David A Asch

University of Pennsylvania, Filadelfia, Pennsylvania, United States

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Publications (259)2189.27 Total impact

  • Peter A Ubel, David A Asch
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    ABSTRACT: As hard as it may be for clinicians to adopt new practices, it is often harder for them to "de-innovate," or give up old practices, even when new evidence reveals that those practices offer little value. In this article we explore recent controversies over screening for breast and prostate cancer and testing for sleep disorders. We show that these controversies are not caused solely by a lack of clinical data on the harms and benefits of these tests but are also influenced by several psychological biases that make it difficult for clinicians to de-innovate. De-innovation could be fostered by making sure that advisory panels and guideline committees include experts who have competing biases; emphasizing evidence over clinical judgment; resisting "indication creep," or the premature extension of innovations into unproven areas; and encouraging clinicians to explicitly consider how their experiences bias their interpretations of clinical evidence. Project HOPE—The People-to-People Health Foundation, Inc.
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    ABSTRACT: We tested whether providing adults with obstructive sleep apnea (OSA) with daily Web-based access to their positive airway pressure (PAP) usage over 3 mo with or without a financial incentive in the first week improves adherence and functional outcomes. Academic- and community-based sleep centers. One hundred thirty-eight adults with newly diagnosed OSA starting PAP treatment. Participants were randomized to: usual care, usual care with access to PAP usage, or usual care with access to PAP usage and a financial incentive. PAP data were transmitted daily by wireless modem from the participants' PAP unit to a website where hours of usage were displayed. Participants in the financial incentive group could earn up to $30/day in the first week for objective PAP use ≥ 4 h/day. Mean hours of daily PAP use in the two groups with access to PAP usage data did not differ from each other but was significantly greater than that in the usual care group in the first week and over 3 mo (P < 0.0001). Average daily use (mean ± standard deviation) during the first week of PAP intervention was 4.7 ± 3.3 h in the usual care group, and 5.9 ± 2.5 h and 6.3 ± 2.5 h in the Web access groups with and without financial incentive respectively. Adherence over the 3-mo intervention decreased at a relatively constant rate in all three groups. Functional Outcomes of Sleep Questionnaire change scores at 3 mo improved within each group (P < 0.0001) but change scores of the two groups with Web access to PAP data were not different than those in the control group (P > 0.124). PAP adherence is significantly improved by giving patients Web access to information about their use of the treatment. Inclusion of a financial incentive in the first week had no additive effect in improving adherence. © 2014 Associated Professional Sleep Societies, LLC.
    Sleep 01/2015; · 5.06 Impact Factor
  • Mitesh S Patel, David A Asch, Kevin G Volpp
    JAMA The Journal of the American Medical Association 01/2015; 313(5). DOI:10.1001/jama.2014.14781 · 30.39 Impact Factor
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    ABSTRACT: William Howard Taft was obsessed with his health—an observation many will find surprising given that he is remembered as the nation’s most obese president. But Taft kept a detailed diary of his diet, exercise, reflux symptoms, and bowel movements. He shared his logs with his personal physician, who used the information to provide feedback and, with this support, Taft lost nearly sixty pounds.1Now, close to 70 % of Americans track some form of health-related behavior.2 The traditional leather-bound diaries of Taft’s era are less common, but personal journals are more popular than ever in the form of blogs, social media posts, and other online activities. A growing number of sensors, including wearable devices and smartphone apps, collect biometric data passively or with minimal inputs from users, supporting what is called “the quantified self,” with assessments of blood sugar, heart rhythm, or peak respiratory flow.3 The majority of these platforms and devices are never intended to be s ...
