Financial Incentives for Alzheimer's Prevention
(FIND-AD Trial)
Recruiting in Palo Alto (17 mi)
Age: 18+
Sex: Any
Travel: May Be Covered
Time Reimbursement: Varies
Trial Phase: Academic
Recruiting
Sponsor: University of Southern California
Disqualifiers: Below age 50, Dementia diagnosis
No Placebo Group
Trial Summary
What is the purpose of this trial?This single-blind, three-arm, randomized, controlled trial will assess the impact of messages and financial incentives on the enrollment of demographically diverse individuals to the Alzheimer Prevention Trials (APT) Webstudy. The APT Webstudy is a novel, online registry that employs quarterly cognitive testing using validated platforms. The APT Webstudy implements fully remote assessments, coordinated by the Alzheimer's Therapeutic Research Institute (ATRI) under USC IRB #HS-17-00746. The purpose of the current study is to test whether we can increase enrollment of diverse individuals into the registry. To do this, we will work with Contra Costa Regional Medical Center (CCRMC), the county public hospital and its affiliated health centers in Contra Costa County, California, to test whether sending messages with and without financial incentives to patients who receive primary care with the health system can increase enrollment to the APT Webstudy. The investigators hypothesize that 1) a certain small financial incentive and an award opportunity based incentive (or a drawing with a prize) will increase enrollment rates of CCHS members into the APT Webstudy relative to the control group. The investigators further hypothesize that the award opportunity incentive will increase the enrollment rate of CCRMC patients into the APT Webstudy more than a certain financial incentive with the same expected value.
Will I have to stop taking my current medications?
The trial information does not specify whether you need to stop taking your current medications.
What data supports the effectiveness of the treatment Financial Incentives for Alzheimer's Prevention?
Research shows that financial incentives can motivate changes in health-related behaviors and improve performance in healthcare settings. However, the effectiveness of these incentives can vary based on how they are designed and implemented, especially for older adults who may have different decision-making processes.
12345Is the treatment involving financial incentives for Alzheimer's prevention safe for humans?
The research does not provide specific safety data for financial incentives as a treatment for Alzheimer's prevention, but it mentions the importance of considering safety and tolerability in future trials.
678910How does the financial incentive treatment for Alzheimer's prevention differ from other treatments?
This treatment is unique because it uses financial incentives to encourage healthy behaviors that may prevent Alzheimer's, rather than relying on medication or traditional therapies. It focuses on motivating lifestyle changes through monetary rewards, which is a novel approach compared to standard medical treatments for Alzheimer's.
111121314Eligibility Criteria
This trial is for individuals aged 50 or older who are patients at Contra Costa Regional Medical Center and its affiliated health centers. Participants must be literate in English or Spanish. The study aims to recruit a diverse group of people into an online Alzheimer's disease registry.Inclusion Criteria
I am 50 years old or older.
I can read and understand either English or Spanish.
You are a patient registered at CCRMC or its associated health centers.
Trial Timeline
Screening
Participants are screened for eligibility to participate in the trial
2-4 weeks
Enrollment
Participants are enrolled into the APT Webstudy and randomized into different arms with or without financial incentives
2 weeks
Fully remote
Cognitive Assessment
Participants complete cognitive assessments using the Cognitive Function Instrument and/or Cogstate Brief Battery
2 weeks
Quarterly remote assessments
Follow-up
Participants are monitored for enrollment status and completion of cognitive assessments
Annual
Participant Groups
The study is testing if sending messages with financial incentives, such as small cash rewards or prize drawings, can increase enrollment in the APT Webstudy—a remote cognitive testing program—compared to just sending messages without incentives.
3Treatment groups
Experimental Treatment
Active Control
Group I: Small IncentiveExperimental Treatment1 Intervention
16,000 participants will be randomized to Arm 2 where a small one-time monetary incentive is offered.
Group II: Prize IncentiveExperimental Treatment1 Intervention
16,000 participants will be randomized to Arm 3 where an opportunity based incentive (or a drawing with a prize) with a single winner will be offered.
Group III: Messaging OnlyActive Control1 Intervention
16,000 participants will be randomized to Arm 1 where no monetary incentive is offered.
Find a Clinic Near You
Research Locations NearbySelect from list below to view details:
Contra Costa Health PlanMartinez, CA
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Who Is Running the Clinical Trial?
University of Southern CaliforniaLead Sponsor
American Heart AssociationCollaborator
Schaeffer Center for Health Policy & EconomicsCollaborator
Alzheimer's Therapeutic Research InstituteCollaborator
References
Challenges and opportunities for developing and implementing incentives to improve health-related behaviors in older adults. [2021]There is growing interest in using patient-directed incentives to change health-related behaviors. Advocates of incentive programs have proposed an ambitious research agenda for moving patient incentive programs forward. The unique cognitive and psychological features of older adults, however, present a challenge to this agenda. In particular, age-related changes in emotional regulation, executive function, and cognitive capacities, and a preference for collaborative decision-making raise questions about the suitability of these programs, particularly the structure of current financial incentives, for older adults. Differences in decision-making in older adults need to be accounted for in the design and implementation of financial incentive programs. Financial incentive programs adjusted to characteristics of older adult populations may be more likely to improve the lives of older persons and the economic success of programs that serve them.
