Behavioral Economics / Behavior Change

The application of principles of economics and psychology to examine how individuals make choices in complex contexts--such as personal finances and health--and to improve these decisions and behaviors.

Rationale and design of a randomized trial of automated hovering for post myocardial infarction patients: The HeartStrong program

Sep. 22, 2016

Andrea B. Troxel, David A. Asch, Shivan J. Mehta, Laurie Norton, Devon Taylor, Tirza A. Calderon, Raymond Lim, Jingsan Zhu, Daniel M. Kolansky, Brian M. Drachman, Kevin G. Volpp

In the American Heart Journal, Andrea Troxel and colleagues, including Kevin Volpp, David Asch and Shivan Mehta, discuss the rationale and design of the HeartStrong program, a randomized controlled trial aimed at increasing medication adherence among patients with coronary artery disease. This trial features three main innovations: first, it uses behavioral economics concepts such as intermittent feedback, regret aversion and the entertainment value of a daily lottery; second, it automates procedures using new technology such as wireless pill bottles and remote feedback; and third...

Participation Rates With Opt-out Enrollment in a Remote Monitoring Intervention for Patients With Myocardial Infarction

Sep. 13, 2016

Shivan J. Mehta, Andrea B. Troxel, Noora Marcus, Christina Jameson, Devon Taylor,  David A. Asch, and Kevin G. Volpp

In JAMA Cardiology, Shivan Mehta and colleagues, including Andrea Troxel, David Asch and Kevin Volpp, evaluate whether an opt-out approach to enrollment, which has been shown to be effective in behavioral economics research, increases participation in a remote monitoring intervention among patients with myocardial infarction. This prospective cohort study compared enrollment rates in a remote monitoring intervention for medication adherence, using an opt-in vs an opt-out approach. Opt-in participants were recruited in the 60 days after discharge by sending a recruitment letter to...

The Influence of Sugar-Sweetened Beverage Warnings - A Randomized Trial of Adolescents’ Choices and Beliefs

Sep. 13, 2016

Eric VanEpps and Christina Roberto 

In the American Journal of Preventive Medicine, Eric VanEpps and Christina Roberto measure the extent to which health-related warning labels on sugar-sweetened beverages influence adolescents’ perceptions of different beverages and their choice of beverages. The authors conducted and analyzed an online survey of 2202 demographically diverse adolescents, aged 12-18. Participants were asked to choose a beverage in a hypothetical vending machine task, rate perceptions of different beverages and indicate their interest in coupons for beverages. The participants were randomly assigned...

A Nudge Toward Participation: Improving Clinical Trial Enrollment with Behavioral Economics

Aug. 15, 2016

Eric M. VanEpps, Kevin G. Volpp, Scott D. Halpern

In Science Translational Medicine, Eric VanEpps, Kevin Volpp and Scott Halpern suggest behaviorally informed interventions, or “nudges” that might be tested and implemented to improve patient recruitment and enrollment in randomized controlled trials (RCTs). Participant recruitment represents one of the largest costs of conducting RCTs, and barriers to recruitment can generate problems of selective enrollment and under-enrollment. The authors present a taxonomy of different approaches aimed at increasing clinical trial enrollment, based on behavioral economics principles. The...

A Synchronized Prescription Refill Program Improved Medication Adherence

Aug. 5, 2016

Jalpa A. Doshi, Raymond Lim, Pengxiang Li, Peinie P. Young, Victor F. Lawnicki, Joseph J. State, Andrea B. Troxel, and Kevin G. Volpp

In Health Affairs, Jalpa Doshi and colleagues, including Pengxiang Lee, Andrea Troxel and Kevin Volpp, evaluate whether renewing all medications at the same time from the same pharmacy improves adherence to medication regimens. Synchronizing medication refills is an increasingly popular strategy, but there has been little research regarding its effectiveness. The authors looked at a pilot refill synchronization program implemented by Humana, a large national insurer, and analyzed patients’ adherence before and after participation in the program, compared to a control group. The...

A Randomized Trial of Social Comparison Feedback and Financial Incentives to Increase Physical Activity

Aug. 5, 2016

Mitesh S. Patel, Kevin G. Volpp, Roy Rosin, Scarlett L. Bellamy, Dylan S. Small, Michele A. Fletcher, Rosemary Osman-Koss, Jennifer L. Brady, Nancy Haff, Samantha M. Lee, Lisa Wesby, Karen Hoffer, David Shuttleworth, Devon H. Taylor, Victoria...

In the American Journal of Health Promotion, Mitesh Patel and colleagues, including Kevin Volpp, Roy Rosin, Dylan Small and David Asch, investigate the different social and financial drivers of increased physical activity. Physical activity is the leading risk factor for cardiovascular disease and mortality. This 13-week study grouped participants into 72 competing teams of four members each, tasked with walking at least 7,000 steps per days, and monitored via a smartphone application. The members were given team-based physical activity performance feedback either with or without...

The Effect of a Sunday Liquor-Sales Ban Repeal on Crime: A Triple-Difference Analysis

Jun. 21, 2016

SeungHoon Han, Charles BranasJohn MacDonald

In Alcoholism: Clinical and Experimental Research, SeungHoon Han, Charles Branas and John MacDonald investigate whether alcohol availability in state-run liquor stores affects a neighborhood’s crime rates, and if the relationship between alcohol availability and crime differs based on a neighborhood’s socioeconomic status (SES).  In 2003, Pennsylvania repealed the Sunday alcohol-sales ban for a portion of its state-run stores. The authors utilized this policy change for their analysis. They find that the repeal was associated with a significant increase in total and property-crime...

Generic Medication Prescription Rates After Health System–Wide Redesign of Default Options Within the Electronic Health Record

May. 19, 2016

Mitesh Patel, Susan Day, Scott Halpern, William Hanson, Joseph Martinez, Steven Honeywell Jr, Kevin Volpp

In JAMA Internal Medicine, Mitesh Patel and colleagues, including Scott Halpern and Kevin Volpp, evaluate how changing electronic health record (EHR) defaults affects physician prescribing of generic drugs. For the study, the researchers utilized a systemic change to the University of Pennsylvania Health System’s EHR defaults. As part of this change, an opt-out checkbox labeled “dispense as written” was added to the prescription screen, and if left unchecked the generic-equivalent medication was prescribed. The authors find that generic prescribing rates increased significantly...

Effect of a Financial Incentive for Colorectal Cancer Screening Adherence on the Appropriateness of Colonoscopy Orders

May. 18, 2016

Thomas B. Morland, Marie Synnestvedt, Steven Honeywell Jr, Feifel Yang, Katrina Armstrong, Carmen Guerra

Abstract: Performance incentives for preventive care may encourage inappropriate testing, such as cancer screening for patients with short life expectancies. Defining screening colonoscopies for patients with a >50% 4-year mortality risk as inappropriate, the authors performed a pre-post analysis assessing the effect of introducing a cancer screening incentive on the proportion of screening colonoscopy orders that were inappropriate. Among 2078 orders placed by 23 attending physicians in 4 academic general internal medicine practices, only 0.6% (n = 6/1057) of screening colonoscopy...