Accelerate: What the Elephant and the Rider Teaches Us About Change in Health Care
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Transcript of Accelerate: What the Elephant and the Rider Teaches Us About Change in Health Care
© 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 7
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%
© U N I V E R S I T Y O F U T A H H E A L T H ,
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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
© 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
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
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 ,
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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 /
© 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 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 ,
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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 /
© U N I V E R S I T Y O F U T A H H E A L T H ,
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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 /
© U N I V E R S I T Y O F U T A H H E A L T H ,
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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 /
© U N I V E R S I T Y O F U T A H H E A L T H ,
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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)
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 7
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 /