Selected Publications
Patel MS, Volpp KG, Asch DA. Nudge units to improve the delivery of health care. New England Journal of Medicine. 2018;378(3):214-21
Patel MS, Kurtzman GW, Kannan S, Small DS, Morris A, Honeywell S, Leri D, Rareshide CLA, Day SC, Mahoney KB, Volpp KG, Asch DA. Effect of an automated patient dashboard using active choice and peer comparison performance feedback to physicians on statin prescribing rates: The PRESCRIBE Cluster Randomized Clinical Trial. JAMA Network Open. 2018;1(3):e180818. doi:10.1001/jamanetworkopen.2018.0818
Chokshi NP, Adusumalli S, Small DS, Morris A, Feingold J, Ha Y, Lynch MD, Rareshide C, Hilbert V, Patel MS. Loss-Framed Financial Incentives and Personalized Goal Setting to Increase Physical Activity Among Ischemic Heart Disease Patients Using Wearable Devices: The ACTIVE REWARD Randomized Trial. J Am Heart Assoc. 2018; 7(12):e009173.
Greysen SR, Patel MS. Bedrest is toxic: Why mobility matters in the hospital. Annals of Internal Medicine. 2018;169(2):HO2-HO3.
Patel MS, Benjamin EJ, Volpp KG, Fox CS, Small DS, Massaro JM, Lee JJ, Hilbert V, Valentino M, Taylor DH, Manders ES, Mutalik K, Zhu J, Wang W, Murabito JM. Effect of a game-based intervention designed to enhance social incentives to increase physical activity among families: The BE FIT Randomized Clinical Trial. JAMA Internal Medicine. 2017;177(11):1586-1593.
Patel MS, Foschini L, Kurtzman GW, Zhu J, Wang W, Rareshide CAL, Zbikowski SM. Using wearable devices and smartphones to track physical activity: Initial activation, sustained use, and step counts across sociodemographic characteristics in a national sample. Annals of Internal Medicine. 2017;167(10):755-757.
Sedrak MS, Myers JS, Small DS, Nachamkin I, Ziemba JB, Murray D, Kurtzman GW, Zhu J, Wang W, Mincarelli D, Danoski D, Wells BP, Berns JS, Brennan PJ, Hanson CW, Dine CJ, Patel MS. Effect of a price transparency intervention in the electronic health record on clinician ordering of inpatient laboratory tests: The PRICE randomized clinical trial. JAMA Internal Medicine. 2017;177(7):939-945.
Wong CA, Miller V, Murphy K, Small D, Ford C, Willi S, Feingold J, Morris A, Ha Y, Zhu J, Wang W, Patel MS. Effect of financial incentives on glucose monitoring adherence and glycemic control among adolescents and young adults with type 1 diabetes: A Randomized Clinical Trial. JAMA Pediatrics. 2017;171(12):1176-1183.
Patel MS, Asch DA, Rosin R, Small DS, Bellamy SL, Heuer J, Sproat S, Hyson C, Haff N, Lee SM, Wesby L, Hoffer K, Shuttleworth D, Taylor D, Hilbert V, Zhu J, Yang L, Wang X, Volpp KG. Framing financial incentives to increase physical activity among overweight and obese adults: a randomized, controlled trial. Ann Intern Med. 2016;164(6):385-394.
Patel MS, Asch DA, Rosin R, Small DS, Bellamy SL, Eberbach K, Walters KJ, Haff N, Lee SM, Wesby L, Hoffer K, Shuttleworth D, Taylor D, Hilbert V, Zhu J, Yang L, Wang X, Volpp KG. Individual versus team-based financial incentives to increase physical activity: a randomized, controlled trial. JGIM.2016;31(7):746-754.
Patel MS, Volpp KG, Rosin R, Bellamy SL, Small DS, Fletcher MA, Osman-Koss R, Brady JL, Haff N, Lee SM, Wesby L, Hoffer K, Shuttleworth D, Taylor DH, Hilbert V, Zhu J, Yang L, Wang X, Asch DA. A randomized trial of social comparison feedback and financial incentives to increase physical activity. Am J Health Promot. 2016;30(6):416-424.
Patel MS, Asch DA, Troxel AB, Fletcher MA, Osman-Koss R, Brady JL, Wesby L, Hilbert V, Zhu J, Wang W, Volpp KG. Premium-based financial incentives did not promote workplace weight loss in a 2013-15 study. Health Affairs. 2016; 35(1):71-79.
