Automated Hovering to Improve Medication Adherence Among Myocardial Infarction Patients (Heartstrong)
Condition: Patients With Principal or Secondary Diagnosis Code of Intrntl Classification of Diseases, 9th Revision, (ICD-9-CM) 410 (Except When 5th Digit Was 2)
MeSH terms: Myocardial Infarction; Infarction
Study type: Interventional

Summary: 
      The goal of this proposal is to test the implementation of an innovative approach to
      improving health and lowering cost for a high risk population of patients with acute
      myocardial infarction (AMI) immediately post-hospitalization. The investigators will
      implement a new service delivery approach that will provide a foundation for a payment system
      that rewards keeping high-risk patients healthy and that deploys technology and a health care
      workforce of the future to implement prevention, care coordination, care process
      re-engineering, team-based care, and the use of data to support new care delivery models.
      This program is focused on coronary artery disease (CAD), but we expect that a successful
      implementation of this model will demonstrate a sustainable pathway to the three-part aim not
      just for CAD, but for many other conditions whose outcomes are highly sensitive to
      post-discharge coordination.

      This proposal has three main principles:

        1. Principles of behavioral economics that have been developed, refined, and tested over
           the past decade offer practical insights into health behaviors that were previously
           unavailable and are not reflected in existing care models.

        2. New technology, typically wireless devices for pill bottles, and mobile telephones, make
           engagement with patients substantially easier and more immediate now than ever before.

        3. While randomized clinical intervention trials provide exceptional confidence of
           comparative effectiveness in narrow interventions, they are slow and rigid and dont
           reflect the urgency that health care transformation currently requires. Principles of
           rapid cycle innovation are gaining acceptance as an alternative to or supplement of
           these traditional methods in supporting evidence for implementation success.
    

Detailed description: 
      The specific aims of this study are to:

        1. Test the effectiveness of a state-of-the-art web-based portal with home-based wireless
           medication adherence devices and behavioral economic feedback mechanisms in preventing
           vascular events or re-hospitalization in the 12 months following hospital admission for
           AMI

        2. Deploy a new model of evidence based evolutionary learning that uses rapid cycle
           innovation in 3 successive planning cycles over the 36 months of this proposal

      Patients will be randomized into 1 of the 2 study groups.

        1. The control group will have their health insurance claims records analyzed over a 12
           month period for comparison to the participants in the intervention arm.

        2. The intervention group:

      (1) will use the GlowCaps, a remote monitoring and reminder pill bottle; (2) will be assigned
      an engagement advisor from the study team; (3) be asked to provide the study team with names
      and contact information of up to 3 family members or friends as support partners for
      medication adherence; (4) will be eligible for daily sweepstakes-based engagement incentives
      in which eligibility to win will be conditional on medication adherence; (5) can choose to
      modify their preferences for Way to Health platform communication methods during the study.

      The group receiving the program intervention will also have their claims data analyzed for
      the 12 months post-enrollment.
    

Intervention name(s): Electronic Pill Bottle, Incentives, Social Influence
Intervention type(s): Behavioral
Intervention description(s): The intervention group (1) will use GlowCaps, a remote monitoring and reminder pill bottle; (2) assigned an engagement advisor from the study team; (3) asked to provide study team with names and contact information of up to 3 family members or friends as support partners for med adherence. The study team will contact these people in order listed until 1 agrees to this role; (4) will select a 2-digit lucky number to be used as part of the sweepstakes-based engagement incentives in which eligibility to win will be conditional on med adherence; and (5) will determine preferences for Way to Health platform communication methods.The group receiving the program intervention will also have their claims data analyzed for the 12 months post-enrollment.
Allocation: Randomized
Intervention model: Single Group Assignment
Masking: None (Open Label)
Primary purpose: Health Services Research
Keywords: Initial occurrence Acute Myocardial Infarction (AMI)