    Journal of General Internal Medicine 12/2014; DOI:10.1007/s11606-014-3145-x · 3.42 Impact Factor
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    ABSTRACT: Adoption of electronic health record systems has increased the availability of patient-level electronic health information. To examine public support for secondary uses of electronic health information under different consent arrangements. National experimental survey to examine perceptions of uses of electronic health information according to patient consent (obtained vs. not obtained), use (research vs. marketing), and framing of the findings (abstract description without results vs. specific results). Nationally representative survey. 3064 African American, Hispanic, and non-Hispanic white persons (response rate, 65%). Appropriateness of health information use described in vignettes on a scale of 1 (not at all appropriate) to 10 (very appropriate). Mean ratings ranged from a low of 3.81 for a marketing use when consent was not obtained and specific results were presented to a high of 7.06 for a research use when consent was obtained and specific results were presented. Participants rated scenarios in which consent was obtained as more appropriate than when consent was not obtained (difference, 1.01 [95% CI, 0.69 to 1.34]; P < 0.001). Participants rated scenarios in which the use was marketing as less appropriate than when the use was research (difference, -2.03 [CI, -2.27 to -1.78]; P < 0.001). Unconsented research uses were rated as more appropriate than consented marketing uses (5.65 vs. 4.52; difference, 1.13 [CI, 0.87 to 1.39]). Participants rated hypothetical scenarios. Results could be vulnerable to nonresponse bias despite the high response rate. Although approaches to health information sharing emphasize consent, public opinion also emphasizes purpose, which suggests a need to focus more attention on the social value of information use. National Human Genome Research Institute.
    Annals of internal medicine 12/2014; 161(12):855-62. DOI:10.7326/M14-1118 · 16.10 Impact Factor
  • Source
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    ABSTRACT: Objectives. We sought to explore the feasibility of using a crowdsourcing study to promote awareness about automated external defibrillators (AEDs) and their locations. Methods. The Defibrillator Design Challenge was an online initiative that asked the public to create educational designs that would enhance AED visibility, which took place over 8 weeks, from February 6, 2014, to April 6, 2014. Participants were encouraged to vote for AED designs and share designs on social media for points. Using a mixed-methods study design, we measured participant demographics and motivations, design characteristics, dissemination, and Web site engagement. Results. Over 8 weeks, there were 13 992 unique Web site visitors; 119 submitted designs and 2140 voted. The designs were shared 48 254 times on Facebook and Twitter. Most designers-voters reported that they participated to contribute to an important cause (44%) rather than to win money (0.8%). Design themes included: empowerment, location awareness, objects (e.g., wings, lightning, batteries, lifebuoys), and others. Conclusions. The Defibrillator Design Challenge engaged a broad audience to generate AED designs and foster awareness. This project provides a framework for using design and contest architecture to promote health messages. (Am J Public Health. Published online ahead of print October 16, 2014: e1-e7. doi:10.2105/AJPH.2014.302211).
    American Journal of Public Health 10/2014; DOI:10.2105/AJPH.2014.302211 · 4.23 Impact Factor
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    ABSTRACT: In October 2013, multiple United States (US) federal health departments and agencies posted on Twitter, "We're sorry, but we will not be tweeting or responding to @replies during the shutdown. We'll be back as soon as possible!" These "last tweets" and the millions of responses they generated revealed social media's role as a forum for sharing and discussing information rapidly. Social media are now among the few dominant communication channels used today. We used social media to characterize the public discourse and sentiment about the shutdown. The 2013 shutdown represented an opportunity to explore the role social media might play in events that could affect health. (Am J Public Health. Published online ahead of print October 16, 2014: e1-e3. doi:10.2105/AJPH.2014.302118).
