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.

Self-Efficacy Of Family Caregivers Of Older Adults With Cognitive Impairment: A Concept Analysis

Sep. 4, 2020

Tarik S. Khan, Karen B. Hirschman, Matthew D. McHugh, Mary D. Naylor

Abstract [from journal]

Background: Research demonstrates that increased self-efficacy can help family caregivers of older adults with Alzheimer's and other types of cognitive impairment experience lower burden and depressive symptom severity.

Aims: The purpose of this concept analysis is to address fundamental gaps in the understanding of self-efficacy in family caregivers of older adults with cognitive impairment, including updating the 26-year-old concept analysis with a contemporary definition.

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High Rates of Partial Participation in the First Year of the Merit-Based Incentive Payment System

Nate Apathy
Sep. 1, 2020

Nate C. Apathy and Jordan Everson

Abstract [from journal]

There has been widespread concern over the design of the Merit-based Incentive Payment System (MIPS) since its authorization with the Medicare Access and CHIP Reauthorization Act of 2015. Using detailed performance data from 2017, the first implementation year of MIPS, we found that although 90 percent of participating clinicians reported performance equal to or better than the low performance threshold of 3 out of 100 (a calculated composite score), almost half of clinicians did not participate in at least one of the three

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Evaluating The Quality Of Research Ethics Review And Oversight: A Systematic Analysis Of Quality Assessment Instruments

Holly Fernandez Lynch 160
Aug. 21, 2020

Holly Fernandez Lynch, Mohamed Abdirisak, Megan Bogia, Justin Clapp

Abstract [from journal]

Background: Research ethics review committees (RERCs) and Human Research Protection Programs (HRPPs) are responsible for protecting the rights and welfare of research participants while avoiding unnecessary inhibition of valuable research. Evaluating RERC/HRPP quality is vital to determining whether they are achieving these goals effectively and efficiently, as well as what adjustments might be necessary. Various tools, standards, and accreditation mechanisms have been developed in the United States and

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Neither Mad Nor Bad? The Classification Of Antisocial Personality Disorder Among Formerly Incarcerated Adults

Jason S. Schnittker, PhD
Aug. 17, 2020

Jason Schnittker, Savannah H. Larimore, Hedwig Lee

Abstract [from journal]

Using the National Comorbidity Survey, this study explores the presence and symptoms of antisocial personality disorder (ASPD) among people with varying degrees of contact with the criminal justice system. The study finds an elevated prevalence of ASPD among formerly incarcerated persons, but also that ASPD is not a simple linear function of actual or potential contact with the criminal justice system. For example, among people who have been arrested the prevalence of ASPD is not much greater than among those who committed a crime

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Do Physician Incentives Increase Patient Medication Adherence?

Aug. 1, 2020

Edward Kong, John Beshears, David Laibson, Brigitte Madrian, Kevin Volpp, George Loewenstein, Jonathan Kolstad, James J. Choi

Abstract [from journal]

Objective: To test the effectiveness of physician incentives for increasing patient medication adherence in three drug classes: diabetes medication, antihypertensives, and statins.

Data sources: Pharmacy and medical claims from a large Medicare Advantage Prescription Drug Plan from January 2011 to December 2012.

Study design: We conducted a randomized experiment (911 primary care practices and 8,935 nonadherent patients) to test the effect of paying physicians for

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The Landscape Of Cardiovascular Clinical Trials In The United States Initiated Before And During COVID-19

Jul. 27, 2020

Senthil Selvaraj, Stephen J. Greene, Sameed Ahmed M. KhatanaAshwin S. Nathan, Scott D. Solomon, Deepak L. Bhatt

Abstract [from journal]

The Coronavirus Disease 2019 (COVID-19) pandemic has taken an unprecedented toll on the American healthcare system and economy. While numerous COVID-19 clinical trials have been initiated in hopes of curtailing its impact, most pre-existing clinical trials have been forced to suspend or limit activity, which itself can have significant consequences. Missed or postponed trial-related assessments may hinder data quality, and heterogeneity in data collection both across the country and over time introduces bias. In addition, COVID-19

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The Psychological Benefits Of Marriage And Children In Rural Malawi

Iliana Kohler
Jul. 27, 2020

Shelley Clark, Cassandra Cotton, Rachel Margolis, Hans-Peter Kohler

Abstract [from journal]

