Kevin G Volpp's research while affiliated with University of Pennsylvania and other places
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Publications (394)
Background:
Higher levels of physical activity are associated with improvements in cardiovascular health, and consensus guidelines recommend that individuals with or at risk for atherosclerotic cardiovascular disease (ASCVD) participate in regular physical activity. However, most adults do not achieve recommended levels of physical activity. Conce...
Introduction:
Multiple U.S. localities have introduced legislation requiring sugar-sweetened beverage warnings. This study effects of different warning designs on beverage selections and perceptions.
Study design:
The study was an RCT.
Setting/participants:
An online virtual convenience store and survey were used with a nationally representati...
OBJECTIVE
We sought to evaluate the use of behavioral economics approaches to promote the carrying of epinephrine auto-injectors (EAIs) among adolescents with food allergies. We hypothesized that adolescents who receive frequent text message nudges (Intervention 1) or frequent text message nudges plus modest financial incentives (Intervention 2) wo...
Importance
Statins reduce the risk of major adverse cardiovascular events, but less than one-half of individuals in America who meet guideline criteria for a statin are actively prescribed this medication.
Objective
To evaluate whether nudges to clinicians, patients, or both increase initiation of statin prescribing during primary care visits.
De...
Background
The Diabetes Prevention Program (DPP) and metformin can prevent or delay the onset of type 2 diabetes mellitus (T2DM) among patients with prediabetes. Yet, even when these evidence-based strategies are accessible and affordable, uptake is low. Thus, there is a critical need for effective, scalable, and sustainable approaches to increase...
Background: Heart failure (HF) is one of the most common reasons for hospital admission and is a major cause of morbidity, mortality, and increasing health care costs. The EMPOWER study was a randomized trial that used remote monitoring technology to track patients’ weight and diuretic adherence and a state-of-the-art approach derived from behavior...
Purpose
To evaluate if nudges delivered by text message prior to an upcoming primary care visit can increase influenza vaccination rates.
Design
Randomized, controlled trial.
Setting
Two health systems in the Northeastern US between September 2020 and March 2021.
Subjects
74,811 adults.
Interventions
Patients in the 19 intervention arms receive...
Importance
The COVID-19 pandemic has claimed nearly 6 million lives globally as of February 2022. While pandemic control efforts, including contact tracing, have traditionally been the purview of state and local health departments, the COVID-19 pandemic outpaced health department capacity, necessitating actions by private health systems to investig...
Background
Google and Apple’s Exposure Notifications System (ENS) was developed early in the COVID-19 pandemic to complement existing contact tracing efforts while protecting user privacy. An analysis by the Associated Press released in December 2020 estimated approximately 1 in 14 people had downloaded apps in states one was available. In this stu...
Lotteries have been shown to motivate behaviour change in many settings, but their value as a policy tool is relatively untested. We implemented a pre-registered, citywide experiment to test the effects of three high-pay-off, geographically targeted lotteries designed to motivate adult Philadelphians to get their COVID-19 vaccine. In each drawing,...
Consumers, public officials, and even managers of health care and insurance are unhappy about care quality, access, and costs. This book shows that is because efforts to do something about these problems often rely on hope or conjecture, not rigorous evidence of effectiveness. In this book, experts in the field separate the speculative from the pro...
Consumers, public officials, and even managers of health care and insurance are unhappy about care quality, access, and costs. This book shows that is because efforts to do something about these problems often rely on hope or conjecture, not rigorous evidence of effectiveness. In this book, experts in the field separate the speculative from the pro...
Introduction
Little is known about the impact of cumulative workdays on medical residents' alertness. The purpose of this study was to examine changes in alertness over consecutive workdays following a day off for internal medicine interns.
Methods
This is a secondary report of a randomized non-inferiority trial of 12 internal-medicine residency p...
Objective:
The aim of this study was to evaluate the effectiveness of a digital health intervention plus community health worker (CHW) support on self-monitoring of blood glucose and glycosylated hemoglobin (HbA1c) among adult Medicaid beneficiaries with diabetes.
Design:
Randomized controlled trial.
Setting:
Urban outpatient clinic.
Particip...
Importance:
Close remote monitoring of patients following discharge for heart failure (HF) may reduce readmissions or death.
Objective:
To determine whether remote monitoring of diuretic adherence and weight changes with financial incentives reduces hospital readmissions or death following discharge with HF.
Design, setting, and participants:...
To promote COVID-19 vaccination, many states in the US introduced financial incentives ranging from small, guaranteed rewards to lotteries that give vaccinated individuals a chance to win large prizes. There is limited evidence on the effectiveness of these programs and conflicting evidence from survey experiments and studies of individual states’...
Statement of Purpose
To compare the effectiveness of novel interventions aimed at building the habit of putting down one’s phone while driving, among drivers eligible for a smartphone telematics-based auto-insurance rate.
