Paying employees to exercise doesn't work, but the reverse might

1. Paying employees to exercise doesn't work, but the reverse might

Abstract: http://www.annals.org/article.aspx?doi=10.7326/M15-1635 URL goes live when the embargo lifts

Financial incentives for promoting daily physical activity goals are most effective when the award can be lost, according to a randomized, controlled trial published in Annals of Internal Medicine. This means that the threat of having an award taken away is more effective than not earning one in the first place.

More than half of adults in the United States do not get the minimum amount of exercise required to reduce their risk for disease and death. Workplace wellness programs are growing in popularity and more than 80 percent of large employers now use some form of financial incentive to encourage participation. However, little research exists on the efficacy of financial incentive designs.

Researchers sought to determine the effectiveness of three methods to frame financial incentives to increase physical activity among overweight and obese adults. Participants in a 13-week intervention were given a goal of 7,000 steps a day and were randomly assigned to the control group or one of three financial incentives: gain (a fixed amount of money given each day the goal was achieved); lottery (daily eligibility for cash if goal was achieved); and loss (cash given monthly upfront and a small amount removed each day the goal was not achieved).

The researchers found that the gain incentive was no more effective than control. In comparison, a loss incentive resulted in a 50 percent relative increase in the mean proportion of time participants achieved their physical activity goals. According to the authors, these findings suggest that the way in which a financial incentive is framed is important to its effectiveness. This information may be especially helpful to employers looking to implement workplace wellness programs.

Note: For an embargoed PDF, please contact Cara Graeff. To interview the lead author, Dr. Mitesh Patel, please contact Katie Delach at Katharine.Delach@uphs.upenn.edu or 215-349-5964.

2. Evidence does not support using erythropoietin-stimulating agents (ESAs) to obtain higher hemoglobin targets in patients with anemia and CKD

Abstract: http://www.annals.org/article.aspx?doi=10.7326/M15-1839 URL goes live when the embargo lifts

According to an evidence review published in Annals of Internal Medicine, treating anemia with erythropoietin-stimulating agents (ESAs) to obtain higher hemoglobin targets does not seem to improve health-related quality of life for patients with chronic kidney disease (CKD), even for younger, healthier patients.

Anemia is common in CKD and is often treated with ESAs. The optimal hemoglobin targets for treating anemia with ESAs is an ongoing source of controversy, with some clinicians aiming for higher hemoglobin targets for younger patients as a way to improve health-related quality of life. They argue that cardiovascular risks associated with ESAs may be limited to older patients.

Researchers reviewed 17 published studies to determine the effect of ESAs on health-related quality of life at different hemoglobin targets in adults with dialysis-dependent or -- independent CKD. They found that randomization to a higher hemoglobin target resulted in no clinically or statistically significant improvement in any measure of health-related quality of life. These findings support current guidelines for achieving lower hemoglobin targets in patients requiring treatment for anemia, but do not support using ESAs to achieve individualized hemoglobin targets.

Note: For an embargoed PDF, please contact Cara Graeff. To interview the lead author, Dr. Navedeep Tangri, please contact Toby Maloney at tmaloney@sogh.mb.ca or 204-632-3341.

3. Computer-assisted stethoscope may help docs better understand what they hear during chest auscultation

Abstract: http://www.annals.org/article.aspx?doi=10.7326/L15-0350 URL goes live when the embargo lifts

An observation piece published in Annals of Internal Medicine describes a new technology designed to help health care professionals better understand what they hear during chest auscultation. The authors developed a computer-assisted stethoscope that utilizes an algorithm to physically and mathematically divide sounds into one of five categories specified by the International Lung Sounds Association (normal, rhonchi, wheezes, fine crackles, course crackles). It can be difficult for clinicians to differentiate these respiratory sounds because their frequencies overlap. In a test, the computer-assisted stethoscope successfully analyzed the sounds and displayed the information in real time. When different respiratory sounds were present at the same time, the algorithm classified the sounds. In addition to helping clinicians better understand what they hear, the authors suggest that the technology could be used in medical education and in settings were invasive procedures are performed.

Note: For an embargoed PDF or author contact information, please contact Cara Graeff.

4. Health officials urge action to ban the sale of powdered alcohol

Abstract: http://www.annals.org/article.aspx?doi=10.7326/M15-2291 URL goes live when the embargo lifts

Health officials urge action to ban the sale of powdered alcohol, in an editorial published in Annals of Internal Medicine. Early last year, the U.S. Alcohol and Tobacco Tax and Trade Bureau approved a formulation of powdered alcohol, or Palcohol, for distribution and sale in the United States. Sold in packet form in five different flavors (vodka, rum, cosmopolitan, powderita, and lemon drop), Palcohol contains 55 percent alcohol by weight and can be reconstituted to its liquid form by adding water. Citing a lack of safety data and the potential for abuse and misuse among both youth and adults, the Baltimore City Health Department convened physicians and public health leaders to endorse a statement on the clinical and public health dangers of the product. Their advocacy efforts led to a ban on the sale and distribution of Palcohol in the city of Baltimore as well as the state of Maryland. Baltimore public health officials urge clinicians in local jurisdictions to form coalitions in their own areas to help keep Palcohol off the market.

Note: For an embargoed PDF, please contact Cara Graeff. To interview the lead author, Dr. Leana Wen, please contact Sean Naron at Sean.Naron@baltimorecity.gov or 443-414-0075.

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Also in this issue:

The Patient-Centered Medical Home and Associations With Health Care Quality and Utilization: A 5-Year Cohort Study

Lisa M. Kern, MD, MPH; Alison Edwards, MStat; and Rainu Kaushal, MD, MPH Original Research

http://www.annals.org/article.aspx?doi=10.7326/M14-2633

What Do You Mean by Medical Home?

Mark W. Friedberg, MD, MPP

Editorial

http://www.annals.org/article.aspx?doi=10.7326/M16-0058