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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.  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


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


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


The Impact of Nonlinear Pricing on Portion Size of Unhealthy Food Purchases

Principal Investigators: Julie Downs, PhD; George Loewenstein, PhD 

This study will test the differential impact of nonlinear pricing on (over) consumption of healthy versus non-healthy food items. 

Funder: NIA Penn Roybal Center on Behavioral Economics and Health


A Randomized Trial of Expanded Choice Sets to Increase Completion of Advance Directives

Principal Investigator: Scott Halpern, MD, PhD

This study will examine whether expanding choice sets can increase the completion of and choices within advance directives among patients with end-stage renal disease (ESRD) presenting at DaVita Dialysis Centers in Philadelphia, PA. 

Funder: Medical Ethics and Health Policy, CHIBE


Choice Architecture and Organ Donation

Principal Investigators: Judd Kessler, PhD; Alvin Roth

This project will investigate how choice architecture affects decisions to register as organ donors among a representative sample of residents from the state of Massachusetts.

Funded by: Medical Ethics and Health Policy

 

Tags: Judd Kessler

The Fresh Start Effect: Temporal Landmarks Motivate Healthy Behaviors

Principal Investigators: Katherine Milkman, PhD; Jason Riis, PhD; Hengchen Dai

This project will determine what types of life transition and calendar events or temporal landmarks are most likely to motivate healthy behaviors and how to leverage these temporal landmarks to enhance peoples’ engagement in healthy activities.

Funder: NIA Penn Roybal Center on Behavioral Economics and Health


Incentives, Information, and Impulse: A Field Experiment on Food Choice

Principal Investigator: Saurabh Bhargava, PhD

The research objective of the study is to understand the factors that influence how families choose the food they consume and to identify strategies that can be used to improve such choices.  While existing research has been largely limited to short-run assessments in experimental restaurants and the laboratory, this project aims to investigate the economic and psychological determinants of food choice using a large and novel panel dataset of actual food purchases and a series of randomized experiments on real-world consumers through collaboration with the world’s largest online food delivery firm.  Specifically, the project seeks to understand the role of financial stress on food choice through analysis of archival data, and the role of (i) Incentives, (ii) Information (and the context within which such information is provided), and (iii) Impulsivity on food choice through a series of field experiments.

Funder: NIA Penn Roybal Center on Behavioral Economics and Health


Eating Phenotypes for Childhood Obesity in the Context of Familial Obesity Risk

Principal Investigator: Tanja Kral

The aim of this study is to test the effects of three different types of breakfast on appetite, food intake, and cognitive performance in 8- to 10-year-old children. Using an integrated approach, this research aims to study multiple child eating traits concurrently under states of hunger and satiety. It will examine the impact of short-term appetite and intake regulation on longer-term energy intake control and weight development in a cohort of ethnically diverse normal-weight and obese boys and girls with different familial predispositions to obesity.

Funder: NIH/NIDDK

Tags: Tanja Kral

Effects of Commercial Insurer Payment Policy on Chemotherapy Use and Costs

Principal Investigator: Justin Bekelman

Over the past several years, a large, national commercial insurer implemented reimbursement changes to incentivize the use of generic chemotherapies, presenting a natural experiment which we will leverage to examine the effects of chemotherapy reimbursement policy changes on treatment patterns, quality and costs.

Funder: American Cancer Society


Understand Health Insurance and Policy Using Massachusetts Health Reform

Principal Investigator: Jonathan Kolstad

Understand Health Insurance and Policy Using Massachusetts Health Reform

Funder: Robert Wood Johnson Foundation

 


The Role of Behavioral Economic Incentive Design and Demographic Characteristics in Financial-Incentive Based Approaches to Changing Health Behaviors

Prinicpal Investigators: Nancy Haff, Mitesh Patel, Kevin Volpp

Financial incentives are increasingly being used to promote health behavior change.  The role of participant demographic characteristics and incentive structure has not been well studied.  In this meta-analysis, participant-level data was pooled from previously published studies using financial incentives to promote health behavior change and associations between the effectiveness of financial incentives, demographic characteristics, and incentive structure were evaluated.