Article Impact Level: HIGH Data Quality: STRONG Summary of JAMA Internal Medicine. https://doi.org/10.1001/jamainternmed.2024.3338 Dr. Diann E. Gaalema et al.
Points
- A randomized clinical trial investigated the effects of early case management and financial incentives on cardiac rehabilitation adherence among patients with lower socioeconomic status (SES).
- Conducted from December 2018 to December 2022, the trial included 192 patients eligible for cardiac rehabilitation due to conditions like myocardial infarction and stable systolic heart failure.
- Participants were divided into four groups: usual care, case management starting in-hospital, financial incentives for completing sessions, and a combination of both interventions.
- Results showed significant adherence differences: 11% completion in usual care, 25% in case management, 42% with financial incentives, and 62% with combined interventions.
- The combined approach of case management and financial incentives significantly outperformed other strategies, with an adjusted odds ratio (AOR) of 13.2 (95% CI, 4.0-43.5; P < .001) for session completion, suggesting its broader application in clinical practice to improve health outcomes.
Summary
In a comprehensive randomized clinical trial, researchers investigated the impact of early case management and financial incentives on increasing cardiac rehabilitation adherence among patients with lower socioeconomic status (SES). Conducted from December 2018 to December 2022, the trial included 192 patients who qualified for cardiac rehabilitation based on conditions such as myocardial infarction and stable systolic heart failure. These patients were randomly assigned to one of four groups: usual care, case management starting in-hospital, financial incentives for completing rehabilitation sessions, or a combination of both interventions. The main goal was to assess which intervention, if any, effectively increased the completion rate of cardiac rehabilitation sessions.
The study’s results demonstrated significant variations in rehabilitation adherence across the different intervention groups. Specifically, 11% of patients in the usual care group completed at least 30 rehabilitation sessions, compared to 25% in the case management group, 42% in the financial incentives group, and 62% in the combined case management and financial incentives group. The statistical analysis confirmed the superior efficacy of combining case management and financial incentives, with an adjusted odds ratio (AOR) for completing rehabilitation being 13.2 (95% CI, 4.0-43.5; P < .001) when compared to usual care. Moreover, this combined approach was more effective than either intervention alone.
These findings underscore the effectiveness of integrated intervention strategies in promoting cardiac rehabilitation among patients with lower SES. The dual approach of providing financial incentives and case management significantly outperformed standard care and individual interventions, suggesting that such comprehensive strategies may improve health outcomes for vulnerable populations. The study advocates for the broader application of these interventions in clinical practice to enhance adherence rates and, ultimately, patient outcomes in cardiac rehabilitation programs.
Link to the article: https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2821357
References Gaalema, D. E., Khadanga, S., Savage, P. D., Yant, B., Katz, B. R., DeSarno, M., & Ades, P. A. (2024). Improving Cardiac Rehabilitation Adherence in Patients With Lower Socioeconomic Status: A Randomized Clinical Trial. JAMA Internal Medicine. https://doi.org/10.1001/jamainternmed.2024.3338