Methods/Approach
We enrolled 1,670 Progressive Snapshot usage-based auto insurance customers in a 10-week randomized trial (NCT...
An initial opioid prescription with a greater number of pills is associated with a greater risk for future long-term opioid use, yet few interventions have reliably influenced individual clinicians' prescribing. Our objective was to evaluate the effect of feedback interventions for clinicians in reducing opioid prescribing. The interventions includ...
Significance
Encouraging vaccination is a pressing policy problem. Our megastudy with 689,693 Walmart pharmacy customers demonstrates that text-based reminders can encourage pharmacy vaccination and establishes what kinds of messages work best. We tested 22 different text reminders using a variety of different behavioral science principles to nudge...
Introduction. Pragmatic clinical trials test interventions in patients representative of real-world medical practice and reduce data collection costs by using data recorded in the electronic health record (EHR) during usual care. We describe our experience using the EHR to measure the primary outcome of a pragmatic trial, hospital readmissions, and...
This randomized clinical trial examines the effect of digital contact tracing using smartphone app nudges to increase downloads of Pennsylvania’s COVID Alert PA app.
Policy-makers are increasingly turning to behavioural science for insights about how to improve citizens’ decisions and outcomes¹. Typically, different scientists test different intervention ideas in different samples using different outcomes over different time intervals². The lack of comparability of such individual investigations limits their po...
Background
Insulin-dependent diabetes is a challenging disease to manage and involves complex behaviors, such as self-monitoring of blood glucose. This can be especially challenging in the face of socioeconomic barriers and in the wake of the COVID-19 pandemic. Digital health self-monitoring interventions and community health worker support are pro...
The use of wearables is increasing and data from these devices could improve the prediction of changes in glycemic control. We conducted a randomized trial with adults with prediabetes who were given either a waist-worn or wrist-worn wearable to track activity patterns. We collected baseline information on demographics, medical history, and laborat...
Incentives are a useful tool in encouraging healthy behavior as part of public health initiatives. However, there remains concern about motivation crowd out—a decline in levels of motivation to undertake a behavior to below baseline levels after incentives have been removed—and few public health studies have assessed for motivation crowd out. Here,...
Lotteries have been shown to motivate behavior change in many settings. However, the value of large-scale, geographically-targeted lotteries as a policy tool for changing the behaviors of entire populations is a matter of heated debate. In mid-2021, we implemented a pre-registered, city-wide experiment in Philadelphia to test the effects of three,...
Purpose of Review
Behavioral economics represents a promising set of principles to inform the design of health-promoting interventions. Techniques from the field have the potential to increase quality of cardiovascular care given suboptimal rates of guideline-directed care delivery and patient adherence to optimal health behaviors across the spectr...
Importance
Financial incentives may improve health behaviors. It is unknown whether incentives are more effective if they target a key process (eg, medication adherence), an outcome (eg, low-density lipoprotein cholesterol [LDL-C] levels), or both.
Objective
To determine whether financial incentives awarded daily for process (adherence to statins)...
Background
Medical interns are at risk for sleep deprivation from long and often rotating work schedules. However, the effects of specific rotations on sleep are less clear.
Objective
To examine differences in sleep duration and alertness among internal medicine interns during inpatient intensive care unit (ICU) compared to general medicine (GM) r...
Objective We describe the design, implementation, and validation of an online, publicly available tool to algorithmically triage patients experiencing severe acute respiratory syndrome coronavirus (SARS-CoV-2)-like symptoms.
Methods We conducted a chart review of patients who completed the triage tool and subsequently contacted our institution's ph...
Importance
Incentivizing research participation is controversial and variably regulated because of uncertainty regarding whether financial incentives serve as undue inducements by diminishing peoples’ sensitivity to research risks or unjust inducements by preferentially increasing enrollment among underserved individuals.
Objective
To determine wh...
Importance
Modest weight loss can lead to meaningful risk reduction in adults with obesity. Although both behavioral economic incentives and environmental change strategies have shown promise for initial weight loss, to date they have not been combined, or compared, in a randomized clinical trial.
Objective
To test the relative effectiveness of fi...
Importance
Health promotion efforts commonly communicate goals for healthy behavior, but the best way to design goal setting among high-risk patients has not been well examined.
Objective
To test the effectiveness of different ways to set and implement goals within a behaviorally designed gamification intervention to increase physical activity.
D...
Background
Oral health care use remains low among adult Medicaid recipients, despite the Patient Protection and Affordable Care Act’s expansion increasing access to care in many states. It remains unclear the extent to which low use reflects either low demand for care or barriers to accessing care. The authors aimed to examine factors associated wi...
Research Objective
Prescribing opioids, particularly the number of pills, is associated with greater likelihood of patients developing longer-term opioid dependence. Nudges targeted to clinicians are a low-cost strategy that could reduce unnecessary opioid prescribing. In particular, clinician-focused peer comparison feedback has been effective in...
