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An Effective Incentive for Successful Participation in Home Memory Monitor Study

Carl E. Hunt, MD; Jane K. Durham, RN, MSN; Susann J. Guess, RN, MSN; Linda E. Kapuniai, DrPH; Howard Golub, MD, PhD; and the Collaborative Home Infant Monitoring Evaluation Study Group

Arch Pediatr Adolesc Med. 2001;155:954-959.

Context  The Collaborative Home Infant Monitoring Evaluation (CHIME) study enrolled healthy term infants and 3 groups of infants considered to be at increased risk for sudden infant death syndrome to evaluate apnea and bradycardia events in the home. Mother-infant pairs without a telephone were ineligible for enrollment.

Objective  To determine whether mother-infant pairs who were offered a telephone subsidy would agree to enroll in CHIME and achieve protocol compliance rates comparable with those of matched subjects able to afford telephones.

Design  Thirty-one telephone subsidy subjects were retrospectively compared with 55 control subjects matched for study group, site, birth weight, and maternal race, age, and education.

Setting  Collaborative Home Infant Monitoring Evaluation clinical research centers in Honolulu, Hawaii, and Toledo, Ohio.

Intervention  Provision of telephone subsidy to otherwise eligible enrollees for CHIME.

Main Outcome Measures  Frequency of compliance with protocol requirements for follow-up evaluations and for extent of home monitoring.

Results  Subsidy subjects achieved protocol completion rates that were comparable with those of control subjects, for developmental assessments at 56 and 92 weeks postconceptional age (PCA), and for the polysomnogram. Unexpectedly, however, subsidy subjects were more likely to have a developmental assessment at 44 weeks PCA (P = .02), as well as a cry analysis (P = .04). They were also more likely to use the CHIME home monitor for more hours during weeks 2 through 5 (P = .004), have a higher percentage using the monitor for 10 or more hours per week during weeks 2 through 5 (P = .009), and have a higher total number of days of monitor use throughout 6 months (P <.001). Mean cost of the subsidy was $3.25 per day of monitor use, and monitor use per day was directly related to total cost of the subsidy (P = .02).

Conclusions  Telephone subsidy is an effective financial incentive. At least within the context of the CHIME study, telephone subsidy enhanced access to health care, and in some categories it resulted in enhanced protocol compliance.

From the Department of Pediatrics, Medical College of Ohio, Toledo (Dr Hunt and Mss Durham, and Ms Guess); the Department of Pediatrics, University of Hawaii and the Kapi'olani Medical Center for Women and Children, Honolulu (Dr Kapuniai); and the Departments of Pediatrics and Epidemiology and Biostatistics, Boston University, Boston, Mass (Dr Golub). Dr Hunt is now at the National Center on Sleep Disorders Research; National Heart, Lung, Blood Institute; National Institutes of Health; Bethesda, Md.

Corresponding author: Carl E. Hunt, MD, National Center on Sleep Disorders Research; National Heart, Lung, Blood Institute; National Institutes of Health, Two Rockledge Center, 6701 Rockledge Dr, Suite 10038, MSC 7920, Bethesda, MD 20892-7920 (e-mail: HuntC{at}nhlbi.nih.gov).