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Connecting the Dots: Behavioral Economics and a Cluster Randomized Trial 


Adrian F. Hernandez, MD, MHS, Duke University Medical Center and Duke Clinical Research Institute


Cluster randomized trial; Patient engagement; Clinician engagement; Behavioral economics; Mobile health; mHealth; Health behavior change; CONNECT-HF

Key Points

  • Principles of behavioral economics help us understand the barriers to behavior change so that we can design better health interventions. New methods are especially needed considering the projected prevalence and cost of heart failure in the United States.
  • A new trial, CONNECT-HF, is using behavioral economics concepts to develop interventions that optimize the care for patients with heart failure. Direct engagement will be used that includes site visits and ongoing mentoring from teams of healthcare professionals with specialized training and field experience.
  • The trial also involves the use of mobile technology, wearables, and telemonitoring for outpatient management. Such digital engagement with patients is intended to advance a sense of ownership in care. Patients can play a role in the design of new digital tools aimed at optimizing adherence, commitment, and motivation that may lead to a durable change in health behavior.

Discussion Themes

How can we increase the use of mobile devices, especially with patients whom it would benefit? Can we utilize patients’ social networks to encourage behavior change? Is there an ideal combination of incentives and monitoring?
It doesn’t take much incentive to change behavior; small incentives can shift the needle. Incentives do not always need to be monetary.
What are the long-term impacts and sustainability of behavioral change of the interventions?
Is there a role for “nudge” units in hospitals or healthcare systems? Many governments have divisions that study how subtle changes in decision architectures can improve systems.

For More Information

Books referenced in today’s Grand Rounds presentation that discuss behavioral economics:


#BehavioralEconomics, #pctGR
@PCTGrandRounds, @Collaboratory1, @PCORnetwork

 Grand Rounds 1-27-17

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