CHIBEblog

Hardwiring Patient Engagement to Deliver Better Health

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Providers often throw up their hands in frustration when they see the same patients repeatedly readmitted to the hospital for behaviors such as failing to take their medications at home or eating a high salt diet when they have heart failure. Many acute exacerbations of chronic disease are from patients having trouble following through with provider recommendations — whether to eat healthy foods, watch fluid balance, take medications, lose weight, quit smoking, or avoid alcohol or other drugs. Generally, the standard approaches clinicians take to address these issues, such as cajoling or providing information in a brief face-to-face encounter, don’t…

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A/B Testing Health Behavior

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Medicine has been accused of implementing new interventions without a strong underlying evidence base, and that impulse for quick implementation is understandable, says Scott Halpern, Deputy Director for the University of Pennsylvania’s Center for Health Incentives and Behavioral Economics. “We have sick people. We need to do something. We can’t sit idly by,” he says. “But I wonder if that instinct to not just stand there — to do something — might have some unintended consequences, crowding out the potential for greater innovation that has better evidence to support it.” What can we learn from other industries that have grappled…

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RWJF: How Behavioral Economics Can (and Can’t) Boost Health

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What the Robert Wood Johnson Foundation learned from a six-year exploration As the bestsellers started piling up, from 2008’s Predictably Irrational and Nudge to 2011’s Thinking Fast, Thinking Slow, the buzz around behavioral economics — the science and practice of nudging people toward a particular decision — could be heard from the classroom to the board room. Many dismissed it as a passing fad. Some balked at its paternalism. Others considered it “kinda creepy.” We at the Robert Wood Johnson Foundation were cautiously optimistic. Could behavioral economics, a tool that has helped people save money, also help save people’s lives? Could its power be…

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Behavioral Insights for Health Innovation Spotlight Series: Tackling the Rising Obesity Rate

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First Lady Michelle Obama put it this way: “The physical and emotional health of an entire generation and the economic health and security of our nation is at stake.” Her statement speaks to one of the most significant health challenges our nation is facing—more than a third of American children and teens are overweight or obese. For adults, the rate jumps to over two-thirds. From the recent taxes on sugar-sweetened drinks to changes in FDA food labeling, there’s been no shortage of public initiatives to boost healthy eating. Although we’ve certainly seen signs of declining obesity rates among our youngest…

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My Favorite Slide: One Size Does Not Fit All in Behavioral Interventions

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This is one of my favorite slides because it highlights how behavioral interventions can have very different effects in different portions of the population. MI FREEE was a randomized controlled trial in which Aetna waived copayments for all patients hospitalized with heart attacks. The trial showed that overall adherence to evidence-based therapy in the year following a heart attack is poor: 39% in the control group, 45% in the “free medication” group. Among African-Americans and Hispanics, however, the effects of the trial are striking — rates of major vascular events or revascularization dropped by 35% and total health care spending…

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When Compared to Each Other, Doctors Pay Attention

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Social comparisons can improve physician practice In two recent JAMA Viewpoints, Amol Navathe and colleagues point to the potential of social comparisons to motivate physicians to improve the care they provide. Fulfilling this potential, however, will take careful attention to how these comparisons are designed and delivered. When done right, social comparisons can improve physician practice without changing payment structures. For example, when ranked against their peers, physicians reduced inappropriate antibiotic prescriptions. But in another case, public reporting of percutaneous revascularization likely prompted physicians to avoid high-risk patients, rather than improve care. In the first viewpoint, Joshua Liao, Lee Fleisher,…

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The Value Of ‘Social Comparisons’ in Medicine: How Patients Can Be Affected When Doctors Are Compared to Each Other

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Among health care leaders and policymakers, there is growing support to improve the value of US health care by providing doctors with feedback about their performance relative to that of their peers (i.e., comparing doctors to each other). The logic for this strategy, called “social comparisons”, is straightforward: if a doctor sees that he is underperforming in some area of patient care compared to his colleagues, a confluence of motivations — his desire to take good care of patients, his innate desire to achieve, and his desire to be viewed favorably by peers — will compel him to change his…

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Sugary Drinks – You’ve Been Warned

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What policymakers can learn from research While a tax on sugary drinks is grabbing the headlines in Philadelphia, several cities and states are exploring other interventions to curb the consumption of sugary drinks, and hopefully reap health benefits. One such proposal is to put warning labels on sugary drinks, or on the advertising for them, calling out adverse health effects, particularly obesity, diabetes and tooth decay. A San Francisco ordinance, which requires publicly displayed advertising for sugary drinks to devote 20 percent of the ad to a warning label, was scheduled to take effect this summer but is on hold…

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What Do Hospitalized Patients Say Would Be Worse Than Death?

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Survey says… In caring for hospitalized patients with serious illnesses, and in evaluating interventions designed to help them, clinicians and researchers often focus on death as the primary outcome to be avoided. We tend to pay less attention to avoiding other outcomes that may be equally or more unacceptable to some patients. Between July 2015 and March 2016, Anna Buehler, Scott Halpern, and I asked 180 patients with serious illnesses who were hospitalized at the Hospital of the University of Pennsylvania to rate a series of single-dimension health states on a 5 point Likert scale with options of worse than…

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Applying Behavioral Economics to the Thorny Issue of Vaccine Acceptance

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The Theory and Practice Can insights from behavioral economics inform creative approaches to increasing vaccination rates, and help prevent outbreaks of vaccine-preventable diseases? In a JAMA Pediatrics Viewpoint, LDI Senior Fellows Alison Buttenheim and David Asch suggest how to apply behavioral economic principles to the thorny issue of vaccine acceptance, and discuss the challenges in doing so. Buttenheim and Asch suggest vaccine interventions that leverage default and omission biases, increase the salience of vaccine-preventable diseases, and make vaccination social and the benefits immediate. Each of these suggested approaches come with caveats about what could go wrong in putting them into…

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