Patel MS, Patel N, Small DS, Rosin R, Rohrbach JI, Stromberg N, Hanson CW, Asch DA. Change in length of stay and readmissions among hospitalized medical patients after inpatient medicine service adoption of mobile secure text messaging. JGIM. 2016;31(8):863-870.
Patel MS, Day SC, Halpern SD, Hanson CW, Martinez JR, Honeywell S, Volpp KG. Change in generic medication prescription rates after health system-wide redesign of default options within the electronic health record. JAMA Internal Medicine. 2016;176(8):847-848.
Patel MS, Volpp KG, Small DS, Wynn C, Zhu J, Yang L, Honeywell S, Day SC. Using active choice within the electronic health record to increase physician ordering and patient completion of high-value cancer screening tests. Healthcare: The Journal of Delivery Science and Innovation. Published Online May 11,2016. DOI: 10.1016/j.hjdsi.2016.04.005
Patel MS, Asch DA, Volpp KG. Wearable devices as facilitators, not drivers, of health behavior change.JAMA. 2015;313(5):459-460.
Case MA, Burwick HA, Volpp KG,Patel MS. Accuracy of smartphone applications and wearable devices for tracking physical activity data.JAMA.2015;313(6):625-626.
Patel MS, Volpp KG, Small DS, Hill AS, Even-Shoshan O, Rosenbaum L, Ross RN, Bellini L, Zhu J, Silber JH. Association of the 2011 ACGME resident duty hour reforms with mortality and readmissions among hospitalized Medicare patients.JAMA. 2014;312(22):2364-2373.
Patel MS, Day S, Howell JT, Lautenbach GL, Nierman EH, Volpp KG. Using default options within the electronic health record to increase the prescribing of generic equivalent medications: A quasi experimental study.Ann Intern Med.2014;161:S44-52.
Patel MS, Reed DA, Loertscher L, McDonald FS, Arora VM. Teaching residents to provide cost-conscious care – A national survey of residency program directors.JAMA Internal Medicine.2014;174(3):470
Patel MS, Volpp KG. Leveraging insights from behavioral economics to increase the value of health-care service provision.JGIM. 2012;27:1544-1547.
Patel MS, Davis MM, Lypson ML. The VALUE Framework: Training residents to provide value-based care for their patients.JGIM. 2012;27(9);1210-1214.
Patel MS, Davis MM, Lypson ML. Advancing medical education by teaching health policy.New England Journal of Medicine. 2011;364(8):695-697.
Mitesh Patel, Katherine L. Milkman, Linnea Gandhi, Heather N. Graci, Dena Gromet, Hung Ho, Joseph S. Kay, Timothy W. Lee, Jake Rothschild, Modupe Akinola, John Beshears, Jonathan E. Bogard, Alison Buttenheim, Christopher F. Chabris, Gretchen B. Chapman, James J. Choi, Hengchen Dai, Craig R. Fox, Amir Goren, Matthew D. Hilchey, Jillian Hmurovic, Leslie K. John, Dean Karlan, Melanie Kim, David Laibson, Cait Lamberton, Brigitte C. Madrian, M. Meyer, Maria Modanu, Jimin Nam, Todd Rogers, Renante Rondina, Silvia Saccardo, Maheen Shermohammed, Dilip Soman, Jehan Sparks, Caleb Warren, Megan Weber, Ron Berman, Chalanda N. Evans, Seung Hyeong Lee, Christopher K. Snider, Eli Tsukayama, Christophe Van den Bulte, Kevin Volpp, Angela Duckworth (2022), A Randomized Trial of Behavioral Nudges Delivered through Text Messages to Increase Influenza Vaccination Among Patients with an Upcoming Primary Care Visit, American Journal of Health Promotion, 37 (3), pp. 324-332.
