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CHIBE Research

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. 

CHIBE Basic Science Core Request for Applications

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.

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Using Social Forces to Improve Medication Adherence in Statin Users With Diabetes

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.


Using Social Comparison to Improve Medication Adherence in Statin Users With Diabetes

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.


A Rapid Cycle Approach to Improving Medication Adherence Through Incentives and Remote Monitoring for Coronary Artery Disease Patients

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 in metropolitan Philadelphia and adjoining areas of New Jersey.  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 telemonitoring and a visual and audible “reminder” system. It will also retrain social workers as engagement advisors to monitor adherence, offer incentives, and enlist patient support from family and friends. The anticipated result will be improved health outcomes and lower cost.

Funder: Center for Medicare and Medicaid Innovation


Using Implementation Intentions Prompts to Enhance Influenza Vaccination Rates

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


Behavioral Economics and Aging

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.


Payments to Physicians

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


A Randomized Clinical Trial of Default Options in Advance Directives for the Elderly

Principal Investigator: Scott Halpern

Default options - the plans that are enacted if no other options are selected - influence peoples' choices in many domains. Whether defaults influence critical health-related decisions is unknown. Patients 65 or older with terminal lung diseases were randomized to receive 1 of 3 advance directives which differed in the default framing of what plans of care and interventions would be enacted if patients did not make decisions to the contrary, completed the directives, and subsequently became so ill that they lost decision-making capacity. We evaluated how defaults influence patients' preferred goals of care (comfort-oriented vs. life extending), desires to receive specific life-sustaining interventions, and satisfaction with advance care planning.

Funding: Greenwall Foundation 

Financial Incentives in Surveys of Healthcare Providers: Lotteries versus Guaranteed Payments

Principal Investigators: Halpern / Volpp 

Co-investigator:  Asch

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


Behavioral Economics of Privacy

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.


A Randomized Trial of Behavioral Economic Interventions to Reduce CVD Risk

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


Developing Interactive Technologies to Improve Research and Health Behavior

Principal Investigators: Asch / Volpp

Co-investigators:  Bellamy, Halpern, Glanz, Goldberg, Groeneveld, Karlawish, Kimmel, Kuna, Loewenstein, Rozin, Shea, Troxel, Zauberman

David A. Asch, MD, MBA and Kevin G. Volpp, MD, PhD are developing IT infrastructure that will deploy clinical and behavioral research studies to advance the science at the intersection of behavioral economics and health.  The project is called Way to Health. For more information see: waytohealth.org

Funded by: National Institutes of Health / National Institute on Aging


Behavioral Economic Approaches to Dietary Control

Principal Investigators: Loewenstein / Volpp / Asch

George Loewenstein, PhD is leading a team in pilot studies to explore different ways of encouraging consumption of healthier food items by framing caloric content using various formats.

 Funded by: Aramark


Process Versus Outcomes Incentives for Lipid Management

Principal Investigators: Peter Reese, Kevin Volpp

Financial incentives have been shown to be effective at improving patient health behaviors including medication adherence in a wide variety of contexts. The delivery of such incentives has been enhanced by the recent development of new wireless technologies that facilitate the measurement of daily medication adherence and the provision of incentives in an automated fashion. However, the relative effectiveness of incentives based on process (e.g. statin adherence) versus outcome (e.g. improvements in LDL cholesterol) is unknown.This is a randomized controlled trial to evaluate the relative effectiveness and cost-effectiveness of improving cholesterol levels among participants who are at high risk of CVD and who have elevated LDL cholesterol levels by testing process versus outcomes financial incentives. 

Funder: National Heart, Lung and Blood Institute


Donor Registration Trial

Principal Investigator: Peter Reese

This Roybal pilot is a randomized, controlled trial to compare the effects of four interventions on the rate of organ donor registration by members of the general public who visit the DMV website for business unrelated to organ donor registration.

Funded by: Roybal P30 Pilot


A Pilot Intervention of an MI-Informed SMS Intervention For Poorly Controlled Type II Diabetes

Principal Investigators: Judith Long, Ilona Lorincz

This project will develop and pilot a three month randomized control trial (RCT) of a Motivational Interviewing (MI)‐informed SMS intervention tailored to patient level of activation in a population of patients with poorly controlled type II diabetes. The pilot will inform the development of a larger RCT, powered to detect a change in glycemic control.

Funded By: Roybal P30 Pilot


Retail pharmacy vouchers to promote Tdap vaccination for adults living with infants

Principal Investigators: Alison Buttenheim, Kristen Feemster

The goal of this study is to assess the feasibility, acceptability, and impact of vouchers and a high-salience celebrity PSA  on uptake of Tdap vaccination for adult caregivers of infants.

Funder: Robert Wood Johnson Foundation Health & Society Scholars Program Research Grants in Population Health and Leonard Davis Institute Health Services Research Pilot Grant


Can policies change norms? Measuring school vaccine exemption norms in the context of regulatory change

Principal Investigator: Alison Buttenheim

The goal of this study is to assess school-level norms related to exemptions from vaccine mandates prior to change in California’s exemption law.


Improving participation in vector control campaigns through behavioral economics

Principal Investigators: Alison Buttenheim, Michael Levy

The goal of this study is to increase participation in a Chagas disease vector control campaign in urban Peru through lotteries, advance commitment responsive scheduling, and peer recruitment. The study takes a  behavioral design approach to identify specific behavioral barriers and address them through novel interventions informed by behavioral economic theory. 

Funder: University of Pennsylvania Global Engagement Fund and University Research Foundation


Evaluation of a Workplace Wellness Program Implementation

Principal Investigator: Scott Halpern

We propose to develop an evidence base regarding best practices in workplace wellness program implementation by leveraging a unique opportunity: an evaluation of 6 of KKR’s portfolio companies, within which we will determine which program features are most effective for improving employee cardiovascular health. Differences in program feature implementation, and in incentive size and structure, offer considerable potential for determining how and for whom wellness programs work.

Funder: AHA


Program in Behavioral Economics and End-of-Life Decisions

Principal Investigators: Scott Halpern

This grant provides initial support for development of a new research program seeking to (1) understand how choice architecture influences end-of-life care decisions, (2) develop interventions based on this understanding that improve the quality of end-of-life care while reducing its costs, and (3) develop new paradigms for thinking about end-of-life decision making.

Funder: Otto Haas Charitable Trust