Applying Nobel Prize-winning "Nudge Theory" to Enhance Use of Heart Medications

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Researchers at the Intermountain Medical Center Heart Institute have been enrolling patients since 2015 in a new study that directly applies the Nobel Prize-winning “nudge theory” to medication compliance. The study is one of the only clinical trials to explicitly implement the new model to encourage patients to live healthier lifestyles.  

Nudging – a term coined by newly honored Nobel Prize laureate and economist Richard H. Thaler – is based on the idea that people don’t always make rational choices based on their own best interest. Rather, people are influenced by their emotions and personal needs, resulting in choices that may not lead to the best outcome. Thaler suggests that people can be “nudged” in the right direction by simple processes, and these nudges can help people take actions that benefit them.  
 
Benjamin Horne, PhD, a cardiovascular genetic epidemiologist at the Intermountain Medical Center Heart Institute, is the principal investigator for the clinical trial called Improvement in Medication Compliance Through the Implementation of Personalized Nudges: the ENCOURAGE Trial. The 12-month study looks at how effective personalized nudges improve compliance with cardiovascular prescriptions.  

“While the safety and efficacy of approved cardiovascular medications is well-documented, nationally only approximately 50 percent of patients comply with their heart medication prescriptions. At Intermountain Healthcare, compliance is only marginally better at approximately 60 percent,” says Dr. Horne. “From this study, we hope to determine whether or not the behavior of taking medications actually changes in response to our nudge intervention. If so, we want to find ways to implement the nudge framework on a broader scale to improve outcomes and reduce hospital readmissions among patients at Intermountain.” 
 
This study is done in collaboration with CareCentra, a population health analytics and patient activation company. CareCentra’s innovative patient engagement solution combines a patient’s social, behavioral, clinical, and claims data together to classify him or her into one of 16 segments. These segments help caregivers determine a person’s likelihood of completing actions such as medication compliance. As data and feedback on a patient build in the CareCentra platform, it’s able to generate and deliver personalized nudges that can help persuade patients toward a desired behavior.  

“Intermountain Healthcare was the first to recognize the innovative application of nudge theory using CareCentra’s behavior-shaping platform and set up a formal trial to study its impact on medication compliance,” says Vasant Kumar, chief executive officer of CareCentra. “Understanding the patient’s context immersively allows prompts that are predictive, personalized, and persuasive, and that have a higher probability of delivering the desired health action.”  

Starting with the ENCOURAGE Trial, CareCentra is also incorporating Intermountain’s Risk Score – developed by Dr. Horne – into the platform. The Intermountain Risk Score uses data from basic clinical tests to predict the likelihood of a major medical event occurring in a patient’s life. The addition of the Risk Score helps CareCentra’s platform predict which patients need to be nudged by taking into account a patient’s health, their motivations, and abilities. This encourages patients to take the desired actions.  

“Through this study, we hope to see that this easily implemented risk assessment and nudging system will lead to improved outcomes for patients and no added time for physicians,” says Dr. Horne.   

If you’re interested in learning more about the clinical trial, please review the information regarding the ENCOURAGE Trial on clinicaltrails.gov.  

About Intermountain 

Intermountain Healthcare is a Utah-based, not-for-profit system of 22 hospitals, 180 clinics, a Medical Group with 1,500 employed physicians, a health plans division called SelectHealth, and other health services. As it works to help people live the healthiest lives possible, Intermountain is widely recognized as a leader in transforming healthcare through high quality and sustainable costs. For more information about Intermountain, visit intermountainhealthcare.org.  

About CareCentra 

CareCentra is a healthcare analytics and behavior design company that shapes health behaviors in patients, employees, and healthcare professionals. The company’s personalized engagement platform is augmented intelligence built on deep data analytics and adapts through interactions with patients. For more information about CareCentra, visit www.carecentra.com.