The Healthy Nudge
Welcome to The Healthy Nudge . Each month, we'll get you up to speed on the latest developments in policy-relevant health behavioral economics research at CHIBE. Want more frequent updates? Follow us on Twitter @PennCHIBE and visit our website .
Targeting Opioid Prescribing
Two researchers at CHIBE have been awarded a $600,000 grant from the Donaghue Foundation to evaluate the effect of two scalable behavioral economics approaches to reduce physician opioid prescribing. Amol Navathe, PhD and Mitesh Patel, MD, MBA, MS will conduct the study at more than 50 emergency departments and urgent care sites within the Sutter Health System. "Our goal is to identify interventions that include education and behavioral economics techniques that can move physicians toward prescribing lower doses of shorter duration and substitute non-opioids when appropriate," says Navathe.
Behavioral Design in a Health System
The Penn Medicine Nudge Unit is the world's first behavioral design team embedded within a health system. Launched in 2016, the nudge unit bridges research activities at the Center for Health Incentives and Behavioral Economics and innovation efforts at the Penn Medicine Center for Health Care Innovation with the goal of leveraging insights from behavioral economics and psychology to design and test approaches that steer medical decision-making toward higher value and improved patient outcomes.
Primary Care as the New Tertiary Care
In a recent commentary, David Asch, MD, MBA, Kevin Volpp, MD, PhD and Christian Terwiesch, PhD identify barriers slowing the transition of episodic, in-person primary care to more innovative models that separate care from location and empower patients to take on more of their own care. The authors describe steps needed to overcome these obstacles, lowering costs and improving quality.
Blog Spotlight
CHIBE was pleased to welcome David Laibson, PhD as a keynote speaker on day two of our annual Behavioral Economics & Health Symposium, hosted jointly this year with the NBER Roybal Center for Behavior Change in Health and Savings. In his talk, Laibson presented attendees with a problem he calls the commitment puzzle, and a solution: private paternalism.
Work-in-Progress Seminar:
"Testing Behavioral Economics Insights in Large-Scale Government Programs"
Nicholas Wilson, PhD
White House Social & Behavioral Sciences Fellow,
Associate Professor of Economics,
Reed College
12/14 @ Noon
104 Stellar-Chance Laboratories
In The News
Kept in the Dark About Doctors, but Having to Pick a Health Plan

In the Quest for Lasting Behavior Change, Two Researchers Lead the Charge

Lower Medicaid Fees Linked to Scarcer Primary Care Appointments

Commentary: How Can We Help People Quit Smoking? Pay Them.

Photo Page - 2017 Penn/CMU Roybal Behavioral Economics Retreat

Why the First, FDA-approved Pill with a Sensor Will Be Controversial

Can Firms Help Employees Make Better Retirement Choices?

Humana’s Wellness Program Features a Small But Committed Group of Wearables Users

How ‘Medicines First’ HIV Policy is Changing Sex in Kenya

Does it Work to Dangle a Carrot for Patients to Take Healthy Steps?

Healthcare Consumers Find Little Information Online
 CHIBE Profile
Mitesh Patel, MD, MBA, MS is an Assistant Professor of Medicine and Health Care Management at the Perelman School of Medicine and The Wharton School, and is the Director of the Penn Medicine Nudge Unit.
What is the value of situating a nudge unit directly within a health system?
The design of environments in which clinicians practice medicine influences how they make decisions that impact patient care. For example, subtle changes to the way choices are framed or information is delivered in the electronic health record can lead to significant differences in how clinicians order tests and treatments. Similarly, social networks and norms can impact daily patient behavior that occurs outside of the health system - such as physical activity, diet, and medication adherence. In many cases, these influences go unnoticed or are not given much thought. Nudge units can help health systems take a systematic approach to identifying opportunities to test ways to design these environments to steer patient and clinician decisions towards higher value and better outcomes.

What are some examples of effective nudges you have tested and later implemented at Penn Medicine?
In one of our studies, we found that prescription defaults increased generic prescribing rates in one clinical department. The design was further improved and expanded to all outpatient clinics across the entire health system and overnight the generic prescribing rate increased from 75% to 98%, which has been sustained now nearly 3 years later.

In another project, we evaluated a primary care clinic that implemented a series of active choice interventions in the EHR to address gaps in care. We found that compared to a control group, the intervention led to a 35% relative increase in clinician ordering of influenza vaccination, colonoscopy, and mammography. The intervention was refined to fit better into clinician workflow and then expanded to all internal medicine clinics in Philadelphia.

In a third project, we found that when two inpatient medicine floors shifted communications from pagers to smartphone-based secure text messaging, it reduced patient length-of-stay by 14% without increasing readmissions. The health system expanded the technology from 2 floors to all medical and surgical floors in 2 entire hospitals. We are now working with clinicians across the health system to test these types of nudges in other settings such as cardiology, emergency medicine, oncology, and radiation oncology.
You were recently awarded a $1.5 million grant from the NIH National Institute on Aging for a project testing nudges to improve clinician statin prescribing. Can you tell us more about the intervention you will be testing? 
Atherosclerotic cardiovascular disease (ASCVD) is the leading cause of morbidity and mortality in the United States. Statins reduce ASVCD-related events and mortality by up to 30%, are generally well-tolerated, and affordable. However, more than 50% of patients that meet widely-accepted practice guidelines for statin therapy have never been prescribed the medication. In a pilot clinical trial, we tested the use of automated patient dashboards for primary care physicians (PCP) and found that nudges increased their utilization and significantly increased statin prescribing rates. This grant helps us to take the next step by accelerating wide-scale implementation of these approaches throughout our health system through the electronic health record.
New Publications

The Center for Health Incentives and Behavioral Economics (CHIBE) at the University of Pennsylvania conducts behavioral economics research aimed at reducing the disease burden from major U.S. public health problems. Originally founded within the Leonard Davis Institute of Health Economics , our mission is to inform health policy, improve healthcare delivery and increase healthy behavior.
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