Using Real Time Financial Incentives to Help Hospitalized Smokers
Vincere Health partners up with Boston Medical Center on how to best serve low-income smokers.
February 28th, 2022
Vincere Health teamed up with one of the premier tobacco treatment teams in New England to bring their smoking cessation solution to a very vulnerable population. Under the direction of Dr. Hasmeena Kathuria, a nationally renowned Pulmonologist and expert in tobacco dependence treatment, and Internal Medicine physician Dr. Sara Shusterman, the team set out to learn more about the impact of real time financial incentives on patient satisfaction, engagement, motivation to quit smoking, and likelihood of recommending the program to others.
To frame how exciting some of the insights of this trial are, let’s take a deeper look at the population we served together. Here are some important highlights:
~73% of patients were in minority groups
>50% of patients had an annual income less than $15,000 per year
~70% of patients had less than a high school education
“We got overwhelmingly positive feedback from the patient population” said Dr. Shusterman. “The carbon monoxide sensor was really important. The patients loved having a visual representation of their progress in the mobile app.” Traditionally, of course, this population is very difficult to engage with technology. The outcomes that Vincere Health software helped achieve with, on average, less than $15 per participant is a testament to how the incentives are delivered as well as when the incentives are delivered.
“The combination of a well-timed incentive and the relationship developed with their care team helped patients find new motivation in themselves to change. There are a lot of other exciting things to build on and try in a larger study” said Dr. Shusterman.
The study design had 3 tracks:
Track 1 offered incentives based on participation.
Track 2 offered a combination of participation based incentives and incentives contingent on patients staying under a specific carbon monoxide threshold.
Track 3 offered the greatest amount of incentives and they were contingent on staying under a specific carbon monoxide threshold.
The data show that the highest levels of engagement were achieved in the group where the incentive was the highest and the carbon monoxide (CO) threshold was the lowest. Also, of note for this group, is the fact that the average CO readings were all consistent with clinically quit levels (< 6 parts per million).1
For a closer look at what we learned, here are some insightful data visualizations for each track. In the figures below, the y-axis measures carbon monoxide readings in parts per million and the x-axis is the time during the day when breath tests were completed by the patients. The blue circles are breath tests conducted by patients over the course of a day and the green shaded area is where we enforced the “reward windows” for the participants; for example, in the morning participants could earn incentives for conducting breath tests between 5AM and 12PM. In the afternoon, the reward window opened again from 5PM and closed at 12AM. Notice how few tests are conducted outside of the reward windows below:
So, what did we learn?
98% percent of the breath tests were conducted in specific time windows and the tests for Tracks 2 and 3 – where the thresholds were enforced – yielded the lowest carbon monoxide readings. Notice how in Track 1 the breath tests look to be fairly dispersed vertically across the carbon monoxide scale. Alternatively, notice how on Tracks 2 and 3, the cluster of breath tests sits below the enforced threshold towards the bottom of the scale. These learnings might imply the intervention helped motivate healthy behavior change at specific time intervals and the incentive helped increase awareness of smoking habits. All of this happened in a very low-income, traditionally non-tech savvy population. Pretty cool!
Why are we optimistic about these insights?
Take a look at a few of our metrics:
Overall satisfaction: 6.3 / 7
The degree to which the program motivated smoking cessation: 6.1 / 7
Likelihood of recommending the program to others: 4.8 / 5
In the entire digital health landscape, if there are other young companies achieving what we are achieving in this difficult to engage population, we encourage you to reach out and collaborate. Vincere Health believes in order to maximize impact for our low-income populations, we need to continue to work together. We are thankful and grateful to the world class Boston Medical Center team for their clinical guidance and expertise in this endeavor. Our next step is to assess the effects of the program on smoking cessation in a larger randomized control trial.
We have much larger studies on the horizon that we are excited to report on: more work with low-income pregnant smokers, those with mental and behavioral health comorbidities, COPD, other chronic care issues and the like.
1. S. Shusterman et al. "Field Testing a Mobile Technology Intervention for Feasibility and Acceptability Using Real Time Financial Incentives in Hospitalized Individuals Who Smoke Cigarettes". American Journal of Respiratory and Critical Care Medicine 2021;203:A1676. https://doi.org/10.1164/ajrccm-conference.2021.203.1_MeetingAbstracts.A1676