    American Journal of Public Health 10/2014; DOI:10.2105/AJPH.2014.302118 · 4.23 Impact Factor
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    ABSTRACT: Background. Financial incentives and peer networks could be delivered through eHealth technologies to encourage older adults to walk more. Methods. We conducted a 24-week randomized trial in which 92 older adults with a computer and Internet access received a pedometer, daily walking goals, and weekly feedback on goal achievement. Participants were randomized to weekly feedback only (Comparison), entry into a lottery with potential to earn up to $200 each week walking goals were met (Financial Incentive), linkage to four other participants through an online message board (Peer Network), or both interventions (Combined). Main outcomes were the proportion of days walking goals were met during the 16-week intervention and 8-week follow-up. We conducted a content analysis of messages posted by Peer Network and Combined arm participants. Results. During the 16-week intervention, there were no differences in the proportion of days walking goals were met in the Financial Incentive (39.7%; p = .78), Peer Network (24.9%; p = .08), and Combined (36.0%; p = .77) arms compared with the Comparison arm (36.0%). During 8 weeks of follow-up, the proportion of days walking goals were met was lower in the Peer Network arm (18.7%; p = .025) but not in the Financial Incentive (29.3%; p = .50) or Combined (24.8%; p = .37) arms, relative to the Comparison arm (34.5%). Messages posted by participants focused on barriers to walking and provision of social support. Conclusions. Financial incentives and peer networks delivered through eHealth technologies did not result in older adults walking more.
    Health Education &amp Behavior 10/2014; 41(1 Suppl):43S-50S. DOI:10.1177/1090198114540464 · 1.54 Impact Factor
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    ABSTRACT: Aim: To characterize defibrillation and cardiac arrest survival outcomes in movies. Methods: Movies from 2003 to 2012 with defibrillation scenes were reviewed for patient and rescuer characteristics, scene characteristics, defibrillation characteristics, additional interventions, and cardiac arrest survival outcomes. Resuscitation actions were compared with chain of survival actions and the American Heart Association (AHA) Emergency Cardiovascular Care (ECC) 2020 Impact Goals. Cardiac arrest survival outcomes were compared with survival rates reported in the literature and targeted by the AHA ECC 2020 Impact Goals. Results: Thirty-five scenes were identified in 32 movies. Twenty-five (71%) patients were male, and 29 (83%) rescuers were male. Intent of defibrillation was resuscitation in 29 (83%) scenes and harm in 6 (17%) scenes. Cardiac arrest was the indication for use in 23 (66%) scenes, and the heart rhythm was made known in 18 scenes (51%). When the heart rhythm was known, defibrillation was appropriately used for ventricular tachycardia or ventricular fibrillation in 5 (28%) scenes and inappropriately used for asystole in 7 (39%) scenes. In 8 scenes with in-hospital cardiac arrest, 7 (88%) patients survived, compared to survival rates of 23.9% reported in the literature and 38% targeted by an AHA ECC 2020 Impact Goal. In 12 movie scenes with out-of-hospital cardiac arrest, 8 (67%) patients survived, compared to survival rates of 7.9-9.5% reported in peer-reviewed literature and 15.8% targeted by an AHA ECC 2020 Impact Goal. Conclusion: In movies, defibrillation and cardiac arrest survival outcomes are often portrayed inaccurately, representing missed opportunities for public health education.
    Resuscitation 09/2014; 85(12). DOI:10.1016/j.resuscitation.2014.09.005 · 3.96 Impact Factor
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    ABSTRACT: The purpose of this study was to describe clinicians' perceptions of interprofessional collaboration in the intensive care unit and identify factors associated with interprofessional collaboration. We performed 64 semi-structured interviews in seven hospitals with ICU nurses, physicians, respiratory therapists, nurse managers, clinical pharmacists, and dieticians. ICU clinicians perceived two distinct types of facilitators to interprofessional collaboration in critical care: cultural and structural. In the critical care setting, cultural and structural facilitators worked independently as well as in concert to create effective interprofessional collaboration. Initiatives aimed at creating and facilitating interprofessional collaboration should focus attention on cultural and structural facilitators to improve patient care and team effectiveness. © 2014 Wiley Periodicals, Inc.
