Literature Collection

This report describes how innovative models to improve health and health care--developed with funding from the Robert Wood Johnson Foundation (RWJF)-- spread and adapted and became integrated into the U.S. health care system (and also were taken up by some other countries), all without further input or influence from the Foundation. Prescription for health: promoting healthy behaviors in primary care research networks, a $9 million RWJF national program launched in 2002, tested the use of evidence-based models and innovative tools in primary care to counsel patients to change unhealthy behaviors related to chronic disease and death.

Health care has widely adopted behavioral economics to influence clinical practice, with documented success using defaults and social comparison feedback in electronic health records. However, online medical education, now the dominant modality for continuing professional development, remains designed on assumptions of rational learning that behavioral science has disproven in clinical contexts. This viewpoint examines the paradox of applying sophisticated behavioral insights to clinical work while designing digital learning environments as if learners are immune to cognitive limitations. We propose digital choice architecture for medical education: intentional integration of behavioral design principles into learning management systems and online platforms. Drawing from clinical nudge units and implementation science, we demonstrate how defaults, social norms, and commitment devices can be systematically applied to digital continuing education. As medical education becomes increasingly technology-mediated, behavioral science provides the theoretical foundation and practical tools for designing online learning environments that align with how clinicians actually make decisions.

BACKGROUND: Many adults are overdue for important screenings and vaccines, but providers have limited resources to address these care gaps. Electronic messaging, including patient portal messaging, can be an effective intervention to increase screening and vaccine adherence. However, there is limited research examining variables influencing intervention efficacy beyond demographic variables. OBJECTIVE: This study aims to identify whether patient portal engagement and primary care visits affect the efficacy of patient portal-based screening or vaccine reminders. METHODS: A retrospective analysis of electronic medical record data was used to evaluate the completion of screening mammograms, influenza vaccinations, and fecal immunochemical test (FIT) screenings for approximately 400,000 MyChart patient portal users at a large integrated health system. A logistic regression analysis was performed to calculate odds ratios associated with intervention completion. RESULTS: When adjusted for age, race, and sex, MyChart engagement is associated with increased odds of completing patient portal interventions for mammograms, flu vaccines, and FIT screenings. When adjusted for age, race, and sex, primary care visits are associated with increased odds of completing flu vaccines and FIT screenings but not mammograms following a patient portal intervention. CONCLUSIONS: Overall patient portal engagement is critical to portal-based preventive health interventions. These interventions are most successful when combined with office-based interventions, but there is a potential in some scenarios that digital interventions can be successful without office-based interventions. This research contributes to the existing literature around screening adherence and patient portals' impact on health outcomes.