Abstract: Purpose: To evaluate if nudges delivered by text message prior to an upcoming primary care visit can increase influenzavaccination rates.Design: Randomized, controlled trial.Setting: Two health systems in the Northeastern US between September 2020 and March 2021.Subjects: 74,811 adults.Interventions: Patients in the 19 intervention arms received 1-2 text messages in the 3 days preceding their appointment thatvaried in their format, interactivity, and content.Measures: Influenza vaccination.Analysis: Intention-to-treat.Results: Participants had a mean (SD) age of 50.7 (16.2) years; 55.8% (41,771) were female, 70.6% (52,826) wereWhite, and 19.0% (14,222) were Black. Among the interventions, 5 of 19 (26.3%) had a significantly greater vaccinationrate than control. On average, the 19 interventions increased vaccination relative to control by 1.8 percentage pointsor 6.1% (P = .005). The top performing text message described the vaccine to the patient as “reserved for you” and ledto a 3.1 percentage point increase (95% CI, 1.3 to 4.9; P < .001) in vaccination relative to control. Three of the top fiveperforming messages described the vaccine as “reserved for you.” None of the interventions performed worse thancontrol.Conclusions: Text messages encouraging vaccination and delivered prior to an upcoming appointment significantly increasedinfluenza vaccination rates and could be a scalable approach to increase vaccination more broadly.
Alison Buttenheim, Katherine L. Milkman, Angela Duckworth, Dena Gromet, Mitesh Patel, Gretchen B. Chapman (2022), Effects of Ownership Text Message Wording and Reminders on Receipt of an Influenza Vaccination: A Randomized Clinical Trial, Journal of the American Medical Association Network Open, 5 (2).
Abstract: ImportanceDespite the availability of safe and effective vaccines, many people fail to get vaccinated. Messages using behavioral science principles may increase vaccination rates.ObjectiveTo determine the effect on influenza vaccination rates of a text message telling patients that an influenza vaccine had been reserved for them.Design, Setting, and ParticipantsAs part of a larger influenza vaccine messaging megastudy, in this randomized clinical trial, 11 188 patients in 2 large health systems were assigned to receive a text message that stated “a flu shot has been reserved for you,” a text message that stated “flu shots will be available,” or no text message. Both messages included the option to reply yes (Y) or no (N) to indicate that the patient wanted to get vaccinated. Patients 18 years or older were included if they had new or routine (nonsick) primary care appointments scheduled from September 20, 2020, through March 31, 2021.InterventionsThe evening before the scheduled appointment, patients in the 2 message conditions were sent 3 back-to-back SMS messages containing the study wording. Patients in the usual care control group did not receive any study messages.Main Outcomes and MeasuresReceipt of an influenza vaccine on the date of the patient’s scheduled appointment.ResultsA total of 11 188 patients were randomized to the reserved or the available message conditions or to usual care. The 10 158 patients analyzed in the study had a mean (SD) age of 50.61 (16.28) years; 5631 (55.43%) were women; and 7025 (69.16%) were White. According to health records, 4113 (40.49%) had been vaccinated in the previous influenza season, and 5420 (53.36%) were patients at Penn Medicine. In an intent-to-treat analysis, changes in vaccination rates in response to the reserved message did not reach statistical significance (increase of 1.4 percentage points, or 4% [P = .31]) compared with the message conveying that influenza vaccines were available. Relative to the usual care control, the reserved message increased vaccination rates by 3.3 percentage points, or 11% (P = .004). Patients in the reserved message condition were more likely to text back Y (1063 of 3375 [31.50%]) compared with those in the available message condition (887 of 3351 [26.47%]; χ2 = 20.64;P < .001), and those who replied Y were more likely to get vaccinated (1532 of 1950 [78.56%]) compared with those who did not (749 of 4776 [15.68%]; χ2 = 2400;P < .001).Conclusions and RelevanceThis study found that patients who received text messages regarding flu vaccination had greater vaccine uptake than those who received no message. Messages that increase the likelihood that patients will indicate their intention to be vaccinated may also increase vaccination behavior.
