Behavioral interventions to improve population health outreach for hepatitis C screening: randomized clinical trial.

Objective: To evaluate whether opt out framing, messaging incorporating behavioral science concepts, or electronic communication increases the uptake of hepatitis C virus (HCV) screening in patients born between 1945 and 1965.

Design: Pragmatic randomized controlled trial.

Setting: 43 primary care practices from one academic health system (Philadelphia, PA, USA) between April 2019 and May 2020.

Phenotyping physician practice patterns and associations with response to a nudge in the electronic health record for influenza vaccination: A quasi-experimental study.

Background: Health systems routinely implement changes to the design of electronic health records (EHRs). Physician behavior may vary in response and methods to identify this variation could help to inform future interventions. The objective of this study was to phenotype primary care physician practice patterns and evaluate associations with response to an EHR nudge for influenza vaccination.

Association of an Active Choice Intervention in the Electronic Health Record Directed to Medical Assistants With Clinician Ordering and Patient Completion of Breast and Colorectal Cancer Screening Tests.

Importance: Early cancer detection can lead to improved outcomes, but cancer screening tests are often underused.

Objective: To evaluate the association of an active choice intervention in the electronic health record directed to medical assistants with changes in clinician ordering and patient completion of breast and colorectal cancer screening tests.

Design, Setting, And Participants: A retrospective quality improvement study was conducted among 69 916 patients eligible for breast or colorectal cancer screening at 25 primary care practices at the University of Pennsylvania Health System between September 1, 2014, and August 31, 2017.

Seeking Consensus on the Terminology of Value-Based Transformation Through use of a Delphi Process.

Collaboration among diverse stakeholders involved in the value transformation of health care requires consistent use of terminology. The objective of this study was to reach consensus definitions for the terms , , and . A modified Delphi process was conducted from February 2017 to July 2017.

Electronic Pill Bottles or Bidirectional Text Messaging to Improve Hypertension Medication Adherence (Way 2 Text): a Randomized Clinical Trial.

Background: Poor medication adherence contributes to inadequate control of hypertension. However, the value of adherence monitoring is unknown.

Objective: To evaluate the impact of monitoring adherence with electronic pill bottles or bidirectional text messaging on improving hypertension control.

Association of Primary Care Clinic Appointment Time With Clinician Ordering and Patient Completion of Breast and Colorectal Cancer Screening.

Importance: As the clinic day progresses, clinicians may fall behind schedule and experience decision fatigue. However, the association of time of day with cancer screening rates is unknown.

Objective: To evaluate the association of primary care clinic appointment time with clinician ordering and patient completion of breast and colorectal cancer screening.

Variations in Influenza Vaccination by Clinic Appointment Time and an Active Choice Intervention in the Electronic Health Record to Increase Influenza Vaccination.

Importance: Influenza vaccination rates in the United States are suboptimal near 40%, but little is known about variations in care based on clinic appointment time.

Objectives: To compare differences in influenza vaccination rates by clinic appointment time and to evaluate the association of an active choice intervention in the electronic health record with changes in vaccination rates.

Design, Setting, And Participants: Retrospective, quality improvement study of 11 primary care practices at the University of Pennsylvania Health System from September 1, 2014, to March 31, 2017.

Effect of an Automated Patient Dashboard Using Active Choice and Peer Comparison Performance Feedback to Physicians on Statin Prescribing: The PRESCRIBE Cluster Randomized Clinical Trial.

Importance: Statins are not prescribed to approximately 50% of patients who could benefit from them.

Objective: To evaluate the effectiveness of an automated patient dashboard using active choice framing with and without peer comparison feedback on performance to nudge primary care physicians (PCPs) to increase guideline-concordant statin prescribing.

Design, Setting, And Participants: This 3-arm cluster randomized clinical trial was conducted from February 21, 2017, to April 21, 2017, at 32 practice sites in Pennsylvania and New Jersey.

Impact of an interprofessional transition of care service on 30-day hospital reutilizations.

The objective of this study was to evaluate the impact of an interprofessional Transitions of Care (TOC) service on 30-day hospital reutilization inclusive of hospital readmissions and ED visits. This was a retrospective cohort study including patients discharged from an academic medical center between September 2013 and October 2014. Patients scheduled for a hospital follow-up visit in the post-acute care clinic (PACC) were included in the intervention group and patients without a post-discharge interprofessional TOC service were included in the comparison group.

Patient and physician predictors of hyperlipidemia screening and statin prescription.

Objectives: Appropriate lipid management has been demonstrated to reduce cardiovascular events, but rates of hyperlipidemia screening and statin therapy are suboptimal. We aimed to evaluate patient and physician predictors of guideline-concordant hyperlipidemia screening and statin prescription.

Study Design: Retrospective study of patients with primary care provider (PCP) visits from 2014 to 2016 at the University of Pennsylvania Health System.

Social Incentives and Gamification to Promote Weight Loss: The LOSE IT Randomized, Controlled Trial.

Background: Social networks influence obesity patterns, but interventions to leverage social incentives to promote weight loss have not been well evaluated.

Objective: To test the effectiveness of gamification interventions designed using insights from behavioral economics to enhance social incentives to promote weight loss.

Design: The Leveraging Our Social Experiences and Incentives Trial (LOSE IT) was a 36-week randomized, controlled trial with a 24-week intervention and 12-week follow-up.

Using Active Choice Within the Electronic Health Record to Increase Influenza Vaccination Rates.

Background: Despite the benefits of influenza vaccination, each year more than half of adults in the United States do not receive it.

Objective: To evaluate the association between an active choice intervention in the electronic health record (EHR) and changes in influenza vaccination rates.

Design: Observational study.

Using active choice within the electronic health record to increase physician ordering and patient completion of high-value cancer screening tests.

Background: High value screening tests such as colonoscopy and mammography can improve early cancer detection but are often underutilized.

Methods: We evaluated an active choice intervention using the electronic health record (EHR) to confirm patient eligibility for colonoscopy or mammography during the patient's clinic visit and prompt the physician and his/her medical assistant to actively choose to "accept" or "cancel" an order for it. We fit multivariate logistic regression models using a difference-in-differences approach to evaluate changes in physician ordering and patient completion of colonoscopy and mammography at the intervention practice compared to two control practices, adjusting for time trends, patient and clinic visit characteristics.

Obtaining patient feedback at point of service using electronic kiosks.

Background: Engaging patients in their healthcare is a goal of healthcare reform. Obtaining sufficient, reliable patient feedback about their experiences in an office encounter has been a challenge.

Objective: To determine the feasibility of collecting feedback from patients regarding their office encounter at the point of care using touch screen kiosk technology in an urban primary care clinic.

A primary care intervention for weight loss: results of a randomized controlled pilot study.

Most primary care providers (PCPs), constrained by time and resources, cannot provide intensive behavioral counseling for obesity. This study evaluated the effect of using medical assistants (MAs) as weight loss counselors. The study was a randomized controlled trial conducted in two primary care offices at an academic medical center.