Accelerate: What the Elephant and the Rider Teaches Us About Change in Health Care

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BEHAVIORAL INTERVENTIONS IMPACT ON

INAPPROPRIATE AMBULATORY ABX RX

B o b P e n d l e t o n , M D u o f u h e a l t h . u t a h . e d u / a c c e l e r a t e /

JAMA. 2016;315(6):562-570. doi:10.1001/jama.2016.0275

P=0.66 for difference

in trajectories

P<0.001 for

difference in

trajectories

P<0.001 for difference

in trajectories

6.1%3.7%

5.2%

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BEHAVIORAL ECONOMIC PRINCIPLES

1. Ineffectiveness of information provision

2. Status quo bias

3. Choice overload

4. Immediacy

5. Relative social ranking

6. Gradient/threshold effects

7. Mental accounting & salience

8. Loss aversion

9. Willpower limits

B o b P e n d l e t o n , M D u o f u h e a l t h . u t a h . e d u / a c c e l e r a t e /

https://www.nytimes.com/2017/04/13/upshot/answer-to-better-health-care-behavioral-economics.html?_r=0

(accessed May 7, 2017), Emanuel et al .Ann Intern Med (2016); 164, Eisenberg JE. Doctor’s Decisions & the

Cost of Medical Care (1986)

Barriers to change -

System design can address

Non-financial motivators -

Data presentation methods

Financial motivators -

Incentives & penalties

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PEER

COMPARE &

SOCIAL

CONTRACT

INDIVIDUAL

PERFORMANCE

BENCHMARKS

&

THRESHOLDS

HOW WE INCORPORATE BEHAVIORAL ECONOMICS

AT U OF U HEALTH

u o f u h e a l t h . u t a h . e d u / a c c e l e r a t e /

© U N I V E R S I T Y O F U T A H H E A L T H ,

2 0 1 7B o b P e n d l e t o n , M D

Lee et al. Academic Medicine (2016); 91(3):338, Lee N Eng J Med (2017); 376(3):197

UTAH: BEHAVIORAL ECONOMICS EPE EXAMPLE

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SALIENCE – CELEBRATING BRIGHT SPOTS

B o b P e n d l e t o n , M D u o f u h e a l t h . u t a h . e d u / a c c e l e r a t e /

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2 0 1 7B o b P e n d l e t o n , M D u o f u h e a l t h . u t a h . e d u / a c c e l e r a t e /

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VALUE DRIVEN OUTCOMES (VDO) PROGRAM Applying Behavioral Economic Principles

B o b P e n d l e t o n , M D

Kawamoto K et al. J Am Med Inform Assoc (2015) 22 (1): 223-235.

Lee VS. Et al. JAMA. 2016 Sep 13;316(10):1061-72

Behavioral economic principles applied:

• Benchmark/threshold effects

• Dampen choice overload

• Immediacy

• Peer-to-peer comparisons

• Salience (recognition)

Opportunity to study efficacy,

combinations of interventions,

& sustainability of effect.

u o f u h e a l t h . u t a h . e d u / a c c e l e r a t e /

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VDO: BEHAVIORAL ECONOMICS

B o b P e n d l e t o n , M D u o f u h e a l t h . u t a h . e d u / a c c e l e r a t e /

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PEER TO PEER COMPARISON – EXAMPLE,

LORCA

Lee VS. Et al. JAMA. 2016 Sep 13;316(10):1061-72, Yarbrough et al. J Hosp Med (2016); 11(5):348

$452KSAVEDY

EA

R

1 $1.8MSAVEDY

EA

R

3B o b P e n d l e t o n , M D u o f u h e a l t h . u t a h . e d u / a c c e l e r a t e /

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VALUE DRIVEN OUTCOMES (VDO) PROGRAM Support Continuous Improvement

B o b P e n d l e t o n , M D

Kawamoto K et al. J Am Med Inform Assoc (2015) 22 (1): 223-235.

Lee VS. Et al. JAMA. 2016 Sep 13;316(10):1061-72

• Value improvement nomenclature and

methods

• System support (IT, EDW, etc.)

• Systems Engineering coaches

• Repeated improvement cycles

• Goal = improvement (vs. knowledge

generation)

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To learn more, visit:

https://uofuhealth.utah.edu/accelerate/

B o b P e n d l e t o n , M D u o f u h e a l t h . u t a h . e d u / a c c e l e r a t e /