CHIBE researchers apply concepts from the field of behavioral economics to design, implement, and evaluate interventions that improve health and build knowledge about efficacy, cost and effectiveness.
The Basic Science Core aims to support laboratory or low-cost field studies that will shed light on mechanisms that can generate behavior change. In contrast to previous large-scale field studies, which have often combined multiple mechanisms into one intervention in order to maximize impact on behavior, basic science projects supported by the Core focus on disentangling and precisely identifying the impacts of individual mechanisms. CHIBE researchers interested in applying for project support can click here for more information.
Principal Investigators: Polsky / Volpp
The goal of this project is to improve the health of Pennsylvanians at an individual, community, and population level by changing the paradigm of medical care and health care delivery to predicting and preventing onset, exacerbation, and advancement of disease rather than principally reacting to clinical events with expensive treatments. Using medical record data with linkages to administrative claims, wearable monitor data, and social media data, we will develop algorithms to better predict clinical events in the hospital, at home, and in the community. The proposed project will expand an established and highly successful minority health services research training program to provide opportunities for training in big-data research to support the career development of under-represented minorities within the Commonwealth of Pennsylvania.
Funded by: Commonwealth of Pennsylvania
Principal Investigator: Amol Navathe, MD, PhD
Payers and provider groups are in need of novel approaches to structure provider incentives—both financial and non-financial—to better promote the delivery of quality, cost-effective care. In this project, we will study how behavioral economic principles can improve the effectiveness of physician incentives to deliver higher quality and lower cost care. We will test the application of specific behavioral economic principles including loss aversion; physician versus non-physician incentives; and variation in physician-organization relationships in incentive design and implementation.
Funder: The Commonwealth Foundation
Principal Investigators: David Asch, MD, MBA; Kevin Volpp, MD, PhD
The objective of this study is to conduct a pragmatic, randomized controlled trial testing a new approach to chronic disease management combining wireless monitoring devices and behavioral economic engagement incentives to reduce rehospitalization rates among patients with congestive heart failure (CHF) recently hospitalized at the University of Pennsylvania Health System (UPHS).
Principal investigator: Scott Halpern, MD, PhD, M.Bioethics
Paying patients to enroll in randomized clinical trials could dramatically improve the pace and scientific validity with which new interventions for cancer and other diseases are tested, but the practice raises important ethical concerns. To inform the regulation of research incentives and reduce undue variability in their use, we will conduct a randomized trial of 3 real incentives for patients with lung cancer to participate in a real trial comparing two forms of radiation therapy. The trial’s innovative design will enable definitive tests of how patients make research decisions in the face of money, and will provide the best possible evidence regarding the scientific and ethical pros and cons of incentives for research participation.
Principal Investigator: Justin Bekelman, MD
The Radiotherapy Comparative Effectiveness (RADCOMP) Consortium will conduct a pragmatic randomized clinical trial in which 1,716 patients with stage II and III breast cancer involving lymph nodes under the arm or above the collarbone will be randomized after surgery to either proton therapy or photon therapy, the current standard treatment. Patients will be followed to determine differences in heart problems, cancer control, and health-related quality of life (HRQOL) after treatment.
Principal Investigator: Kit Delgado, MD, MS
The objective of this project is to pilot test an interfamily accountability strategy for teens and their parents to work together to reduce their collective cellphone use while driving. The specific aims are to compare measures of acceptance and feasibility across teen-parent dyads randomized to bidirectional teen-parent vs. teen only monitoring of cellphone use while driving.
Principal Investigator: Shivan Mehta, MD, MBA, MSHP
This research project will test a population-based approach to improving colorectal cancer screening rates among UPHS employees, which could serve as a model for other payer or employer populations. The specific aim is to compare conventional email notification, active choice pre-scheduling, and active choice prescheduling with financial incentives against their ability to increase colonoscopy completion rates.
Principal Investigator: Katherine Milkman, PhD
This research project will conduct a randomized controlled trial to test the impact of an intervention designed to increase gym attendance and improve health outcomes related to obesity. This project consists of performing a large-scale field experiment at a Fortune-500 company to determine whether healthy habits can be formed more effectively when consumers are rewarded for repeated engagement in a given healthy behavior at a specific, routinized time each day rather than at any time.
Principal Investigator: Emily Rubin, MD, JD
There has been a strong movement in health care towards the development of decision aids that foster deliberation, but we know little about the use and relative merits of intuitive and deliberative thinking in decisions regarding life-sustaining medical interventions. This research project will determine whether there are systematic differences between the decisions patients make intuitively versus deliberatively about life-sustaining medical interventions and evaluate how decisions about life-sustaining treatments reached intuitively and those reached deliberatively map with the stated underlying values of the patient.
Principal Investigator: Marina Serper, MD
Hepatitis C (HCV) treatment has been revolutionized by the advent of highly effective, but extremely costly drug regimens. Data from clinical trials show >90% cure rates, however, medication adherence and real world cure rates are not known. This research project will test the efficacy of tailored reminders vs. financial incentives compared to usual care to promote medication adherence among a diverse sample of Hepatitis C patients at risk for medication non-adherence, and will determine specific patient characteristics (age, cognitive function) that are associated with medication non-adherence after adjustment by intervention arm.
