Increasing Cardiac Rehabilitation Participation Among Medicaid Enrollees

Participation in outpatient cardiac rehabilitation (CR) decreases morbidity and mortality for
patients hospitalized with myocardial infarction, coronary bypass surgery or percutaneous
revascularization. Unfortunately, only 10-35% of patients for whom CR is indicated choose to
participate. Medicaid coverage and similar state-supported insurance are robust predictors of
CR non-participation. There is growing recognition of the need to increase CR among patients
with this form of insurance and other economically disadvantaged patients, but there are no
evidence-based interventions available for doing so. In the present study we are examining
the efficacy of using financial incentives for increasing CR participation among Medicaid
patients. Financial incentives have been highly effective in altering other health behaviors
among disadvantaged populations (e.g., smoking during pregnancy, weight loss). For this study
are randomizing 130 CR-eligible Medicaid enrollees to a treatment condition where they
receive financial incentives contingent on initiation of and continued attendance at CR
sessions or to a "usual-care" condition where they will not receive these incentives.
Treatment conditions will be compared on attendance at CR and end-of-intervention
improvements in fitness, decision making and health-related quality of life. Cost
effectiveness of the treatment conditions will also be examined by comparing the costs of the
incentive intervention and usual care conditions with their effects on increasing CR
initiation and adherence. Should this intervention be efficacious and cost-effective, it has
the potential to substantially increase CR participation and significantly improve health
outcomes among low-income cardiac patients.