The Penn Medicine Nudge Unit is a first-of-its-kind program to be implemented within a health system.
The Nudge Unit aims to leverage insights from behavioral sciences, principally behavioral economics, to design and test interventions that steer providers and patients toward better decisions to improve health care delivery and outcomes.
What is a nudge?
A nudge is a change in the way choices are presented or information is framed that alters people's behavior in a predictable way without restricting choice. Nudges should be transparent and never misleading, easy to opt out of if needed, and aligned with the welfare of the person being nudged.
Medical decision-making is heavily influenced by how choices are presented and information is framed. In addition, many forms of medical decision-making are shifting from pen and paper to digital formats. As this shift occurs, environments must be carefully designed to optimize the balance between the risk and benefits of health care decisions in the present and future. Systematic errors in decision-making – from what providers do (or fail to do) to choices patients make – often hinder our ability to deliver high value care. Choice architecture is the application of principles from behavioral sciences such as behavioral economics to the design of environments in which decisions are made and can be used to steer us towards better decisions, higher value and improved outcomes.
Examples of effective nudges
- Employees tend to save more for retirement when they have to opt out of saving a portion of their paycheck for their 401k than when they have to opt in
- Countries with an opt out process have higher rates of organ donor consent than countries that require an individual to opt in
- Automatic prescription renewals lead to higher medication adherence rates than having the individual actively renew the medication
We are a multidisciplinary group of clinicians and social scientists who design and test interventions that use evidence-based approaches to leverage default options, choice architecture, and the framing of information. Our goals are to systematically test ways in which nudges can be used to improve care delivery, publish findings and thereby advance the state of decision science in health care.
Nudge Unit Team
Mitesh Patel, MD, MBA, MS, Director, Penn Medicine Nudge Unit, Assistant Professor of Medicine and Health Care Management at the Perelman School of Medicine and The Wharton School, University of Pennsylvania
Greg Kurtzman, BA, Clinical Research Coordinator, Penn Medicine Nudge Unit
David Asch, MD, MBA, Director, Penn Medicine Center for Health Care Innovation
P.J. Brennan, MD, Chief Medical Officer, University of Pennsylvania Health System
Susan Day, MD, MPH, Associate Chief Medical Informatics Officer, University of Pennsylvania Health System
C. William Hanson, MD, Chief Medical Information Officer, University of Pennsylvania Health System
Judd Kessler, PhD Assistant Professor of Business Economics and Public Policy, The Wharton School of the University of Pennsylvania
Roy Rosin, MBA, Chief Innovation Officer, University of Pennsylvania Health System
Kevin Volpp, MD, PhD, Director, LDI Center for Health Incentives and Behavioral Economics, University of Pennsylvania
Brian Wells, MBA, Associate Vice President of Health Technology and Academic Computing, University of Pennsylvania Health System
Christine VanZandbergen, MPH, MS PA-C, Associate CIO of Clinical Applications
Over the course of four weeks, faculty and staff at Penn Medicine submitted 225 creative ideas for areas in which nudges could be applied to improve care delivery or patient outcomes. In addition, more than 350 ratings and comments were logged on the Your Big Idea platform. After several rounds of review, the Nudge Unit team selected three winners. The ideas listed below will move forward toward testing and exploration.
- Changing opioid prescription default settings - Kit Delgado, Assistant Professor, Emergency Medicine & Epidemiology
- Using default options to improve cardiac rehab referral rates - Srinath Adusumalli, Fellow, Cardiovascular Division
- Reducing unnecessary ordering of imaging for radiation therapy - Sonam Sharma, Resident Physician, Radiation Oncology
- Change in Generic Medication Prescription Rates After Health System-Wide Redesign of Default Options Within the Electronic Health Record
- Nudging Students Toward Healthier Food Choices—Applying Insights From Behavioral Economics
- Harnessing the Power of Default Options to Improve Health Care
- Leveraging Insights from Behavioral Economics to Increase the Value of Health-Care Service Provision
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