Speaker
Srinath Adusumalli, MD, MSHP, MBMI, FACC
Adjunct Assistant Professor of Medicine, Perelman School of Medicine
Adjunct Professor of Healthcare Management, The Wharton School
Affiliated Faculty, Center for Health Incentives and Behavioral Economics
Staff Cardiologist, Hospital of the University of Pennsylvania and Philadelphia VAMC University of Pennsylvania
Senior Medical Director, Enterprise
Keywords
Pragmatic trials, cardiovascular medicine, cardiovascular care delivery, behavioral science, electronic health records, implementation science
Key Points
- A nudge is a subtle change in design that is intended to impact human behavior. They are intended to remind, guide, or motivate a decision, and they should be transparent. Dr. Srinath Adusumalli described a nudge as something that helps make the right choice an easier choice.
- Nudges and other behavioral interventions are prevalent in industries like business and entertainment, but there is an opportunity for nudges in medicine and health care delivery.
- Launched in 2016, the Penn Medicine Nudge Unit is the world’s first behavioral design team embedded within a health system. It works to improve health care value and outcomes, advance the science of designing interventions to change behavior and evaluate and disseminate the impact of interventions. The team then worked to incorporate an implementation science lens for designing interventions for scale to the health system.
- The health behavior is supported by a technology backbone, including the Penn Medicine EHR and other systems that bring insight and nudge within workflows. The context and stakeholder input have been key in developing and implementing nudges.
- Useful nudge principles are limitations of information provisions, inertia or status quo bias, choice overload, loss aversion or framing, social ranking and the limits of willpower.
- Implementing the nudge tool within the Penn Medicine revealed several positive impacts, including referral rates increasing significantly via the implementation of a default pathway.
- The PRESCRIBE trial revealed the value of active choice as well as peer decision-making to prompt decision-making.
- The randomized controlled trial Effect of Nudges to Clinicians, Patients or Both to Increase Statin Prescribing published in JAMA found that the clinician nudge and the combined nudge interventions significantly increased the proportion patients prescribed a statin compared with usual care but the patient nudge had no impact.
- Key considerations for developing and implementing a nudge include the right information and guidelines, the right individual to receive the nudge, the right intervention format, the best channel for the nudge and the best time in a provider’s workflow to receive the nudge.
- Key learnings from the studies highlighted included the need for more transparency as to the reason for a nudge, limiting the number of choices in CDS intervention, passive CDS is often ineffective and it is critical to provide the path for the individual to immediately act.
- New frontiers in nudging include integrating nudges and behavioral science with applied machine learning, phenotyping patient and clinician behavior to more precisely target single or combination nudges, the simplification and automation of downstream actions, and the alignment of incentive and behaviors across health care actors, including systems and payers.
Discussion Themes
– In the last few years, there has been great reception to the value of behavioral science and implementation science in the field of cardiology. There is opportunity for more evidence to be developed and to implement lessons that have been learned.
– Behavioral science tools, such as these EHR-integrated nudges, must be modified to fit within different settings and EHR systems, but they often provide a strong foundation for other contexts. Customizing existing tools to different systems can save significant time and resources in developing behavioral health tools.
Tags
#pctGR, @Collaboratory1