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CHICAGO -- A system where patients and caregivers earned points to be redeemed for prizes, helped improve compliance, especially among adolescent and teen patients, coming in for well-child checks, scheduling appointments and being up to date on vaccinations, a researcher reported here.

This system of gamification helped one pediatrics practice to dramatically increase their percentage of appointments scheduled prior to leaving the office, and increased their portion of up-to-date well-child visits by 10 points in 3 years -- well ahead of the national average, according to Robin Warner, MD, of Union Pediatrics in Union, Ky.

She discussed the concept of "gamification," defined as the insertion of game dynamics and mechanisms into non-game activities to drive a desired behavior in a presentation at the annual meeting.

"This strategy combines patient willingness and knowledge in managing healthcare with interventions that encourage positive behaviors," Warner said. "They get motivated, get rewards, feel a sense of accomplishment, and then they want to do even more."

Warner said that traditionally, gamification involves video games, but she used a smart phone app that patients and parents could download to keep track of "points."

Prior to increasing patient engagement, it was necessary for the staff to buy in to the program, Warner emphasized. She said she did this by "gamifying" both the front office and back office staff. She said that every month, she'd choose a different metric, such as who scheduled the most visits or who collected the most co-pays, and gave out a prize to the staff member who had the highest score.

"Gamify the team and say which team can do something the best -- make it front office versus back office, like for scheduling appointments -- the nurse can do it after she gives shots or the front office staff can do it at checkout," Warner explained. "The secret is to change the game every month so you're measuring something differently to make everyone's behavior improve."

Once the staff was "gamified," they were on board with the system Warner implemented. She used an app to create electronic "loyalty cards" on a patient or caregiver's cell phone. Patients could start the game as early as elementary school and continued through their teen years. They were awarded points every time they came in for a well-child check, completed a series of immunizations, or various preventive measures, like physical exercise (by uploading their Fitbit data). Patients with chronic diseases received points for uploading data indicating they were maintaining their condition.

Caregivers were awarded points for bringing in their insurance card, for bringing their kids to well-child checks, for completing online patient questionnaires in advance, and even social media-based activities such as "liking" the practice's Facebook page.

Prizes were mostly gift cards, though Warner said they also considered Fitbits and "spa day trips" for new mothers of infants. Warner said some important considerations included at what point do you want to award the prize, when will points be reset, and is there a limit on the times patients can win.

After 3 years, the percentage of scheduled appointments rose from 17% in 2014 to 62% in 2017. Warner said this saves their practice both time and money from calling parents and sending out postcards.

She added that they increased their percentage of patients, ages 12 to 21, who were up-to-date with well-child visits from 85% in 2014 to 95% in 2017 -- far exceeding the national average of 56%.

For other pediatricians who are considering this program, Warner advised to "weight tasks based on importance to you" and "don't make attaining the goal too easy or too hard."

In fact, Warner said the program was so successful that they ended up retiring it this year, replacing it instead with a social media site focusing on healthy lifestyle and preventive care.

"People started doing everything we asked without expecting a reward, so their actions became automatic," Warner noted.

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