Peer Mentoring and Financial Incentives to Improve Glucose Control in African American Veterans A Randomized Trial

被引:240
作者
Long, Judith A.
Jahnle, Erica C.
Richardson, Diane M.
Loewenstein, George
Volpp, Kevin G.
机构
[1] Philadelphia Vet Affairs Ctr Hlth Equ Research &, Philadelphia, PA USA
[2] Univ Penn, Leonard Davis Inst Hlth Econ, Ctr Hlth Incent, Philadelphia, PA 19104 USA
[3] Carnegie Mellon Univ, Pittsburgh, PA 15213 USA
关键词
GLYCEMIC CONTROL; SELF-MANAGEMENT; SOCIAL SUPPORT; WEIGHT-LOSS; CLINICAL-OUTCOMES; CARE MANAGEMENT; GROUP VISITS; HEALTH-CARE; TYPE-2; BEHAVIORS;
D O I
10.7326/0003-4819-156-6-201203200-00004
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background: Compared with white persons, African Americans have a greater incidence of diabetes, decreased control, and higher rates of microvascular complications. A peer mentorship model could be a scalable approach to improving control in this population and reducing disparities in diabetic outcomes. Objective: To determine whether peer mentors or financial incentives are superior to usual care in helping African American veterans decrease their hemoglobin A(1c) (HbA(1c)) levels. Design: A 6-month randomized, controlled trial. (ClinicalTrials.gov registration number: NCT01125956) Setting: Philadelphia Veterans Affairs Medical Center. Patients: African American veterans aged 50 to 70 years with persistently poor diabetes control. Intervention: 118 patients were randomly assigned to 1 of 3 groups: usual care, a peer mentoring group, and a financial incentives group. Usual care patients were notified of their starting HbA(1c) level and recommended goals for HbA(1c). Those in the peer mentoring group were assigned a mentor who formerly had poor glycemic control but now had good control (HbA(1c) level <= 7.5%). The mentor was asked to talk with the patient at least once per week. Peer mentors were matched by race, sex, and age. Patients in the financial incentive group could earn $100 by decreasing their HbA(1c) level by 1% and $200 by decreasing it by 2% or to an HbA(1c) level of 6.5%. Measurements: Change in HbA(1c) level at 6 months. Results: Mentors and mentees talked the most in the first month (mean calls, 4; range, 0 to 30), but calls decreased to a mean of 2 calls (range, 0 to 10) by the sixth month. Levels of HbA(1c) decreased from 9.9% to 9.8% in the control group, from 9.8% to 8.7% in the peer mentor group, and from 9.5% to 9.1% in the financial incentive group. Mean change in HbA(1c) level from baseline to 6 months relative to control was -1.07% (95% CI, -1.84% to -0.31%) in the peer mentor group and -0.45% (CI, -1.23% to 0.32%) in the financial incentive group. Limitation: The study included only veterans and lasted only 6 months. Conclusion: Peer mentorship improved glucose control in a cohort of African American veterans with diabetes.
引用
收藏
页码:416 / U60
页数:10
相关论文
共 53 条
[1]  
[Anonymous], 2002, DIABETES CARE, V25, pS28, DOI DOI 10.2337/DIACARE.25.2007.S28
[2]  
[Anonymous], ETHICAL CONSIDERATIO
[3]   Differences in the patterns of health care system distrust between blacks and whites [J].
Armstrong, Katrina ;
McMurphy, Suzanne ;
Dean, Lorraine T. ;
Micco, Ellyn ;
Putt, Mary ;
Halbert, Chanita Hughes ;
Schwartz, J. Sanford ;
Sankar, Pamela ;
Pyeritz, Reed E. ;
Bernhardt, Barbara ;
Shea, Judy A. .
JOURNAL OF GENERAL INTERNAL MEDICINE, 2008, 23 (06) :827-833
[4]   Personal responsibility and physician responsibility - West Virginia's Medicaid plan [J].
Bishop, Gene ;
Brodkey, Amy C. .
NEW ENGLAND JOURNAL OF MEDICINE, 2006, 355 (08) :756-758
[5]  
[Centers for Disease Control and Prevention National Institutes of Health American Diabetes Association], 2007, NAT DIAB FACT SHEET
[6]   Evaluating concordance to American Diabetes Association standards of care for type 2 diabetes through group visits in an uninsured or inadequately insured patient population [J].
Clancy, DE ;
Cope, DW ;
Magruder, KM ;
Huang, P ;
Wolfman, TE .
DIABETES CARE, 2003, 26 (07) :2032-2036
[7]   Review: A gentle introduction to imputation of missing values [J].
Donders, A. Rogier T. ;
van der Heijden, Geert J. M. G. ;
Stijnen, Theo ;
Moons, Karel G. M. .
JOURNAL OF CLINICAL EPIDEMIOLOGY, 2006, 59 (10) :1087-1091
[8]   Glucose Control and Vascular Complications in Veterans with Type 2 Diabetes [J].
Duckworth, William ;
Abraira, Carlos ;
Moritz, Thomas ;
Reda, Domenic ;
Emanuele, Nicholas ;
Reaven, Peter D. ;
Zieve, Franklin J. ;
Marks, Jennifer ;
Davis, Stephen N. ;
Hayward, Rodney ;
Warren, Stuart R. ;
Goldman, Steven ;
McCarren, Madeline ;
Vitek, Mary Ellen ;
Henderson, William G. ;
Huang, Grant D. .
NEW ENGLAND JOURNAL OF MEDICINE, 2009, 360 (02) :129-U62
[9]   Ethnicity, race, and baseline retinopathy correlates in the Veterans Affairs Diabetes Trial [J].
Emanuele, N ;
Sacks, J ;
Klein, R ;
Reda, D ;
Anderson, R ;
Duckworth, W ;
Abraira, C .
DIABETES CARE, 2005, 28 (08) :1954-1958
[10]   The influence of social support on chronic illness self-management: A review and directions for research [J].
Gallant, MP .
HEALTH EDUCATION & BEHAVIOR, 2003, 30 (02) :170-195