Changing the referral process for cardiac rehabilitation to opt-out rather than opt-in caused referral rates to jump from 12 percent to 75 percent in nine months at the Hospital of the University of Pennsylvania.
Hospital ‘nudges’ providers to increase cardiac rehab referral by 63%
“We started bringing cardiac rehab into our conversations with patients and adding it to discharge documentation and conversations following discharge as well. Now this is part of our daily workflow.”
The project was part of the Penn Medicine Nudge Unit, the first of its kind created in the healthcare setting.
Borrowed from governments in the United Kingdom and other countries, a “nudge unit” is designed to use behavioral science to influence behavior in a predictable way without restricting choices.
The ideal candidate for a nudge in terms of an intervention is something that has a strong evidence base that most would not argue with but for one reason or another is underutilized,
” We still haven’t solved the basic problems in delivering evidence-based healthcare, in translating our robust evidence base into actual care that reaches our patients,” Srinath Adusumalli, MD said. “I think this is a way that’s generally a low-cost approach that for certain interventions—cardiac rehab is one of them—works really well in trying to crack that nut which has been a difficult one for years.”
March 8, 2018
Dr. Parker’s Commentary
It is always, of course, heart-warming to see behavioral science applied to medicine; psychology is often a neglected part of the process. Economics had a similar issue, until the models in economics included irrational and psychological components of behavior.
Also, of course, the technique of “nudging” can be used for evil as well as good — it has to do with pushing people towards behavior, and can give them the illusion of choice.
If you want people to lose weight, one effective strategy is to put mirrors in the cafeteria. When people see themselves in the mirror, they may eat less if they are chubby. Is this okay? And if mirrors are acceptable, what about mirrors that are intentionally unflattering? Are such mirrors an acceptable strategy in the cafeteria? If so, what should we think about flattering mirrors in a fast food restaurant?”
Richard Thaler, Author of Nudge