An overview of reviews evaluating the effectiveness of financial incentives in changing healthcare professional behaviours and patient outcomes. [2022]There is considerable interest in the effectiveness of financial incentives in the delivery of health care. Incentives may be used in an attempt to increase the use of evidence-based treatments among healthcare professionals or to stimulate health professionals to change their clinical behaviour with respect to preventive, diagnostic and treatment decisions, or both. Financial incentives are an extrinsic source of motivation and exist when an individual can expect a monetary transfer which is made conditional on acting in a particular way. Since there are numerous reviews performed within the healthcare area describing the effects of various types of financial incentives, it is important to summarise the effectiveness of these in an overview to discern which are most effective in changing health professionals' behaviour and patient outcomes.
The effect of pharmacy benefit design on patient-physician communication about costs. [2021]Incentive-based formularies have been widely instituted to control the rising costs of prescription drugs. To work properly, such formularies depend on patients to be aware of financial incentives and communicate their cost preferences with prescribing physicians. The impact of financial incentives on patient awareness of and communication about those costs is unknown.
Increasing performance of health care services within economic constraints: working towards improved incentive structures. [2019]There is increasing evidence that health care systems can create better value for money by improving performance and setting the right incentives. Worldwide this has led to an emergence of financial and non-financial incentive structures as a strategy to improve performance. The role of incentives is not only to motivate high performance through the alignment of results and rewards (financial/non-financial as well as direct/indirect) but also to enable health care providers to perform better by mitigating financial barriers that typically result from funding schemes. Various incentive structures in health care, identified in the scientific literature, are described in this article and available evidence on effectiveness and side effects is summarized. Literature shows that there is no single best approach to create an incentive yet and that the ability of financial and non-financial incentives to achieve desired results depends on a number of circumstantial elements. Several incentive schemes that can be used by health care insurers or local health authorities are discussed and concrete examples are provided. Decision-making on incentive schemes requires a careful design with the involvement of those targeted by incentives.
Paying hospitals for quality: can we buy better care? [2019]Economic theory predicts that changing financial rewards will change behaviour. This is valid in terms of service use; higher costs reduce health care use. It should follow that paying more for quality should improve quality; however, the research evidence thus far is equivocal, particularly in terms of better health outcomes. One reason is that "financial incentives" encompass a range of payment types and sizes of reward. The design of financial incentives should take into account the desired change and the context of existing payment structures, as well as other strategies for improving quality; further, financial incentives should be fair in rewarding effort. Financial incentives may have unintended consequences, including rewarding hospitals for selecting patients with lower risks, diverting attention from the overall patient population to specific conditions, gaming, and "crowding out" or displacing intrinsic motivation. Managers and clinicians can only respond to financial incentives if they have the data, tools and skills to effect changes. Australia should not adopt widespread use of financial incentives for improving quality in health care without careful consideration of their design and context, the potential for unintended effects (particularly beyond their immediate targets), and evaluation of outcomes. The relative cost-effectiveness of financial incentives compared with, or in concert with, other strategies should also be considered.
How redesigning AD clinical trials might increase study partners' willingness to participate. [2022]Timely recruiting and retaining participants into Alzheimer disease (AD) clinical trials is a challenge. We used conjoint analysis to identify how alterations in attributes of clinical trial design improve willingness to participate: risk, home visits, car service, or increased chance of receiving intervention.
Prevention of Alzheimer disease. [2019]The prevention of Alzheimer disease (AD) remains an important goal because of its high prevalence in our society and its associated costs. Two types of primary prevention trials have been conducted in AD to date: trials in independent cohorts specifically recruited for an AD primary prevention trial and cohorts in other studies randomized to a drug of interest where appropriate cognitive measures can be added. There have been numerous difficulties in conducting primary prevention trials in AD because of the need for a large sample size, long length of poor follow up, and adverse event profile or toxicity of the agents being studied. Many primary prevention trials are ongoing. However, to date, no primary prevention trial has successfully delayed the development of AD. Future primary prevention trials for AD will need to carefully consider issues of safety, tolerability, ability to follow subjects over long periods of time, methods of collecting data, and strategies to enhance recruitment to carry out such trials.
Estimating and disclosing the risk of developing Alzheimer's disease: challenges, controversies and future directions. [2021]With Alzheimer's disease increasing in prevalence and public awareness, more people are becoming interested in learning their chances of developing this condition. Disclosing Alzheimer's disease risk has been discouraged because of the limited predictive value of available tests, lack of prevention and treatment options, and concerns regarding potential psychological and social harms. However, challenges to this status quo include the availability of direct-to-consumer health risk information (e.g., genetic susceptibility tests), as well as a growing literature suggesting that people seeking risk information for Alzheimer's disease through formal education and counseling protocols generally find it useful and do not experience adverse effects. This paper reviews current and potential methods of risk assessment for Alzheimer's disease, discusses the process and impact of disclosing risk to interested patients and consumers, and considers the practical and ethical challenges in this emerging area. Anticipated future directions are addressed.
