Innovative, automated strategies to engage patients at home are key to improving health outcomes

June 20, 2012

In a Perspective piece published Online First this week in the New England Journal of Medicine, a group of researchers from the Perelman School of Medicine at the University of Pennsylvania propose a multi-pronged approach to the new practice of so-called "automated hovering" that aims to improve patients' compliance with medication and dietary regimens and other positive health behaviors. These approaches combine newly discovered principles of behavioral economics that offer better ways to motivate patients to improve and protect their own health, technologies such as cell phones and wireless devices, and new reimbursement strategies for health care providers that require them focus more closely on patients' health outside of office visits and hospitalizations.

To be most effective, the authors say automated hovering approaches must be not only cost-effective – inexpensive to provide, without costly personnel oversight on a daily basis – but also guided by the growing field of research, which provides clues about what motivates and helps patients to remain engaged in behaviors that improve their health. "Behavioral economics explains why people are predictably irrational and provides tools for redirecting their behavior with carefully deployed nudges and financial incentives," they write.

"Even patients with chronic diseases might spend no more than a few hours a year in front of a doctor or a nurse. But they spend over 5,000 waking hours a year doing everything else -- and that 'everything else' often has a big impact on their health." says lead author David A. Asch, MD, MBA, director of Penn's Leonard Davis Institute of Health Economics. "If we are to help patients improve their health, we need to find a way to engage them during those 5,000 hours."

The authors cite Penn research on an electronic pill box used to monitor patients taking the blood thinner warfarin as an example of an automated hovering approach that holds promise for management of other illnesses. The dispensers studied were electronically tied to a lottery system that offered patients a chance to win money each time they took their pill – but if they box recorded that they had skipped their warfarin the previous day, they were ineligible to collect the prize even when their number came up in the daily random drawing. The system, which the Penn team detailed in a 2008 paper, reduced the rate of incorrect doses from 22 percent to about 3 percent. The authors suggest that a similar system could be easily deployed to improve medication adherence among patients discharged from the hospital with congestive heart failure or after being treated for acute coronary syndromes.

Asch and his co-author, Kevin Volpp, MD, PhD, director of Penn's Center for Health Incentives and Behavioral Economics recently received a $4.8 million Health Care Innovation Award from the Centers for Medicare and Medicaid Services to test out an automated hovering approach to help patients maintain their prescribed medication regimen when they are discharged from the hospital after a heart attack.

To be most effective, the Penn authors note that these approaches should target specific patient populations – especially those who are at risk of preventable hospitalizations, an enormous driver of U.S. health care spending. Diabetic , for instance, who can keep their disease in check at home by following their recommended diet and exercise guidelines and taking the proper medications, are an optimal target for automated hovering, as are those with heart failure or other cardiac problems who are well enough to manage their disease at home. In those groups, hovering could focus on promoting adherence to the medication regimens that are necessary to prevent costly hospital admissions.

Explore further: Integrating medication regimens into daily routines can improve adherence

Related Stories

Integrating medication regimens into daily routines can improve adherence

September 19, 2011
For medications to be effective, they must be taken in the correct dosage at the right time, as prescribed by healthcare providers. The World Health Organization estimates that half of patients take their medications incorrectly, ...

Home monitoring may help manage and reduce costs for heart failure

January 3, 2012
(Medical Xpress) -- Heart failure affects 5.8 million people in the U.S. alone and is responsible for nearly 1 million hospitalizations each year, most resulting from a build-up of body fluid in the lungs and other organs ...

Researchers focus on secondary stroke prevention after study reveals room for improvement

September 12, 2011
A year after hospital discharge, the majority of stroke patients are listening to doctor's orders when it comes to taking their prescribed secondary stroke prevention medications, new data out of Wake Forest Baptist Medical ...

Concurrent treatment for type 2 diabetes and depression significantly improves both conditions

January 10, 2012
(Medical Xpress) -- Patients simultaneously treated for both Type 2 diabetes and depression improve medication compliance and significantly improve blood sugar and depression levels compared to patients receiving usual care, ...

Recommended for you

Expert: Be concerned about how apps collect, share health data

October 20, 2017
As of 2016 there were more than 165,000 health and wellness apps available though the Apple App Store alone. According to Rice University medical media expert Kirsten Ostherr, the Food and Drug Administration (FDA) regulates ...

Three million Americans carry loaded handguns daily, study finds

October 19, 2017
An estimated 3 million adult American handgun owners carry a firearm loaded and on their person on a daily basis, and 9 million do so on a monthly basis, new research indicates. The vast majority cited protection as their ...

More teens than ever aren't getting enough sleep

October 19, 2017
If you're a young person who can't seem to get enough sleep, you're not alone: A new study led by San Diego State University Professor of Psychology Jean Twenge finds that adolescents today are sleeping fewer hours per night ...

Across Asia, liver cancer is linked to herbal remedies: study

October 18, 2017
Researchers have uncovered widespread evidence of a link between traditional Chinese herbal remedies and liver cancer across Asia, a study said Wednesday.

Eating better throughout adult years improves physical fitness in old age, suggests study

October 18, 2017
People who have a healthier diet throughout their adult lives are more likely to be stronger and fitter in older age than those who don't, according to a new study led by the University of Southampton.

Global calcium consumption appears low, especially in Asia

October 18, 2017
Daily calcium intake among adults appears to vary quite widely around the world in distinct regional patterns, according to a new systematic review of research data ahead of World Osteoporosis Day on Friday, Oct. 20.

1 comment

Adjust slider to filter visible comments by rank

Display comments: newest first

Home Care Assistance
not rated yet Aug 01, 2012
In-home care can provide quality assistance to older adults who wish to age in the comfort of home. To learn more, please visit our Youtube channel at "homecareinfo" and watch our video "Changing the Way the World Ages."

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.