Telehealth Intervention for Improved Blood Pressure Control with Targeted Incentives: Using New Technologies and Insights From Behavioral Economics to Increase the Effectiveness of Behavioral Change

Wellth, Inc., Brooklyn NY

Investigators

Abstract

PROJECT SUMMARY/ABSTRACT: Hypertension, or sustained systolic and diastolic blood pressure (BP) of 140 and 90 mm Hg or higher, is among the most frequently encountered conditions in primary care in the U.S. The estimated prevalence is 30% among all U.S. adults and increases with age to affect 65% of seniors. Hypertension is also the leading risk factor for cardiovascular disease, global mortality, and ranks third among the causes of disability. Treatment of hypertension is relatively straightforward, but patient adherence to long- term self-care strategies is problematically low. Three important behaviors that individuals can adhere to in order to help lower their BP are 1) Taking medications as prescribed by a physician, 2) Monitoring blood pressure at home, and 3) Limiting dietary sodium intake. Adherence to these behaviors is problematic and currently ranges from 25% to 50%; the current proposal is aimed at addressing the behavioral barriers for these three activities with the help of new technology. In particular, this STTR will develop and test an incentive program delivered through a telehealth app to increase adherence to prescribed BP control regimens, and precipitate reduction in BP. The target participants for the test are a vulnerable population of seniors with clinically diagnosed hypertension in the University of California - San Diego community. The product to be developed through this STTR is a telehealth app for patient smartphones, which incorporates financial and targeted incentives framed in a way that targets specific ?mental accounts? to maximize the behavioral effectiveness of the intervention. The approach is to (1) Using focus group to construct an optimal incentive strategy to promote adherence to overcome behavioral barriers, support self-efficacy, and complement intrinsic motivators, and (2) Demonstrate feasibility of combining behavioral economics with state-of-the-art telehealth technology to deliver an optimal incentive strategy to the specific group of patients to promote adherence and reduce BP. The telehealth innovation centers on (a) Immediate delivery of reminder triggers and reinforcement to establish behaviors, (b) Employment of computer vision and artificial intelligence technologies to reduce time and effort costs of adherence, and finally (c) Support for remote monitoring of patient progress by health plans, providers and researchers. Phase II will test the efficacy of this approach in a larger and more diverse population within the UCSD Health system, additionally incorporating incentives for outcomes (e.g., achievement of BP < 140/90 mm Hg) to search for statistically and clinically significant improvements in blood pressure resulting from use of the app with the optimal incentives. Initial customers are health insurers and risk-bearing hospital systems (e.g. those with value-based reimbursement models), who are fiscally responsible for large numbers of patients with poorly controlled BP.