Nudge Units to Improve the Delivery of Health Care

Patel, Mitesh S.; Volpp, Kevin G.; Asch, David A.

doi:10.1056/nejmp1712984

Cited by 216 publications

(199 citation statements)

References 5 publications

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“…Prospect theory provides a basis for understanding human heuristics and biases as well as the types of nudges that can influence humans' choices . The notion of nudges, as they affect health related decisions, is receiving increased attention …”

Section: Ecosystem Integrationmentioning

confidence: 99%

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Service supply chains for population health: Overcoming fragmentation of service delivery ecosystems

Rouse

Johns

Pepe

2019

Learning Health Systems

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Introduction Population health involves integration of health, education, and social services to keep a defined population healthy, to address health challenges holistically, and to assist with the realities of being mortal. The fragmentation of the US population health delivery system is addressed. The impacts of this fragmentation on the treatment of substance abuse in the United States are considered. Innovations needed to overcome this fragmentation are proposed. Approach Treatment capacity issues, including scheduling practices, are discussed. Costs of treatment and lack of treatment are considered. Models of integrated care delivery are reviewed. Potential innovations from systems science, behavioral economics, and social networks are considered. The implications of these innovations are discussed in terms of information technology (IT) systems and governance. Conclusions Enormous savings are possible with more integrated treatment. Based on a range of empirical findings, it is argued that investments of these resources in integrated delivery of care have the potential to dramatically improve health outcomes, thereby significantly reducing the costs of population health.

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Section: Ecosystem Integrationmentioning

confidence: 99%

“…65 The notion of nudges, as they affect health related decisions, is receiving increased attention. 68 Variations of "people like me" can provide pervasive support for patients and caregivers. In fact, "clinicians like me" is a target of ongoing artificial intelligence research.…”

Section: Service Interactions (People)mentioning

confidence: 99%

Service supply chains for population health: Overcoming fragmentation of service delivery ecosystems

Rouse

Johns

Pepe

2019

Learning Health Systems

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“…Clinical nudging is the subject of growing attention: in 2016, Nudging Health , the first book dedicated to nudging in healthcare, was published,2 and the University of Pennsylvania has established the first medical ‘Nudge Unit’, currently working on ways to nudge patients and doctors towards better healthcare choices 3…”

Section: Introductionmentioning

confidence: 99%

Nudging in the clinic: the ethical implications of differences in doctors’ and patients’ point of view

et al. 2018

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There is an extensive ethical debate regarding the justifiability of doctors nudging towards healthy behaviour and better health-related choices. One line of argument in favour of nudging is based on empirical findings, according to which a healthy majority among the public support nudges. In this paper, we show, based on an experiment we conducted, that, in health-related choices, people’s ethical attitudes to nudging are strongly affected by the point of view from which the nudge is considered. Significant differences have been found between doctors’ ethical attitude to clinical nudging and that of patients. We show how these differences weaken the argument for nudging from public support. Moreover, our findings raise concerns regarding doctors’ ability to nudge ethically according to their own standards, as they may underestimate the degree of harm medical nudges can cause to informed consent, doctor–patient trust and other important ethically relevant features of health-related choices.

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“…Recognising that humans make flawed decisions despite the best of intentions, proponents of choice architecture argue that systems can be designed to allow autonomous decisions while ‘nudging’ clinicians and their patients toward best practices 8. Such a design allows for deviations from norms while still promoting evidence-based care.…”

mentioning

confidence: 99%

“…Rather than relying on guidelines, we could design ‘nudges’, such as feedback loops between ordering clinicians, ultrasound technicians and reading cardiologists,8 9 or displaying cost comparisons for standard comprehensive echocardiograms against limited studies 11. Thus far, such strategies have shown marginal improvements in reducing inappropriate studies,9 11 but the nascent choice architecture movement shows great promise in addressing concerns raised by this current study 8…”

mentioning

confidence: 99%

Of best intentions and best practices: thinking beyond guidelines

Dabbouseh

2019

Heart

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Nudge Units to Improve the Delivery of Health Care

Cited by 216 publications

References 5 publications

Service supply chains for population health: Overcoming fragmentation of service delivery ecosystems

Service supply chains for population health: Overcoming fragmentation of service delivery ecosystems

Nudging in the clinic: the ethical implications of differences in doctors’ and patients’ point of view

Of best intentions and best practices: thinking beyond guidelines

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