Objective: Analysis of the effectiveness of a small financial incentive and a written reminder to encourage test taking among persons with diabetes who have missed glycosylated hemoglobin (HbAlc) and low-density lipoprotein cholesterol (LDL-C) screenings.
Research design and methods: The analysis uses data from the University of Wisconsin Medical Foundation medical records of persons diagnosed with diabetes who had not received an HbA1c screening or had not received an LDL-C screening over the previous year (prior to October 2005). This study uses a quasi-experimental design comparing 464 diabetic patients (cases) who received a letter reminder of screening and financial incentive for undergoing screening, and 693 controls who did not receive a letter or financial incentive. The treated patients (464) all were seen in 1 of 4 clinics while those not treated used different clinics within the same system of care. Propensity scores served as the matching procedure using the following covariates: age, gender, ethnicity, marital status, number of HbA1c tests and number of LDL-C tests in the year prior to pilot program, mean HbA1c levels in the year prior to the pilot program (when available), census income data, and a comorbidity measure.
Results: During the 2 years following the pilot program, on average the target or "treated" population received significantly more screenings--3.34-compared to 2.69 screenings for the matched comparison group, and a far smaller proportion of the target population had no screening at all.
Conclusions: The results provide evidence that a small financial incentive coupled with a written reminder work to increase test taking (especially the HbA1c screening) and suggest greater control of HbA1c levels among persons who had previously missed screenings.