Learning How Behavioral Economics Impacts Health Decisions

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Center for Health Incentives and Behavioral Economics 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. 

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.



Health Incentives and Behavioral Economics Research Studies

You are viewing 39 posts in the category Ongoing Research

Smarter Big Data for a Healthy Pennsylvania: Changing the Paradigm of Healthcare

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

Behavioral Economics in Provider Incentive Design

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

Tags: Amol Navathe

RCT of Automated Hovering for Congestive Heart Failure

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).


Incentives for Participation in a Randomized Controlled Trial

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.

Funder: NCI/NIH 

Pragmatic Randomized Trial of Proton vs. Photon Therapy for Patients with Stage II or III Breast Cancer

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.

Funder: PCORI

Promoting Interfamily Accountability for Reducing Cellphone Use While Driving in Adults and their Teen Children: A Pilot Trial

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.

Funder: NIA/NIH

Tags: Kit Delgado

Behavioral Economic Approaches to Improve Colorectal Cancer Screening

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.

Funder: NIA/NIH

Tags: Shivan Mehta

Intuition and Deliberation in Decisions about Life-Sustaining Medical Interventions

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.

Funder: NIA/NIH

Way to Cure: Developing Effective Strategies to Promote Adherence to Hepatitis C Therapy among Older Adults

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. 

Funder: NIA/NIH  

Can the Endowment Effect be Used to Increase the Power of Health Incentives?

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.

Funder: NIA/NIH

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

A Randomized Trial of Cognitive vs. Behavioral Incentives to Induce Sustained Healthy Oral Hygiene Habits and Improve Oral Health

Principal Investigators: Alison Buttenheim, PhD, MBA and Iwan Barankay, PhD

Designing cost-effective, time-limited interventions that lead to persistent healthy habits is a pressing public health challenge. In this planned randomized controlled study, we propose to test and compare the effectiveness of two types of financial incentives-behavioral vs. cognitive-for creating better toothbrushing habits and improving the gingival index, an important measure of oral health.

Funder: NIH: National Institute of Dental and Craniofacial Research

Capturing symptom progression and the physical and cognitive activities of patients daily following concussion using Way To Health

Principal Investigators: Douglas Wiebe, MD; Christina Master, MD; Kit Delgado, MD, MS

Our long term goal is to develop an intervention delivered at the point of care at emergency department or clinic discharge on a smartphone to deliver precise, real-time guidance on activity and rest to optimize post-concussion recovery. The objective of this application is to deploy Way To Health (WTH) as way to enable a robust approach to utilizing remote technologies to monitor symptoms, cognitive rest, and physical rest to carryout critical next studies of concussion. We aim to 1) use WTH to develop a protocol to efficiently recruit and enroll pediatric and adult concussion patients from the ED and monitor patients’ symptoms and activities daily over 3 weeks, and 2) test behavioral strategies to ensure engagement with the study protocol by randomizing patients to different incentive conditions.

Funder: CTSA UL1TR000003 from the National Center for Advancing Translational Science

Increasing physical activity to decrease post-operative morbidity

Principal Investigators: Gregory Tasian, MD and Thomas Guzzo, MD

In this application, we propose a pilot randomized, controlled trial to estimate the effect size of financial incentives on achieving a daily goal of 2000 steps in the hospital and post-discharge for 1 month following radical cystectomy. Secondary outcomes include step count, composite morbidity, and functional decline. Thirty adults with bladder cancer undergoing radical cystectomy at the Hospital of the University of Pennsylvania will be randomized to either control (education of step goal with monitoring and daily feedback) or a gain financial incentive ($1.50 for each day the goal was achieved) combined with a lottery incentive if they achieve 75% of the daily goals during the study period. We will use Fitbit Zips to measure step counts for all participants. This proposal will provide the preliminary data needed to design future, larger trials that will test the effect of financial incentives to increase ambulation on post-operative complications, readmissions, and functional decline.

Funder: CTSA UL1TR000003 from the National Center for Advancing Translational Science

Project LIFT: Lifestyle intervention to promote fitness in transplantation

Principal Investigators: Marina Serper, MD, MS; Iwan Barankay, PhD; Peter Reese, MD

Objectives: 1) To determine whether use of an accelerometer device (Misfit tracker) and financial loss-incentives paired with health trivia information vs. the accelerometer use alone increases walking among kidney and liver transplant recipients, and 2) To evaluate whether the interventions are associated with lower weight and changes in body fat composition.

Funder: CTSA UL1TR000003 from the National Center for Advancing Translational Science

Influence of increased physical activity on patient reported measures of disease activity in inflammatory arthritis

Principal Investigators: Alexis Ogdie-Beatty, MD and Joshua Baker, MD

Rheumatoid arthritis (RA) and psoriatic arthritis (PsA) are two of the most common forms of inflammatory arthritis (IA). Exercise or regular physical activity is a low cost adjunctive therapy for IA that is frequently overlooked due to low adherence rates. We propose a randomized interventional study to examine a) the use of a financial incentive to increase physical activity over 12-weeks and b) the impact of increased physical activity on patient-reported measures of disease activity. This proposed study represents a novel collaboration between rheumatology and behavioral economics at Penn and a novel approach to the management of IA.

Funder: CTSA UL1TR000003 from the National Center for Advancing Translational Science

Pilot trial leveraging smartphone-paired breathalyzers and incentives for reducing binge drinking and drinking and driving

Principal Investigators: Kit Delgado, MD, MS; Henry Kranzler

This project will test the feasibility of implementing a randomized control trial of a behavioral intervention that combines smartphone-paired breathalyzers, financial incentives, and rideshare credits to reduce binge drinking and drinking and driving.

Funder: CTSA UL1TR000003 from the National Center for Advancing Translational Science

Tags: Kit Delgado

Physician Competency in the Use of Choice Architecture

Principal Investigator: Joanna Hart, MD

The overall objective of this project is to obtain preliminary data revealing whether physicians demonstrate skill in the use of choice architecture.

Funder: NIA/NIH P30AG034546 (Roybal Pilot Project)

Tags: Joanna Hart

Choice Architecture and Mailed Outreach for Colorectal Cancer Screening

Principal Investigator: Shivan Mehta, MD

The proposed project will evaluate the effect of mailed colonoscopy outreach, mailed FIT, or mailed FIT with the choice of colonoscopy (active choice). The hypothesis is that offering the choice of mailed FIT or colonoscopy will result in greater screening response than mailed FIT or colonoscopy outreach alone.

Funder: NIA/NIH P30AG034546 (Roybal Pilot Project)

Tags: Shivan Mehta

Communicating the Health Risks of Sugar-Sweetened Beverages

Principal Investigator: Christina Roberto, PhD

This study has two aims: 1) To test the effect of repeated exposure to warning labels on kilocalories purchased over time among older adults; and 2) To demonstrate the feasibility of a novel, online store research protocol that can be used to ship participants’ actual purchases.

Funder: NIA/NIH P30AG034546 (Roybal Pilot Project)