What's Ahead in 2021

It’s a new year and the Penn Medicine Nudge Unit has a lot in store for 2021. We will be hosting a virtual Nudges in Health Care Symposium on May 20, 2021. Sign up here if you are interested in joining. We are looking for a Research Scientist to join the team and help accelerate our portfolio of projects. Click here to learn more about the job opportunity. And we have a lot of projects that have been in the works for the past few years and will be wrapping up and releasing results. Here is sneak peek on those projects. To learn more about our work you can view our entire portfolio of projects here.

Mega Study of Nudges for Vaccination. In a partnership with the team at Behavior Change for Good, we implemented a mega study testing nearly 20 nudges delivered via text messaging to patients in the days leading up to an appointment with their primary care doctor at two large health systems in Pennsylvania. A similar mega study was implemented with large pharmacy chain and included more than 1 million patients. Insights from this work could inform the COVID-19 vaccination effort and we are working quickly to get these results out in the new year.

COVID SAFE. We worked with several groups at Penn Medicine to implement a clinical trial for rapid deployment of a saliva-based screening program for COVID-19. More than 3000 members from the Penn Medicine community have enrolled so far. We embedded several research studies include a randomized trial of different recruitment emails. We compared the traditional approach which invited interested participants to sign up to a opt-out framed email that told participants they were conditionally enrolled and could click a link to complete the process. Insights from this work could help inform COVID-19 strategies to engage participants in a range of behaviors to address the pandemic

REDUCE Trial. The United States is grappling with an opioid epidemic. Strong evidence indicates that the size of the first opioid prescription given for acute pain is directly linked to the likelihood of becoming addicted to opioids. In this study, we partnered with Sutter Health in California and randomly assigned more the 40 emergency departments and urgent care clinics to receive information nudges directed to clinicians. Each site received either monthly peer comparison feedback on their opioid prescribing relative to peers, audit feedback on their outlier opioid prescriptions, both types of feedback or neither. These strategies are low cost and could easily be implemented at other health systems. We look forward to sharing the results in 2021

iDiabetes Trial. Daily health behaviors contribute significantly to management of type 2 diabetes, but changing these behaviors is hard. In this study, we randomized 361 adults with uncontrolled diabetes into either one of three behaviorally design gamification interventions or control. The trial lasted one-year (the longest we’ve run so far) and all participants used wearables devices and a smart weight scale. We look forward to reporting the results on changes in physical activity, weight and hemoglobin A1c.

MOVE IT Trial. Patients who are admitted to the hospital often spend more time in a bed than they should and it can lead to functional decline, specifically among elderly patients. In this trial, we randomly assigned patients at the time of discharge from the hospital to a gamification intervention with social support or control and used wearable devices to monitor their activity over the next 3 months.

Veterans Physical Activity Trial. There has been little work evaluating the use of wearables to engage Veterans in healthy behaviors. In this study, we enrolled 180 overweight and obese Veterans into 3 month intervention with 2 months of follow-up. We tested gamification with and without loss-framed financial incentives and evaluated which intervention increased physical activity relative to control.

ENGAGE Trial. Goal-setting is a fundamental component of nearly every behavior change program, but the best way to set and implement goals is unknown. In this randomized trial, we enrolled 500 patients who either had an atheroscelerotic cardiovascular disease (ASCVD) condition or were at high risk for developing one into a 4 month intervention with 2 months of follow-up. Patients were recruited from lower income neighborhoods near Philadelphia and randomly assigned to how their goals were set (self-chosen or assigned) and implemented (immediately or gradually) or control. We monitored change in daily step counts and minutes of moderate-to-vigorous physical activity.

Statin Nudges Trial. Heart disease is the leading cause of death in the United States. Statins significantly reduce the risk of having a cardiovascular event but less than half of eligible patients have been started on this life-saving medication. In this randomized trial, we compare nudge to clinicians, patients or both for increase statin prescribing rates at 28 primary care practices across Penn Medicine. Clinician nudges include an active choice alert in the EHR and a monthly peer comparison message on their performance relative to peer clinicians. The patient nudge uses a text messages sent to patients in the days before a visit with their primary care doctor that encourages them to learn more and consider a statin. These nudges are fully automated and build upon lessons from several prior clinical trials.

Hepatitis C Screening Trial. Newer treatments can now help cure hepatitis C but many patients who have this viral infection are unaware. The State of Pennsylvania requires that all patients admitted to the hospital be offered screening. In this study, we conducted a stepped-wedge cluster randomized trial evaluating the implementation of an opt-out process for hepatitis C screening. This process is automated through the EHR, low cost and highly scalable.

Summary

We have a lot of exciting initiatives coming out in 2021 and look forward to sharing updates as soon as they are available.

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