CHIBE’s Year in Review: 2020

In 2020, CHIBE members used behavioral science to…

*in no particular order*

1. Establish a first-of-its-kind nudge unit focused on HIV prevention in South Africa. Learn more about Indlela: Behavioural Insights for Better Health, which is developing and testing behavioral solutions that increase uptake of HIV testing, linkage to HIV care, and re-engagement in HIV care, with funding from the Gates Foundation.

2. Conduct the largest-ever study examining how text communications can boost vaccine uptake. The Penn Medicine Nudge Unit and Wharton’s Behavior Change for Good Initiative (both of which include several CHIBE leaders and affiliated faculty members) have partnered with Walmart to test different text communications encouraging Walmart pharmacy customers to get the flu vaccine. Alongside the Geisinger Behavioral Insights Team, these organizations have also been testing SMS interventions in two large health systems: Penn Medicine and Geisinger. The results of this mega study will soon be available and will inform communication strategies for vaccine uptake in 2021.

3. Increase serious illness conversations among patients with cancer. A nudge combined with machine learning mortality predictions can help clinicians start serious illness conversations among patients with cancer. This intervention led to an increase in these important conversations from ~1% to 5% of all patient encounters and from ~4% to 15% of encounters with patients having high predicted mortality risk.

4. Work toward creating a healthy and equitable food system. CHIBE co-hosted an event this year with the PEACH Lab, the Leonard Davis Institute of Health Economics, and the Penn Prevention Research Center to share ways that the food industry can invest in the health of people, communities, and the planet. We heard from Vice Admiral Jerome Adams, MD, MPH, Surgeon General of the United States, as well as leaders from the New York City Department of Health & Mental Hygiene, Guiding Stars, Healthy Food America, and Just Salad.

5. Think about how our field can fight racism. CHIBE has made a commitment to health equity and seeks to examine questions like the distributional equity implications of behavioral economic interventions through its research. Internally, CHIBE and the PAIR Center have partnered to create a Committee for Antiracism and Social Change (CASC), and several CHIBE members are also leaders in the Bold Solutions initiative to fight racism within the health care system.

6. Learn that smartphones may be better than wearable devices in remotely monitoring physical activity after hospital discharge. “Patients discharged from the hospital using smartphones transmitted data for a greater duration and proportion of time, with a 32% relative increase in patients completing the 180-day period compared with those using wearables,” the study authors found.

7. Improve adherence in patients post-hospital discharge for acute coronary syndrome. In this study using a loss aversion behavioral economics-based telehealth intervention, adherence to aspirin was higher in the intervention group than the control group after 90 days (median adherence 90% vs 81%). Re-hospitalization was also lower in the intervention group (13% vs 24%).

8. Determine that financial incentives may improve statin adherence but not LDL-C levels. This 6-month study found that while different financial incentive structures improved medication adherence, the incentive schemes did not reduce LDL-C levels from baseline to one year. “This result points to the importance of directly measuring health outcomes, rather than simply adherence, in trials aimed at improving health behaviors,” the study authors wrote.

9. Explore how behavioral phenotyping can help target behavioral interventions more effectively to individuals who are more likely to respond to them. In this secondary analysis of the STEP UP trial, the study authors grouped participants into distinct behavioral phenotypes and found that they had differential responses to a physical activity intervention.

10. Show how peer comparisons can improve health care quality. This trial with Blue Cross Blue Shield of Hawaii looked at peer comparisons feedback among primary care providers and found that patients in the intervention group experienced a 3.1-percentage-point boost in quality scores compared to the control group, which involved individual feedback only. These results “support Medicare’s decisions to provide comparative feedback as part of recently implemented primary care and specialty payment reform programs,” they wrote.

In 2020, CHIBE also used its expertise to help address the COVID-19 pandemic by…

1. Providing guidance on COVID-19 vaccine roll-out. Our researchers have been elected to national committees to provide a framework for the equitable allocation of vaccines for the coronavirus. CHIBE researchers have also written op-eds on behavior change techniques to use to encourage vaccine uptake, offered 5 behaviorally informed strategies for a national COVID-19 vaccine promotion program, and published extensively on the topic of social justice in vaccine allocation.

2. Optimizing contact tracing. Behavioral science can inform decisions, such as when it’s best to call contacts, what the most successful way to identify the contact tracing team is (e.g. as a health system or public health department), and what the best way to reach people is (e.g. text, call, email).

3. Identifying cognitive bias in the response to the COVID-19 crisis. Read this JAMA paper that explains how we “prioritize the readily imaginable over the statistical, the present over the future, and the direct over the indirect” and what effect that has on our decision-making during the pandemic.

4. Assisting Pennsylvania in creating and increasing sign-ups in COVID PA Alert, a free app designed to help reduce the spread of COVID-19 and which has been used by nearly 700,000 Pennsylvanians so far. The team has been testing message strategies and among other things got the Philadelphia Eagles to record a public service announcement.

5. Creating an AI chatbot for common questions related to COVID-19 to help offload call volume to unburden clinicians and shorten wait times for patients. This had several advantages, including being available 24/7 without wait times and also ensuring that patients always got the best possible answer. This was done in partnership with Verily/Google and made available and free to health systems worldwide through Google’s Contact Center AI Initiative.

6. Working with the Penn Medicine Center for Health Care Innovation and numerous other groups at Penn to create PennOpen Pass, a daily symptom tracking and triage tool used to expedite access to testing and contact tracing for the more than 60,000 faculty, staff, students, and employees of the University of Pennsylvania and Penn Medicine.