LDI Senior Fellow and Director of the Penn Medicine Nudge Unit M. Kit Delgado, MD, MS, opened the two-day 2024 Nudges in Health Care Symposium in the Arthur H. Rubenstein Auditorium. (Photos: Hoag Levins)
National pioneers in the burgeoning field of internal health system innovation research departments, the Penn Medicine Center for Health Care Transformation & Innovation (CHTI) and its Nudge Unit organized the first Nudges in Health Care Symposium in 2018 and have continued the annual event ever since. This year’s meeting, held September 26-27, brought together nearly 200 researchers, clinicians and health system executives from 29 institutions across the U.S. as well as Australia, Singapore, Israel, and Afghanistan.
“Nudge” is a scientific concept made popular by Richard Thaler and Cass Sunstein’s 2008 book, Nudge. In health care, it refers to the process of analyzing patient behaviors or clinical and business-side hospital practices and procedures to determine where people are not making the optimal choices to achieve the best operational outcomes. Then, by altering how information is framed, and choices are presented, nudge strategies are designed to guide or motivate people to make better choices—at the same time their freedom of choice is not restricted. This can all be as simple as changing certain clinician defaults in the EPIC electronic health records (EHR) system or as involved as reorganizing how patients physically move through the emergency department waiting room or respond to invitations for screening tests.
The two-day symposium featured podium presentations, panels, workshops, and poster sessions covering a broad range of nudge-related topics from “An Evidence-Based Calculator for Cesarean Risk During Labor Induction”; and “Practical Approaches to the Design of EHR Clinical Decision Support Nudges”; to “Leveraging Artificial Intelligence and Machine Learning and Behavioral Science to Optimize Hospital Scheduling”; and “Effect of a Nudge on Disparities in Patient Portal Use.” Here’s what the event looked like:
LDI Senior Fellow and Chief Executive Officer of the University of Pennsylvania Health System Kevin Mahoney, MBA, credited the Penn Medicine Nudge Unit with helping to “break down some of our intrainstitutional competition in ways that get health care costs down and improves quality.”
First day keynote speaker Leora Horwitz, MD, MHS, Director of the Center for Healthcare Innovation and Delivery Science at NYU Langone Health presented on the workings of the Rapid Randomized Controlled Trial (RCT) Lab she leads. It uses rapid-cycle RCTs to test simple, pragmatic nudge ideas. She noted NYU’s is “one of the first centers in the country to apply rapid RCT methodologies to routinely change our health system.”
LDI Senior Fellow Rebecca Hamm, MD, MSCE, Assistant Professor of Maternal Fetal Medicine spoke about the increasing utilization of an evidence-based calculator for cesarean risk during labor induction to reduce maternal morbidity. She is Co-Director of the Achieving Maternal Equity and Transforming Health through Implementation Science and Training (AMETHIST) hub at Penn.
LDI Associate Fellow Jasmine Hwang, MD, MS, Penn Medicine General Surgery Resident discussed development of a comprehensive decision support system to improve screening for primary hyperparathyroidism.
LDI Senior Fellow Jaya Aysola, MD, DTMH, MPH, Executive Director of the Penn Medicine Center for Health Equity and Advancement moderated the panel focused on nudges for health equity in health care. Panel members were Jessica S. Ancker, PhD, MPH, Professor of Biomedical Informatics and Health Policy at Vanderbilt University Medical Center; Marguerite Balasta, MD, Associate Director of Population Health in the Penn Medicine Division of General Internal Medicine; and Africa Perianez, PhD, CEO and Co-Founder of Causal Foundry, Inc.
The panel on clinician-facing nudges was moderated by Jason Hoppe, DO, FACEP, Associate Professor and Opioid Research Program Director at the University of Colorado School of Medicine. The speakers were (l to r) Waleed Zafar, MD, Associate in Hospital Medicine at the Geisinger Center for Kidney Health Research; Julie Uspal, MD, Associate Professor of Clinical Emergency Medicine at Penn Medicine; and Daniella Meeker, PhD, Chief Research Information Officer at the Yale School of Medicine.
One of the highlights of the event was the on-stage fireside chat between Thomas H. Lee, MD, the Chief Medical Officer of Press Ganey and former Penn Medicine Chief Innovation Officer Roy Rosin, MBA. During his 12 years in that position Rosin’s department became famous in national health care circles for the many clinical and business side innovations it developed across the University of Pennsylvania Health System’s network of hospitals and clinics. Lee asked Rosin which of those many projects was his “favorite child?” Rosin’s answer was Heart Safe Motherhood, a project that was initiated 10 years ago by Penn Medicine obstetrical physicians and researchers Sindhu Srinivas, MD, MSCE, LDI Senior Fellow, and Adi Hirshberg, MD. The program is an algorithmically driven system that maintains twice daily two-way text-message communications related to hypertension and potential preeclampsia with post-delivery patients after they’ve gone home. Both conditions are leading causes of maternal mortality and morbidity. The system eliminated the blood pressure check disparity between white women and Black women at the same time it reduced seven-day hospital readmissions from 5% to 1%. “Heart Safe Motherhood was an amazing project and the progenitor of dozens of other projects that came after, including ones like COVID Watch,” said Rosin who is now a Board Partner at First Round Capital, a venture capital firm that provides seed-stage funding to technology startups.
The symposium featured four nudge workshops. In this “Unlocking Behavioral Change” workshop Hadassah Raskas, an Applied Behavioral Scientist at Clalit Innovation emphasizes that the importance of exactly defining the problem to be solved by a nudge is often given too little attention, resulting in nudge solutions that don’t work.
The behavioral change model known as COM-B was extensively discussed. That stands for “Capability, Opportunity, Motivation—Behavior” and is a framework for designing nudging interventions aimed at altering behavior. It helps identify the key components that need to be addressed to achieve successful behavior change.
Garvey Cummings, an MD candidate in the Perelman School of Medicine Department of Obstetrics & Gynecology, discusses her poster detailing a new study focused on the injustice and controversies surrounding urine drug screen (UDS) policies for pregnant patients in labor.
Arleen Lopez Cruz, a Clinical Research Coordinator in the Penn Medicine Center for Health Care Transformation & Innovation and Penn Medicine Nudge Unit staff member, with her poster detailing a project underscoring the high risk of adverse health care outcomes faced by Language Other than English (LOE) patients in labor and delivery as well as in the emergency department.
Taking a break amid the poster sessions are Jason Hoppe, DO, FACEP, Associate Professor and Opioid Research Program Director in the Department of Emergency Medicine at the University of Colorado School of Medicine; Jeanmarie Perrone MD, LDI Senior Fellow and Director of the Penn Center for Addiction Medicine and Policy at the Perelman School of Medicine; M. Kit Delgado, MD, MS, LDI Senior Fellow, Associate Professor in both Emergency Medicine and Addiction Medicine in the Perelman School and Director of the Penn Medicine Nudge Unit; and Jeffrey Moon, MD, MPH, Associate Professor of Clinical Emergency Medicine and Director for Informatics in the Department of Emergency Medicine at the Hospital of the University of Pennsylvania.
