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Motivational Brochures Increase the Number of Medicare-Eligible Persons With Diabetes Making Therapeutic Footwear Claims

¹ Department of Family and Community Medicine, University of Missouri, Columbia, Missouri
² Qualis Health, Seattle, Washington
³ Department of Epidemiology, University of Washington, Seattle, Washington
⁴ Department of Health Services, University of Washington, Seattle, Washington
⁵ Health Services and Rehabilitation Research and Development, VA Puget Sound Health Care System, Department of Veteran’s Affairs, Seattle, Washington

OBJECTIVE—This study tests the hypothesis that Medicare beneficiaries at high risk of foot complications who are mailed a motivational brochure describing the Medicare diabetes-related therapeutic footwear benefit will increase their therapeutic footwear–related Medicare claims.

RESEARCH DESIGN AND METHODS—In this quasi-experimental study, a motivational brochure was mailed in the summer of 1997 to 5,872 Medicare beneficiaries in Washington, Alaska, and Idaho who were identified as being at high risk for foot-related claims on the basis of their prior Medicare claims history. Beneficiaries were identified through footwear claims made in these states—and also in three comparison states (Oregon, Montana, and Wyoming)—during the 18 months before and after the mailing. Linear regression was used to compare the number of persons making claims in the intervention states with the comparison states before, at the time of, and after the mailing.

RESULTS—Before the intervention, the number of persons making claims was increasing in the nonintervention states and decreasing in the intervention states. During the first month after the intervention mailing, the number of persons making claims remained nearly the same in nonintervention states, but increased 13 persons per month in intervention states (95% CI 3.5–11 persons/month). After the intervention, the number of persons making claims continued to increase similarly in both intervention and nonintervention states.

CONCLUSIONS—Mailed motivational brochures were associated with an increase in the number of persons making therapeutic footwear claims. Randomized trials should confirm these findings.

Abbreviations: CMS, Centers for Medicare & Medicaid Services

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