Katherine L. Milkman, Linnea Gandhi, Mitesh Patel, Heather N. Graci, Dena Gromet, Hung Ho, Joseph S. Kay, Timothy W. Lee, Jake Rothschild, Jonathan E. Bogard, Ilana Brody, Christopher F. Chabris, Edward Chang, Gretchen B. Chapman, Jennifer E. Dannals, Noah J. Goldstein, Amir Goren, Hal E. Hershfield, Alexander Hirsch, Jillian Hmurovic, Samantha Horn, Dean Karlan, Ariella Kristal, Cait Lamberton, M. Meyer, Allison H. Oakes, Maurice Schweitzer, Maheen Shermohammed, Joachim H. Talloen, Caleb Warren, Ashley Whillans, Kuldeep N. Yadav, Julian J. Zlatev, Ron Berman, Chalanda N. Evans, Rahul Ladhania, Jens Ludwig, Nina Mazar, Sendhil Mullainathan, Christopher K. Snider, Jann Spiess, Eli Tsukayama, Lyle Ungar, Christophe Van den Bulte, Kevin Volpp, Angela Duckworth (2022), A 680,000-Person Megastudy of Nudges to Encourage Vaccination in Pharmacies, Proceedings of the National Academy of Sciences, 119 (6). 10.1073/pnas.211512611
Abstract: Encouraging vaccination is a pressing policy problem. To assess whether text-based reminders can encourage pharmacy vaccination and what kinds of messages work best, we conducted a megastudy. We randomly assigned 689,693 Walmart pharmacy patients to receive one of 22 different text reminders using a variety of different behavioral science principles to nudge flu vaccination or to a business-as-usual control condition that received no messages. We found that the reminder texts that we tested increased pharmacy vaccination rates by an average of 2.0 percentage points, or 6.8%, over a 3-mo follow-up period. The most effective messages reminded patients that a flu shot was waiting for them and delivered reminders on multiple days. The top performing intervention included two texts delivered 3 d apart and communicated to patients that a vaccine was “waiting for you.” Neither experts nor lay people anticipated that this would be the best-performing treatment, underscoring the value of simultaneously testing many different nudges in a highly powered megastudy.
Katherine L. Milkman, Mitesh Patel, Linnea Gandhi, Heather N. Graci, Dena Gromet, Hung Ho, Joseph S. Kay, Timothy W. Lee, Modupe Akinola, John Beshears, Jonathan E. Bogard, Alison Buttenheim, Christopher F. Chabris, Gretchen B. Chapman, James J. Choi, Hengchen Dai, Craig R. Fox, Amir Goren, Matthew D. Hilchey, Jillian Hmurovic, Leslie K. John, Dean Karlan, Melanie Kim, David Laibson, Cait Lamberton, Brigitte C. Madrian, M. Meyer, Maria Modanu, Jimin Nam, Todd Rogers, Renante Rondina, Silvia Saccardo, Maheen Shermohammed, Dilip Soman, Jehan Sparks, Caleb Warren, Megan Weber, Ron Berman, Chalanda N. Evans, Christopher K. Snider, Eli Tsukayama, Christophe Van den Bulte, Kevin Volpp, Angela Duckworth (2021), A Megastudy of Text-Based Nudges Encouraging Patients to Get Vaccinated at an Upcoming Doctor’s Appointment, Proceedings of the National Academy of Sciences, 118 (20). 10.1073/pnas.2101165118
Abstract: Many Americans fail to get life-saving vaccines each year, and the availability of a vaccine for COVID-19 makes the challenge of encouraging vaccination more urgent than ever. We present a large field experiment (N = 47,306) testing 19 nudges delivered to patients via text message and designed to boost adoption of the influenza vaccine. Our findings suggest that text messages sent prior to a primary care visit can boost vaccination rates by an average of 5%. Overall, interventions performed better when they were 1) framed as reminders to get flu shots that were already reserved for the patient and 2) congruent with the sort of communications patients expected to receive from their healthcare provider (i.e., not surprising, casual, or interactive). The best-performing intervention in our study reminded patients twice to get their flu shot at their upcoming doctor’s appointment and indicated it was reserved for them. This successful script could be used as a template for campaigns to encourage the adoption of life-saving vaccines, including against COVID-19.
Esther Y. Hsiang, Shivan J. Mehta, Dylan Small, Charles A. L. Rareshide, Christopher K. Snider, Susan C. Day, Mitesh Patel (2019), Association of Primary Care Clinic Appointment Time With Clinician Ordering and Patient Completion of Breast and Colorectal Cancer Screening, JAMA Network Open, 2(5):e193403.
Mitesh Patel, Kevin Volpp, Dylan Small, Alexander Hill, Orit Even-Shoshan, Lisa Rosenbaum, Richard Ross, Lisa Bellini, Jingsan Zhu, Jeffrey H. Silber (2014), Association of the 2011 ACGME Resident Duty Hour Reforms With Mortality and Readmissions Among Hospitalized Medicare Patients, Journal of the American Medical Association, 312 (22), pp. 2364-2373.
