Source: WHYY Radio, April 16, 2012
CHIBE investigator Judith Long and colleagues compared measures of diabetes control among three groups of diabetic veterans at the Philadelphia VA Medical Center. One group received usual care, one group received a financial incentive plus usual care, and one group received usual care plus they were matched with a peer mentor who contacted them once a week. On average, the peer mentored group had better diabetes control after six months than the group that received usual care, or the group that received financial incentives. Though more research is needed, it seems that peer mentors are an inexpensive, beneficial addition to the healthcare physicians can provide diabetic patients during an office visit.
Every two weeks or so, a group of Penn Medical students, including CHIBE Trainee Kenji Taylor, who is mentored by CHIBE faculty member and Roybal Investigator Alison Buttenheim, head out to barbershops frequented by African American men to perform simple, but potentially life-saving, health screenings.
Scott Halpern wrote in his JAMA editorial that, while patient perspectives on intensity of ICU treatment have long been considered, European research on the views of clinicians delivering the care is important to the conversation. As Halpern noted in his editorial, "What this study shows is that a striking number of ICU physicians and nurses on any given day are providing care they perceive to be inappropriate," and, as he went on to he comment to the media, "What it doesn't tell us is why they are doing it," he said.
Investigators from the Roybal Center gathered to discuss behavioral economics and health among aging populations. Featured guest Heather Schofield, from of the Harvard School of Pubic Health, talked about online games and promoting mental acuity. Roybal investigators Jeffery Kullgren, Jason Karlawish, and others presented their research and Kevin Volpp announced an upcoming innovation tournament.
In her review of “Open Wound,” Abigail Zuger, MD comments that in regard to describing the doctor-patient relationship, “…few efforts in recent memory lay out the frustrations and confusions and crystalline moments of grace better than Dr. Jason Karlawish’s marvelous new book…” Karlawish's “Open Wound” is a historical novel, set in the 19th century. It follows the career of Dr. William Beaumont and his relationship with one of his patients, Alexis St. Martin.
Joshua Metlay and colleague Jane S. Jue, a former Robert Wood Johnson Clinical Scholar at Penn, examined a representative sample of 426 websites designed to provide health information to college and university students. They found that less than 10 percent of the sites provided information about tobacco use, nutrition, and exercise. This dearth of information is a missed opportunity, given rising obesity rates and the health consequences of smoking, and the fact that smoking and obesity are preventable.
Source: New York Times, November 16, 2011
Two recent surveys show that an increasing number of employers—including major US employers such as Home Depot, Walmart, and PepsiCo-- are raising health insurance premiums for employees who smoke, are overweight, or otherwise fail to meet certain health criteria. Kevin Volpp noted that such penalties could have harmful unintended consequences. For example, as others noted, those who have to pay a higher premium may forgo health insurance altogether.
Source: Vitals on MSNBC.com, November 8, 2011
Kevin Volpp noted that humans seek immediate gratification, which is what makes long-term goals involving delayed satisfaction, such as losing weight, difficult. Programs that offer financial incentives for losing weight can meet the human need for gratification and help people reach their weight loss goals.
In the November 9 issue of the Journal of the American Medical Association (JAMA – subscription required) Jason Karlawish and colleague Zachary Meisel propose that physicians use narrative stories to convey new research findings to patients. Citing widely-disseminated celebrity narratives opposing the MMR vaccine and new guidelines about prostate screening, Karlawish and Meisel suggest that developing counternarratives in support of the prevailing scientific evidence would help to spread the correct message and align with how people process information. They note, “Stories are an essential part of how individuals understand and use evidence."
Source: Forbes, November 7, 2011
On a panel called, “From a Nudge to a Shove: How Big a Role for Shared Decision Making?” at the 2011 Society of Medical Decision Making annual meeting, Kevin Volpp talked about the potential of a gradually escalating “intervention ladder” to guide people toward more healthy decisions. He also cautioned against interventions that have may have a punitive impact on those who live with environmental factors that foil better decision-making, for example, overweight people who have limited access to exercise and nutritious foods.
Employers benefit from maintaining a healthy workforce through health plans that emphasize preventive medicine. Kevin Volpp noted that unhealthy behaviors contribute in a significant way to illnesses that increase health care costs. Using financial incentives to change these behaviors can reduce illness, lower health care costs, and benefit employees, employers, and payers.
In an article describing the growing trend of employer-levied penalties for employees with health issues such as obesity, high cholesterol, or who smoke, Harald Schmidt noted that such programs place a higher burden on low-paid workers, who are typically poorer and have less access to exercise facilities and fresh produce.
In a blog post about research demonstrating that labeled chocolate-scented lotions triggered increased cookie consumption among study participants, while unlabeled lotion did not, Jonah Berger commented that labeling might have helped participants identify the scent as chocolate, which cued them to consume more cookies.
Mark Pauly was invited to weigh in on potential solutions to the issue of low adoption of long-term care insurance. On Medicare expansion, Pauly noted that higher deductibles might work; but, he was more skeptical about the idea that better marketing might improve take-up.
Research by CHIBE's Jonah Berger and his colleague Devin Pope found that players who thought they were losing slightly halfway through a competitive game played in a lab setting were more likely to eventually win the game. This finding aligned with the researchers' data from 60,000 collegiate and NBA basketball games, which showed that teams that were down by one point at halftime were more likely to win than teams that were ahead by one point at the half.
Mark Pauly, in an article about the relative lack of health insurance among high-earning residents of Norfolk, Connecticut, offered that these people may be young and healthy, "grasshoppers." Alternatively, perhaps, the data reflect people without health insurance who happen to live with a high earning person.
George Loewenstein and Kevin Volpp were tapped to comment in an overview article about the use and efficacy of different types of incentives to help people lose weight, including deposit contracts, lotteries, negative incentives, and direct incentives. The piece mentioned their collaborative work testing financial incentives to motivate weight loss among veterans.
In an article about The new Dartmouth Institute for Health Care Delivery Science, David A. Asch noted that broadening doctors’ training to include business skills could help them avoid the “gauze ceiling” that blocks their advancement in health care organizations. The Institute combines aspects of the medical school and the business school, similar to the Wharton health care management MBA.