    Research in Nursing & Health 08/2014; 37(4). DOI:10.1002/nur.21607 · 1.16 Impact Factor
  • David A Asch, Debra F Weinstein
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    ABSTRACT: On July 29, 2014, the Institute of Medicine (IOM) released its report on the governance and financing of graduate medical education (GME).(1) An important incidental finding of the IOM's study was that the evidence base available to inform future directions for the substance, organization, and financing of GME is quite limited. The limited evidence reflects a systematic lack of research investment in an area of health care that we believe deserves better. Our nation's lack of research in medical education contrasts starkly with the large and essential commitment to biomedical research funded by industry, philanthropic organizations, and the public. No . . .
    New England Journal of Medicine 07/2014; 371(9). DOI:10.1056/NEJMp1407463 · 54.42 Impact Factor
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    ABSTRACT: Social media has been embraced as a tool for public health promotion.(1-6) However, effective strategies for harnessing the capabilities of social media remain unclear.(7-9) For example, many state and local health departments have adopted Facebook and Twitter accounts, yet public engagement with these accounts varies.(10-12) Several Web-based interventions for smoking cessation have been developed, but few tobacco prevention Web sites allow users to share links via social media.(13,14) While YouTube videos with health messages have amassed millions of views, such as a popular video targeting soft drink consumption, their long-term impact is difficult to evaluate.(15,16) In general, innovative approaches to disseminating health information must be developed to match the behavior and expectations of the public.(17) (Am J Public Health. Published online ahead of print July 17, 2014: e1-e3. doi:10.2105/AJPH.2014.302088).
    American Journal of Public Health 07/2014; 104(9):e1-e3. DOI:10.2105/AJPH.2014.302088 · 4.23 Impact Factor
  • Annals of internal medicine 07/2014; 161(3). DOI:10.7326/L14-0287 · 16.10 Impact Factor
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    ABSTRACT: Purpose To present the principles and rationale of the Proton Priority System (PROPS), a priority points framework that assigns higher scores to patients thought to more likely benefit from proton therapy, and the distribution of PROPS scores by patient characteristics Methods and Materials We performed multivariable logistic regression to evaluate the association between PROPS scores and receipt of proton therapy, adjusted for insurance status, gender, race, geography, and the domains that inform the PROPS score. Results Among 1529 adult patients considered for proton therapy prioritization during our Center's ramp-up phase of treatment availability, PROPS scores varied by age, diagnosis, site, and other PROPS domains. In adjusted analyses, receipt of proton therapy was lower for patients with non-Medicare relative to Medicare health insurance (commercial vs Medicare: adjusted odds ratio [OR] 0.47, 95% confidence interval [CI] 0.34-0.64; managed care vs Medicare: OR 0.40, 95% CI 0.28-0.56; Medicaid vs Medicare: OR 0.24, 95% CI 0.13-0.44). Proton Priority System score and age were not significantly associated with receipt of proton therapy. Conclusions The Proton Priority System is a rationally designed and transparent system for allocation of proton therapy slots based on the best available evidence and expert opinion. Because the actual allocation of treatment slots depends mostly on insurance status, payers may consider incorporating PROPS, or its underlying principles, into proton therapy coverage policies.
    International journal of radiation oncology, biology, physics 07/2014; 89(3). DOI:10.1016/j.ijrobp.2014.03.023 · 4.18 Impact Factor
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    ABSTRACT: Purpose The number of medical schools offering MD and MBA training has increased fivefold in the last two decades. The authors evaluated graduates' perceptions of the role of such training on their career and professional development. Method In 2011, the authors surveyed physician graduates from the Wharton School MBA Program in Heath Care Management at the University of Pennsylvania from 1981 to 2010. Survey responses were analyzed and evaluated using grounded theory. Results Among 247 eligible graduates, 59.9% (148/247) completed the questionnaire and 89.9% (133/148) of them provided free-text responses. Approximately 85.1% (126/148) of respondents were male and 79.7% (118/148) entered residency training; however, both rates declined slightly over time. Among respondents within their first decade after graduation, 46.2% (24/52) reported clinical practice as their primary work sector compared with 39.5% (15/38) among respondents 11 to 20 years after graduation and 19.2% (5/26) of respondents 21 to 30 years after graduation. Overall, graduates reported mostly positive attitudes and often noted the benefits of career acceleration, professional flexibility, and credibility in multidisciplinary domains. The few negative remarks were focused on the opportunity cost of time and how peers in one discipline may negatively perceive the role of the other discipline's degree. Conclusions Graduates with an MD and MBA report mostly positive attitudes towards their training, and many are pursuing leadership and primarily nonclinical roles later in their careers. These findings reveal new insights for policies affecting physician workforce. Further study is necessary to evaluate whether similar trends exist more broadly.
