incentives for Medicaid Beneficiaries With Diabetes: Lessons Learned From HI-PRAISE, an Observational Study and Randomized Controlled Trial.

PURPOSE: The Hawaii Patient Reward and Incentives to Support Empowerment (HI-PRAISE) project examined the impact of financial incentives on Medicaid beneficiaries with diabetes. DESIGN: Observational pre-post study and randomized controlled trial (RCT). SETTING: Federally qualified health centers (FQHCs) and Hawaii Kaiser Permanente. PARTICIPANTS: The observational study included 2003 Medicaid beneficiaries with diabetes from FQHCs. The RCT included 320 participants from Kaiser Permanente. INTERVENTION: Participants could earn up to $320/year of financial incentives for a minimum of 1 year. MEASURES: (1) Clinical outcomes of change in hemoglobin A1c (HbA1c), blood pressure, and cholesterol; (2) compliance with American Diabetes Association (ADA) standards of diabetes care; and (3) cost effectiveness. ANALYSIS: Generalized estimating equation models were used to assess differences in clinical outcomes. General linear models were utilized to estimate the medical costs per patient/day. RESULTS: Changes in clinical outcomes in the observational study were statistically significant. Mean HbA1c decreased from 8.56% to 8.24% ( P < .0001) and low-density lipoprotein decreased from 106.17 mg/dL to 98.55 mg/dL ( P < .0001). No significant differences were found between groups in the RCT. Improved ADA compliance was observed. No reduction in total health cost during the project period was demonstrated. CONCLUSION: The HI-PRAISE found no conclusive evidence that financial incentives had beneficial effect on diabetes clinical outcomes or cost saving measures.

Risk of Diabetes Mellitus Among Medicaid Beneficiaries in Hawaii.

INTRODUCTION: Medicaid is the largest primary health insurance for low-income populations in the United States, and it provides comprehensive benefits to cover treatment and services costs for chronic diseases, including diabetes. The standardized per capita spending on diabetes by Medicare beneficiaries enrolled in the fee-for-service program in Hawaii increased from 2012 to 2015. We examined the difference in odds of diabetes between Medicaid and non-Medicaid populations in major racial/ethnic groups in Hawaii. METHODS: We used data from 2013 through 2015 from the Hawaii Behavioral Risk Factor Surveillance System in this cross-sectional study to compare the difference in risk for self-reported diabetes between Medicaid (n = 1,889) and non-Medicaid (n = 17,207) beneficiaries. We used multivariate logistic regression models that could accommodate the complex sampling design to examine the difference in odds of diabetes between the 2 populations. RESULTS: In Hawaii, the Medicaid population was younger, was less educated, had more health impairments, and was more likely to be obese and Native Hawaiian/Other Pacific Islander (NH/OPI) than the non-Medicaid population. The unadjusted prevalence of diabetes in the Medicaid population in Hawaii was higher than that for the non-Medicaid population (10.3% vs 8.9%, P = .02). After adjusting for confounding variables, the odds of diabetes in the Medicaid population was still significantly higher than those in the non-Medicaid population (adjusted odds ratio [AOR] = 1.75; 95% confidence interval [CI], 1.33-2.31). Adjusted analysis stratified by race/ethnicity showed that non-Hispanic Asian (AOR = 2.23; 95% CI, 1.31-3.78) and NH/OPI (AOR = 3.17; 95% CI, 1.05-9.54) Medicaid beneficiaries had significantly higher odds of diabetes than their non-Medicaid counterparts. CONCLUSION: The odds of diabetes was significantly higher among the Hawaii Medicaid population than among the non-Medicaid population. Diabetes prevention programs should address the challenges and barriers that the Medicaid population faces. Our findings can be used to promote culturally competent diabetes education programs.

Gender differences in home environments related to childhood obesity in Nanchang, China.

BACKGROUND: Childhood obesity is rapidly increasing in China, with rates doubling between 2000 and 2010. Several large, epidemiological studies have shown boys to be consistently more likely to be obese than girls. The aim of this study was to investigate gender differences in the home environment and parenting practices related to childhood obesity. METHODS: A cross-sectional survey using a convenience sampling of 522 (86.1% response rate) primary caregivers of children ages 2-10 years was conducted in four locations in Nanchang, China, in the spring of 2013 using face-to-face, anonymous questionnaires. RESULTS: Boys were significantly (p<0.05) more likely than girls to watch more television (TV) per week, be allowed to have snacks/sweets or soft drinks without permission, and to have sugary drinks at snacks and meals. Girls were significantly more likely than boys to have parental encouragement and support for physical activity, participate in organized sports/group activities, and have fresh fruits accessible. Parents also believed that boys eat too much junk foods or their favorite foods if not controlled. Few differences were noted in the actual physical environment in the home, including access to sports equipment, junk food availability, and access to media. CONCLUSIONS: RESULTS indicate that parents tend to be more permissive with boys than girls, allowing them access to unhealthy foods and more TV time. These differences may contribute to the higher prevalence of obesity in boys in China.

Diabetes knowledge and self-management effects on physiological outcomes in type 2 diabetes.

PURPOSE: The purpose of this study was to determine whether Asian Pacific Islanders with type 2 diabetes who have better knowledge and self-management would have better baseline hemoglobin A1c (HbA1c) and total cholesterol values. Signicant relationships were found among (a) general diet on HbA1c (p < .030), (b) medications on HbA1c (< .009), and (c) diabetes knowledge on HbA1c (p < .001). Participants with active self-management regimens were expected to demonstrate better laboratory values than those who did not implement self-management. However, persons with knowledge may for other reasons still lack self-management. PRACTICAL IMPLICATIONS: Future studies comparing baseline results to post-additional education sessions may yield better comparisons.