Leveraging nudges to improve care delivery

Medical decision-making is heavily influenced by how choices are presented and information is framed. The Penn Medicine Nudge Unit, launched in 2016, aims to leverage insights from behavioral and decision sciences to design and test interventions to steer providers and patients toward better decisions to improve health care delivery and outcomes.

The Nudge Unit’s Your Big Idea Challenge sought to crowdsource ideas for areas in which nudges could be applied to improve care delivery or patient outcomes.  

Participants were asked to submit a problem they believed a nudge could solve or a problem paired with a nudge solution.  Specifically, the Nudge Unit team requested submissions that targeted:

  • Reducing the unnecessary use of low-value services (e.g., prescribing generic medications instead of brand names when possible)
  • Increasing the use of high-value services (e.g., increasing screening rates for colon and breast cancer)
  • Improving care coordination (e.g., decreasing unnecessary inpatient length of stay) 

Over the course of four weeks, faculty and staff from across Penn Medicine submitted 225 creative ideas and logged more than 350 ratings and comments on the Your Big Idea platform.

After several rounds of review, the committee chose the ideas below as winners.  The winning ideas will move forward toward testing and exploration.

Winning Ideas
  • Changing opioid prescription default settings - Kit Delgado
  • Using default options to improve cardiac rehab referral rates - Srinath Adusumalli
  • Reducing unnecessary ordering of imaging for radiation therapy - Sonam Sharma

The individuals below presented to the Nudge Unit steering committee in June and were deemed runners-up.

  • Access to Medications: Defaulting Prescriptions to Penn Outpatient Pharmacies, Christine Cambareri
  • Automatic 90-Day Mail Order Supply for Prescriptions of Established Medications, Mary Coniglio
  • Increasing Long-Access Reversible Contraception Use in the Immediate Postpartum Period, Mara Gordon
  • Using the Wells Criteria to Reduce Unnecessary CTs for Suspected Pulmonary Embolisms, Angela Mills
  • Pharmacist-Managed Inpatient Anticoagulation Monitoring, Bao Nguyen
  • Appointment Scheduling Reminders using myPennMedicine, Carmela Vittorio