    Academic medicine: journal of the Association of American Medical Colleges 06/2014; 89(9). DOI:10.1097/ACM.0000000000000366 · 3.47 Impact Factor
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    ABSTRACT: Rather than seek solutions to health care's problems in facile recommendations from management gurus with experience in unrelated industries, we'd do better to find a solution process to use from within. And the process for high-impact innovation can in fact be learned. Many health care professionals find it irritating when management gurus recommend solving health care's problems with approaches they would copy and paste from unrelated industries a former chief executive of a manufacturing company claims that the same simple lessons that enabled him to transform his own industry can improve value in health care, or a business-school professor offers an eight-point leadership plan that she's translated into health care as easily as if she'd translated it into French. Many people who work in health care value outside perspectives and are open to new approaches and yet bristle at facile ...
    New England Journal of Medicine 05/2014; 370(19):1775-7. DOI:10.1056/NEJMp1401135 · 54.42 Impact Factor
  • Shivan J Mehta, David A Asch
    Clinical gastroenterology and hepatology: the official clinical practice journal of the American Gastroenterological Association 05/2014; 12(5):711-4. DOI:10.1016/j.cgh.2014.02.022 · 6.53 Impact Factor
  • Shivan J Mehta, David A Asch
    Cleveland Clinic Journal of Medicine 03/2014; 81(3):173-5. DOI:10.3949/ccjm.81a.14010 · 3.37 Impact Factor
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    ABSTRACT: Home wireless device monitoring could play an important role in improving the health of patients with poorly controlled chronic diseases, but daily engagement rates among these patients may be low. To test the effectiveness of two different magnitudes of financial incentives for improving adherence to remote-monitoring regimens among patients with poorly controlled diabetes. Randomized, controlled trial. (Clinicaltrials.gov Identifier: NCT01282957). Seventy-five patients with a hemoglobin A1c greater than or equal to 7.5 % recruited from a Primary Care Medical Home practice at the University of Pennsylvania Health System. Twelve weeks of daily home-monitoring of blood glucose, blood pressure, and weight (control group; n = 28); a lottery incentive with expected daily value of $2.80 (n = 26) for daily monitoring; and a lottery incentive with expected daily value of $1.40 (n = 21) for daily monitoring. Daily use of three home-monitoring devices during the three-month intervention (primary outcome) and during the three-month follow-up period and change in A1c over the intervention period (secondary outcomes). Incentive arm participants used devices on a higher proportion of days relative to control (81 % low incentive vs. 58 %, P = 0.007; 77 % high incentive vs. 58 %, P = 0.02) during the three-month intervention period. There was no difference in adherence between the two incentive arms (P = 0.58). When incentives were removed, adherence in the high incentive arm declined while remaining relatively high in the low incentive arm. In month 6, the low incentive arm had an adherence rate of 62 % compared to 35 % in the high incentive arm (P = 0.015) and 27 % in the control group (P = 0.002). A daily lottery incentive worth $1.40 per day improved monitoring rates relative to control and had significantly better efficacy once incentives were removed than a higher incentive.