Principal Investigator: Justin Sydnor, PhD
The specific aims of this study are to (1) estimate the treatment effect of both the standard monetary incentive and the endowment-effect incentive relative to a control in terms of the fraction of members using the gym over time; (2) test whether the endowment-effect treatment increases the fraction of participants meeting the program gym-use goals relative to a standard treatment with the same monetary value; and (3) estimate the size of a standard monetary incentive that is expected to generate the same success rate as the endowment-effect incentive.
Principal Investigators: Kevin Volpp, MD, PhD, Judd Kessler, PhD, Peter Reese, MD, MSCE
There is growing evidence of strong associations between a patient’s social environment and health behavior. Social forces are worth harnessing as a strategy to promote health behaviors because patients usually engage with their physicians and nurses during occasional health system visits, but they interact with their social networks much more frequently. Furthermore, social forces may be particularly effective at building enduring habits for healthy behavior and might be cost effective to implement. This study proposes to complete a randomized controlled trial of 200 subjects with diabetes and evidence of poor adherence to a statin medication (<70% medication possession ratio determined through pharmacy records). Study subjects will use GlowCaps to store their statin medication. Study subjects will identify potential Medication Adherence Partners (MAPs) who can receive information about their adherence patterns at enrollment. The primary outcome will be the percent of statin doses taken during the study as measured by the GlowCaps. The secondary outcome will be subjects’ statin MPR during the study.
Funder: Merck & Co.
Principal Investigators: Kevin Volpp, MD, PhD, Judd Kessler, PhD, Peter Reese, MD, MSCE
This study aims to investigate the association between a patient’s social environment and health behaviors. It has been well documented in non-health domains that providing agents with information about what others are doing can be an effective motivator. Leveraging this social force might be capable of encouraging patients to build habits for healthy behavior and might be cost effective to implement. This study specifically leverages feedback and information about the performance of others to influence individual behavior. An individual can be motivated to improve his performance when he knows he will be receiving feedback about that performance. Additionally, individuals may feel compelled to compete when their performance is compared to the performance of others. This study’s interventions will study the effects of feedback and information about others by varying what individuals are told about their medication adherence and how it compares to other people in the study.
Funder: Merck & Co.
Principal Investigators: Kevin Volpp, David Asch
The goal of this project is to improve medication adherence and health outcomes in post-discharge patients who are recovering from acute myocardial infarctions. Such patients typically have high rates of poor medication adherence and hospital readmissions and are costly to monitor through intensive case management. The intervention will increase medication adherence through use of wireless pill bottles, financial incentives, and social incentives. We are conducting this study in 38 states with 5 major insurer partners. The anticipated result will be improved health outcomes and lower cost.
Funder: Center for Medicare and Medicaid Innovation
Principal Investigator: Milkman
The purpose of this study was to test the association between behavioral nudges and rate of flu shot vaccination among older employees at a large firm. The results were published in the Proceedings of the National Academy of Sciences June 13, 2011. The researchers found that those who received a reminder mailing and were prompted to write down the date and time they planned to get a flu shot had a 4.2 percentage point higher vaccination rate than those who just received a reminder in the mail.
Funder: Roybal Center for Behavior Change in Health and Savings at the National Bureau of Economic Research
Principal Investigator: Karlawish
This line of research is examining the implications of the psychology and neurology of aging on theories of behavioral economics with attention to the clinical, ethical and policy issues.
Principal Investigator: Abrams
There is concern in the medical community that payments to physicians by pharmaceutical companies may distort prescribing behavior, whether through a conscious or unconscious mechanism. By combining a proprietary dataset covering 80 million individual prescriptions with payment data collected by state agencies the goal of this research is to produce the first empirical estimates of the relationship between pharma payments and prescription choice.
Funder: LDI CHIBE Pilot Project
Principal Investigators: Halpern / Volpp
This study will evaluate the relative efficacy of guaranteed payments (either up-front or conditional on response) vs. lotteries (in which respondents are entered into a random drawing for a larger reward) in increasing healthcare provider response to surveys. This study comprises 3 independent randomized trials of actuarially equivalent payments and lotteries.
Funded by: Greenwall Foundation and University of Pennsylvania, LDI CHIBE Pilot Project
Principal Investigators: Loewenstein / Acquisti / John
Dominant theories proposed by economists and psychologists assume that people have stable, coherent, attitudes toward privacy, but this research has found that people are extremely inconsistent in their concern about privacy. A large number of field and laboratory studies have found that people are often protective of their privacy in situations in which there is no need to be, and even more often not concerned about privacy or even motivated to reveal information in situations in which caution would be warranted.
Principal Investigators: Asch / Volpp
Co-investigators: Barg, Bellamy, Berger, Gaziano, Glick, Graf, Jones, Lafata, Loewenstein, Metlay, Rosenthal, Shea, Stewart, Troxel, Weiner, Weinstein
This project aims to test whether financial incentives and/or choice architecture improve the uptake of comparative effectiveness research findings related to reducing cardiovascular disease risk among physicians and patients.
Funded by: National Institutes of Health / National Institute on Aging