A Nudge for Better Outcomes
Mitesh Patel, MD, MBA, MS is the Director of the Nudge Unit at Penn Medicine in Philadelphia, a behavioral design team that helps health system leaders, clinicians and clinical staff deliver care in a way that improves medical decision-making. The Nudge Unit has worked in a wide range of clinical care settings, steering health care delivery toward higher value and better patient outcomes. Its approaches include using defaults, financial incentives, gamification, information framing, social incentives, active choice and prediction to achieve desired care goals. Dr. Patel talks more about the unit’s work below.
Why was the Nudge Unit created?
The Penn Medicine Nudge Unit is the world’s first behavioral design team embedded within the operations of a health system. The Unit was created to improve health care delivery by testing the application of principles from behavioral economics in a systematic way and then scaling successful approaches
What is a nudge?
A nudge is a change in the way choices are presented or information in framed that alters behavior in a predictable way without restricting choice
How are behavioral economics and psychology integrated into the unit’s work?
For each problem, we begin by understanding the decision-making process and how that affects both clinician and patient behaviors. We then identify opportunities to apply insights from behavioral economics and psychology to address gaps in care.
How does your work steer medical decision-making to higher value and improved patient outcomes?
Our group designs and tests nudges to significant improve medical decision-making. This can be done by setting the default setting to the evidence-based option, prompting clinicians and patients to address gaps in care by using an active choice intervention, or framing information in a way that influences behavior such as comparing one’s performance to their peers.
What is the greatest challenge of your work?
The key challenges including identifying opportunities, selected the right nudge, gathering stakeholder alignment, and then implementing interventions in ways that can be well-evaluated
What have been the greatest successes of your work?
We have change default options to increase generic prescribing rates in our health system from 75% to 99%, reduce unnecessary opioid prescribing in emergency departments in half, and increased referral to cardiac rehabilitation programs from 15% to 85%. We’ve used active choice to increase influenza vaccination rates by 10 percentage points and peer comparison feedback to triple statin prescription rates by primary care physician
How broadly have the unit’s work/interventions been applied?
Our work has been scaled from small pilots within our health system to interventions launched health-system wide. We have also translated our work at Penn to other health systems across the country. In September 2018, we held the first Nudge Units in Health Care Symposium which was attended by leadership from 22 health systems across the US and Canada who are interested in replicating our model by launching their own nudge unit within their health system.
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