    Journal of General Internal Medicine 02/2014; 29(5). DOI:10.1007/s11606-014-2778-0 · 3.42 Impact Factor
  • Source
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    ABSTRACT: Use of social media has become widespread across the United States. Although businesses have invested in social media to engage consumers and promote products, less is known about the extent to which hospitals are using social media to interact with patients and promote health. The aim was to investigate the relationship between hospital social media extent of adoption and utilization relative to hospital characteristics. We conducted a cross-sectional review of hospital-related activity on 4 social media platforms: Facebook, Twitter, Yelp, and Foursquare. All US hospitals were included that reported complete data for the Centers for Medicare and Medicaid Services Hospital Consumer Assessment of Healthcare Providers and Systems survey and the American Hospital Association Annual Survey. We reviewed hospital social media webpages to determine the extent of adoption relative to hospital characteristics, including geographic region, urban designation, bed size, ownership type, and teaching status. Social media utilization was estimated from user activity specific to each social media platform, including number of Facebook likes, Twitter followers, Foursquare check-ins, and Yelp reviews. Adoption of social media varied across hospitals with 94.41% (3351/3371) having a Facebook page and 50.82% (1713/3371) having a Twitter account. A majority of hospitals had a Yelp page (99.14%, 3342/3371) and almost all hospitals had check-ins on Foursquare (99.41%, 3351/3371). Large, urban, private nonprofit, and teaching hospitals were more likely to have higher utilization of these accounts. Although most hospitals adopted at least one social media platform, utilization of social media varied according to several hospital characteristics. This preliminary investigation of social media adoption and utilization among US hospitals provides the framework for future studies investigating the effect of social media on patient outcomes, including links between social media use and the quality of hospital care and services.
    Journal of Medical Internet Research 01/2014; 16(11):e264. DOI:10.2196/jmir.3758 · 4.67 Impact Factor

Publication Stats

7k Citations
2,189.27 Total Impact Points

Institutions

  • 1993–2015
    • University of Pennsylvania
      • • "Leonard Davis" Institute of Health Economics Center for Health Incentives and Behavioral Economics
      • • Department of Medicine
      • • Division of General Internal Medicine
      • • Center for Health Equity Research
      Filadelfia, Pennsylvania, United States
  • 1991–2014
    • William Penn University
      Filadelfia, Pennsylvania, United States
  • 2007–2013
    • Cornell University
      • Department of Policy Analysis and Management
      Ithaca, New York, United States
    • U.S. Department of Veterans Affairs
      • Center for Health Equity Research and Promotion (CHERP)
      Washington, D. C., DC, United States
  • 2012
    • Dartmouth College
      Hanover, New Hampshire, United States
  • 2011
    • University of Pittsburgh
      Pittsburgh, Pennsylvania, United States
  • 2001–2009
    • University of Michigan
      • Division of Pulmonary and Critical Care Medicine
      Ann Arbor, MI, United States
    • The Philadelphia Center
      • Philadelphia Veterans Administration Medical Center
      Philadelphia, Pennsylvania, United States
  • 2008
    • University of Texas - Pan American
      • Department of Economics & Finance
      Edinburg, Texas, United States
  • 2006
    • National Institute on Aging
      Baltimore, Maryland, United States
  • 2005
    • Temple University
      Filadelfia, Pennsylvania, United States
  • 2004
    • University of Toledo
      • Department of Psychology
      Toledo, Ohio, United States
  • 2003
    • Johns Hopkins University
      Baltimore, Maryland, United States
  • 1998–2003
    • Carnegie Mellon University
      • • Department of Social and Decision Sciences
      • • Department of Engineering and Public Policy
      Pittsburgh, Pennsylvania, United States
  • 1999
    • University of Toronto
      Toronto, Ontario, Canada
  • 1997
    • Hospital of the University of Pennsylvania
      • Department of Obstetrics and Gynecology
      Philadelphia, Pennsylvania, United States
  • 1996
    • Minneapolis Veterans Affairs Hospital
      Minneapolis, Minnesota, United States
    • University of Miami
      • Department of Management
      Coral Gables, FL, United States
  • 1995
    • University of Chicago
      • Section of General Internal Medicine
      Chicago, IL, United States
  • 1990
    • Robert Wood Johnson Foundation
      Princeton, New Jersey, United States