Smoking burdens are greatest among underserved patients. Lung cancer screening (LCS) reduces mortality among individuals at risk for smoking-associated lung cancer. Although LCS programs must offer smoking cessation support, the interventions that best promote cessation among underserved patients in this setting are unknown. This stakeholder-engage...
Importance
Gamification is increasingly being used to promote healthy behaviors. However, it has not been well tested among patients with chronic conditions and over longer durations.
Objective
To test the effectiveness of behaviorally designed gamification interventions to enhance support, collaboration, or competition to promote physical activit...
Many Americans fail to get life-saving vaccines each year, and the availability of a vaccine for COVID-19 makes the challenge of encouraging vaccination more urgent than ever. We present a large field experiment ( N = 47,306) testing 19 nudges delivered to patients via text message and designed to boost adoption of the influenza vaccine. Our findin...
Rationale:
A trial of four financial-incentive programs, conducted at CVS Caremark, a large employer, documented their effectiveness in promoting sustained abstinence from smoking, but their cost-effectiveness is unknown and the significant up-front cost of the incentives is a deterrent to their adoption.
Objectives:
To determine the cost-effect...
Importance
Financial incentives may improve health by rewarding patients for focusing on present actions—such as medication regimen adherence—that provide longer-term health benefits.
Objective
To identify barriers to improving statin therapy adherence and control of cholesterol levels with financial incentives and insights for the design of futur...
During fall 2020, many U.S. kindergarten through grade 12 (K-12) schools closed campuses and instituted remote learning to limit in-school transmission of SARS-CoV-2, the virus that causes COVID-19 (1,2). A New Jersey grade 9-12 boarding school with 520 full-time resident students, 255 commuter students, and 405 faculty and staff members implemente...
Objective:
Many patients with advanced illness are unrealistically optimistic about their prognosis. We test for the presence of several cognitive biases, including optimism bias, illusion of superiority, self-deception, misattribution, and optimistic update bias, that could explain unrealistically optimistic prognostic beliefs among advanced canc...
Background
Identifying individuals at risk for future hospitalization or death has been a major priority of population health management strategies. High-risk individuals are a heterogeneous group, and existing studies describing heterogeneity in high-risk individuals have been limited by data focused on clinical comorbidities and not socioeconomic...
Background
Routine screening reduces colorectal cancer mortality, but screening rates fall below national targets and are particularly low in underserved populations.Objective
To compare the effectiveness of a single text message outreach to serial text messaging and mailed fecal home test kits on colorectal cancer screening rates.DesignA two-armed...
Importance
Hip and knee arthroplasty are the most common inpatient surgical procedures for Medicare beneficiaries in the US, with substantial variation in cost and quality. Whether remote monitoring incorporating insights from behavioral science might help improve outcomes and increase value of care remains unknown.
Objective
To evaluate the effec...
Behavioral interventions involving electronic devices, financial incentives, gamification, and specially trained staff to encourage healthy behaviors are becoming increasingly prevalent and important in health innovation and improvement efforts. Although considerations of cost are key to their wider adoption, cost information is lacking because the...
![Reanalysis of the motivating five-arm smoking cessation trial [3]](profile/Tim-Morris-4/publication/345671677/figure/tbl2/AS:956275714174981@1605005305622/Reanalysis-of-the-motivating-five-arm-smoking-cessation-trial-3_Q320.jpg)
Introduction
In a five-arm randomized clinical trial (RCT) with stratified randomization across 54 sites, we encountered low primary outcome event proportions, resulting in multiple sites with zero events either overall or in one or more study arms. In this paper, we systematically evaluated different statistical methods of accounting for center in...
In the literature on behavior change it has commonly been assumed that sustained changes in behavior means that habits have been formed and that sustained behavior change is achieved through the formation of habits. In this paper we argue that habit formation is often confused with a variety of alternative mechanisms through which sustained changes...
Section 1115 demonstration waivers provide a mechanism for states to implement changes to their Medicaid programs. While such waivers are mandated to include evaluations of their impact, randomization – the gold standard for assessing causality – has not typically been a consideration. In a critical departure, the Commonwealth of Kentucky opted to...
Importance:
Statin therapy is underused for many patients who could benefit.
Objective:
To evaluate the effect of passive choice and active choice interventions in the electronic health record (EHR) to promote guideline-directed statin therapy.
Design, setting, and participants:
Three-arm randomized clinical trial with a 6-month preinterventio...
We examine the effect of a value‐based insurance design (VBID) program implemented at a large public employer in the state of Oregon. The program substantially increased cost‐sharing for several healthcare services likely to be of low value for most patients: diagnostic services (e.g., imaging services) and surgeries (e.g., spinal surgeries for pai...