Disclosure of amyloid status is not a barrier to recruitment in preclinical Alzheimer's disease clinical trials. [2023]Preclinical Alzheimer's disease (AD) clinical trials may require participants to learn if they meet biomarker enrollment criteria. To examine whether this requirement will impact trial recruitment, we presented 132 older community volunteers who self-reported normal cognition with 1 of 2 hypothetical informed consent forms (ICFs) describing an AD prevention clinical trial. Both ICFs described amyloid Positron Emission Tomography scans. One ICF stated that scan results would not be shared with the participants (blinded enrollment); the other stated that only persons with elevated amyloid would be eligible (transparent enrollment). Participants rated their likelihood of enrollment and completed an interview with a research assistant. We found no difference between the groups in willingness to participate. Study risks and the requirement of a study partner were reported as the most important factors in the decision whether to enroll. The requirement of biomarker disclosure may not slow recruitment to preclinical AD trials.
Participant satisfaction with dementia prevention research: Results from Home-Based Assessment trial. [2022]Little is known about factors affecting motivation and satisfaction of participants in dementia prevention trials.
Financial incentives for a healthy life style and disease prevention among older people: a systematic literature review. [2018]To motivate people to lead a healthier life and to engage in disease prevention, explicit financial incentives, such as monetary rewards for attaining health-related targets (e.g. smoking cessation, weight loss or increased physical activity) or disincentives for reverting to unhealthy habits, are applied. A review focused on financial incentives for health promotion among older people is lacking. Attention to this group is necessary because older people may respond differently to financial incentives, e.g. because of differences in opportunity costs and health perceptions. To outline how explicit financial incentives for healthy lifestyle and disease prevention work among older persons, this study reviews the recent evidence on this topic.
Medicaid incentive programs to encourage healthy behavior show mixed results to date and should be studied and improved. [2022]In September 2011 the Centers for Medicare and Medicaid Services awarded $85 million in grants to ten states to test financial incentive programs to encourage healthy behavior among Medicaid enrollees with chronic diseases. There is little published evidence about the effectiveness of such incentives within the Medicaid program. We evaluated the available research from three earlier Medicaid incentive programs and found mixed results. On the one hand, in Florida only about half of the $41.3 million in available credits was "claimed" by enrollees between 2006 and 2011. On the other, Idaho's incentive program was credited with improving the proportion of children who were up-to-date on well-child visits. Our findings suggest that Medicaid incentive programs should be designed so that enrollees can understand them and so that the incentives are attractive enough to motivate participation. Medicaid incentive programs also should be subject to rigorous evaluation to more clearly establish their effectiveness.
Evaluation of the Effectiveness of Behavioral Economic Incentive Programs for Goal Achievement on Healthy Diet, Weight Control and Physical Activity: A Systematic Review and Network Meta-analysis. [2023]Healthy diet, weight control and physical activity to reduce obesity can be motivated by financial incentives (FI). Behavioral-economic approaches may improve the incentivization effectiveness. This study compares and ranks the effectiveness of standard and behavioral incentivization for healthy diet, weight control, and physical activity promotion.
Promoting Healthy Childhood Behaviors With Financial Incentives: A Narrative Review of Key Considerations and Design Features for Future Research. [2023]In the last decade, there has been a robust increase in research using financial incentives to promote healthy behaviors as behavioral economics and new monitoring technologies have been applied to health behaviors. Most studies of financial incentives on health behaviors have focused on adults, yet many unhealthy adult behaviors have roots in childhood and adolescence. The use of financial incentives is an attractive but controversial strategy in childhood. In this review, we first propose 5 general considerations in designing and applying incentive interventions to children. These include: 1) the potential impact of incentives on intrinsic motivation, 2) ethical concerns about incentives promoting undue influence, 3) the importance of child neurodevelopmental stage, 4) how incentive interventions may influence health disparities, and 5) how to finance effective programs. We then highlight empirical findings from randomized trials investigating key design features of financial incentive interventions, including framing (loss vs gain), timing (immediate vs delayed), and magnitude (incentive size) effects on a range of childhood behaviors from healthy eating to adherence to glycemic control in type 1 diabetes. Though the current research base on these subjects in children is limited, we found no evidence suggesting that loss-framed incentives perform better than gain-framed incentives in children and isolated studies from healthy food choice experiments support the use of immediate, small incentives versus delayed, larger incentives. Future research on childhood incentives should compare the effectiveness of gain versus loss-framing and focus on which intervention characteristics lead to sustained behavior change and habit formation.