Despite an extensive literature on the psychological rewards of marriage and children in high-income countries, research on these relationships in low-income countries remains limited. This paper draws on data from 4,133 adult women and men interviewed in the Malawi Longitudinal Study of Families and Health to examine how marital status, categorized as never, formerly, monogamously, and polygynously married, and number of children are associated with psychological well-being. With respect to marital status, we find that women in

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Identifying Risk Factors For Suicidal Ideation Across A Large Community Healthcare System

Jul. 18, 2020

Emily Schriver, Shari Lieblich, Reem AlRabiah, Danielle L. Mowery, Lily A. Brown

Abstract [from journal]

Background: Suicide is the tenth leading cause of death in the United States. Several studies have leveraged electronic health record (EHR) data to predict suicide risk in veteran and military samples; however, few studies have investigated suicide risk factors in a large-scale community health population.

Methods: Clinical data was queried for 9,811 patients from the Penn Medicine Health System who had completed a Patient Health Questionnaire-9 (PHQ-9) documented in the EHR between January

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External Validation Of The Skilled Nursing Facility Prognosis Score For Predicting Mortality, Hospital Readmission, And Community Discharge In Veterans

Robert Burke, MD, University of Pennsylvania
Jul. 1, 2020

Robert E. Burke, Anne Canamucio, Elina Medvedeva, Kirstin A. Manges, Mary Ersek

Abstract [from journal]

Background/objectives: Prognostic tools are needed to identify patients at high risk for adverse outcomes receiving post-acute care in skilled nursing facilities (SNFs) and provide high-value care. The SNF Prognosis Score was developed in a Medicare sample to predict a composite of long-term SNF stay, hospital readmission, or death during the SNF stay. Our goal was to evaluate the score's performance in an external validation cohort.

Design: Retrospective observational analysis.

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The Association Of A Sweetened Beverage Tax With Changes In Beverage Prices And Purchases At Independent Stores

Nandita Mitra, PhD
Jul. 1, 2020

Sara N. Bleich, Hannah G. Lawman, Michael T. LeVasseur, Jiali Yan, Nandita Mitra, Caitlin M. Lowery, Ana Peterhans, Sophia Hua, Laura A. Gibson, Christina A. Roberto

Abstract [from journal]

In January 2017 Philadelphia, Pennsylvania, implemented an excise tax of 1.5 cents per ounce on beverages sweetened with sugar or artificial sweeteners. Small independent stores are an important yet understudied setting. They are visited frequently in urban and low-income areas, and sugary beverages are among the most commonly purchased items in them. We compared changes in beverage prices and purchases before and twelve months after tax implementation at small independent stores in Philadelphia and an untaxed control city, Baltimore

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What Do We Know About Health Insurance Choice?

Issue Brief
Jun. 30, 2020

From choosing a doctor to selecting an insurance plan, choices pervade nearly all aspects of our health care system. However, there is little agreement among policymakers and the public about what constitutes “choice,” which choices are important, and how and whether patients should be asked to make various health care choices. Although Americans claim to value having health insurance choices, research shows that when presented with options, people do not actually like to choose. Other studies suggest that people frequently make health insurance decisions that leave them worse off, or not much better than before. At Penn LDI’s Medicare for All and Beyond conference, a panel of researchers and policy experts discussed the current evidence around health insurance choice and implications for future health care reform efforts. This brief summarizes the panel’s key takeaways.

Determinants Of Stigma Among Patients With Hepatitis C Virus (HCV) Infection

Jun. 5, 2020

M. Elle Saine, Julia E. Szymczak, Tyler M. Moore, Laura P. Bamford, Frances K. Barg, Jason SchnittkerJohn H. HolmesNandita Mitra, Vincent Lo Re

Abstract [from journal]

Stigma around hepatitis C virus (HCV) infection is an important and understudied barrier to HCV treatment and elimination. The determinants of HCV-related stigma, including the impacts of stage of HCV treatment (i.e., spontaneously-cleared; diagnosed, untreated; previously treated, not cured; currently being treated; treated, cured) and coinfection with human immunodeficiency virus (HIV), remain unknown. To address these gaps, we conducted a cross-sectional study among patients with a history of HCV infection (n=270) at outpatient

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