Importance:
Financial incentives can improve medication adherence and cardiovascular disease risk, but the optimal design to promote sustained adherence after incentives are discontinued is unknown.
Objective:
To determine whether 6-month interventions involving different financial incentives to encourage statin adherence reduce low-density lipo...
Background:
Suicide is a global health issue. There are a number of evidence-based practices for suicide screening, assessment, and intervention that are not routinely deployed in usual care settings. The goal of this study is to develop and test implementation strategies to facilitate evidence-based suicide screening, assessment, and intervention...
Although antidepressant medications are efficacious for depression,¹ nonadherence frequently undermines their effectiveness.² Antidepressants have a delayed onset and therefore do not offer prompt symptom relief that would support adherence.³ It is unknown whether financial incentives, which encourage adherence to some⁴ but not other⁵ health behavi...
Background/objective:
Risk-stratification tools for cardiac complications after noncardiac surgery based on preoperative risk factors are used to inform postoperative management. However, there is limited evidence on whether risk stratification can be improved by incorporating data collected intraoperatively, particularly for low-risk patients.
M...
Due to the global shortage of PPE caused by increasing number of COVID-19 patients in recent months, many hospitals have had difficulty procuring adequate PPE for the clinicians who care for these patients. Faced with a shortage, hospitals have had to implement new PPE conservation policies. In this paper, we describe a tool to help hospitals bette...
Background
Cardiac interventions account for a significant share of overall healthcare spending and have been the focus of several large-scale interventions to develop effective bundled payments. To date, however, none have proven successful in commercially insured populations. In 2018, we worked with Hawaii Medical Service Association (HMSA), the...
Lower extremity joint replacement (LEJR) is the most common inpatient surgery for Medicare beneficiaries with substantial variation in cost and quality. Remote monitoring and insights from behavioral science have the potential to improve outcomes and value of care. We evaluated the impact of activity monitoring and bidirectional text messaging on t...
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 randomiz...
More than a dozen states have sought federal approval for Section 1115 Medicaid waivers to make premiums and work requirements (ie, requirements to work, volunteer, or engage in education, or caretaking), a condition of Medicaid eligibility for adults deemed able‐bodied. Support for these waivers may differ among adults based on Medicaid participat...
Connected healthcare is a form of health delivery that connects patients and providers through connected health devices, allowing providers to monitor patient behavior and proactively intervene before an adverse event occurs. Unlike the costs, the benefits of connected healthcare in improving patient behavior and health outcomes are usually difficu...
Background & Aims
Financial incentives might increase participation in prevention such as screening colonoscopy. We studied whether incentives informed by behavioral economics increase participation in risk assessment for colorectal cancer (CRC) and completion of colonoscopy for eligible adults.
Methods
Employees of a large academic health system...
Introduction
Duty hour regulations affect resident sleep, education, and patient care in complex ways. We performed a national cluster-randomized trial (iCOMPARE) in 63 internal medicine residency programs comparing the effects of the 2011 duty-hour standards to a more flexible set of duty hour rules characterized by maintaining an 80-hour workweek...
Introduction
Little is known about the impact of specific rotations on medical residents’ sleep. The purpose of this analysis was to examine the difference in sleep duration and alertness among internal-medicine resident interns during intensive care unit (ICU) compared to general medicine (GM) rotations.
Methods
This is a secondary report of a ra...
Much of the greatest innovation in industries other than health care deploys technology-enabled approaches to making services more accessible and convenient and lower cost or higher quality. For example, companies such as Blockbuster Video, which provided what seemed like essential services, was supplanted by Netflix, which offered on-demand, perso...
This cohort study examines the association of implementation of Medicaid sanctions in the Temporary Assistance for Needy Families program with Medicaid coverage rates among low-income adults.
Background:
Social comparison feedback is often used in physical activity interventions but the optimal design of feedback is unknown.
Methods:
This 4-arm, randomized trial consisted of a 13-week intervention period and 13-week follow-up period. During the intervention, 4-person teams were entered into a weekly lottery valued at about $1.40/day...
Policy makers are increasingly using performance feedback that compares physicians to their peers as part of payment policy reforms. However, it is not known whether peer comparisons can improve broad outcomes, beyond changing specific individual behaviors such as reducing inappropriate prescribing of antibiotics. We conducted a cluster-randomized...
Background
Oncology care is expensive and exhibits substantial variation in cost and quality across clinicians and patients. Unlike many conditions with established bundled payment programs, cancer care includes a mix of inpatient and outpatient care that precludes hospital-based designs. In 2018, we worked with Hawaii Medical Service Association (...
Importance
There is limited evidence regarding how patients make choices in advance directives (ADs) or whether these choices influence subsequent care.
Objective
To examine whether default options in ADs influence care choices and clinical outcomes.
Design, Setting, and Participants
This randomized clinical trial included 515 patients who met cr...
