Way to Health

Peer reviewed publications

Innovative research using the Way to Health platform published in peer reviewed journals.

83 publications and counting


Apr 7, 2021
Operationalizing Equity: A Rapid-Cycle Innovation Approach to Covid-19 Vaccination in Black Neighborhoods

Kathleen C. Lee, MD, Nida Al-Ramahi, MHA, Lauren Hahn, MBA, Terrilynn Donnell, Lillian J. Schonewolf, Neda Khan, Christina O’Malley, MHA, Utsha G. Khatri, MD, Ellen Pearlman, MS, Mohan Balachandran, MA, David A. Asch, MD, MBA, W. L. Herndon, Colleen Mallozzi, MBA, RN, Judith Green-McKenzie, MD, MPH, Nishaminy Kasbekar, PharmD, Christopher Cullom, MBA, Sharon Carney, MD, Reverend William Shaw, DMin, Patricia Sullivan, PhD, Phil Okala, MHA, Patrick J Brennan, MD & Eugenia South, MD, MS

The Covid-19 vaccine rollout has been highly inequitable, with white individuals being vaccinated at higher rates than Black individuals in 38 states. In just 2 weeks, we designed and launched a community clinic model. As of March 2021, we have run three 7-hour clinics, vaccinating a total of 2,821 people, of whom 85% were Black. Logistical innovations allowed the clinics to operate line-free throughout most of the day and with a Net Promoter score of 94, evidencing outstanding patient satisfaction.


Mar 10, 2021
How Penn Medicine Reimagined Breast Reconstruction, Shifting the Balance of Postoperative Care from Clinic to Home

Michael G. Tecce, DO, Lauren Hahn, MBA, Bethany Welch, PA-C, MHS, David Okawa, MBA, Daniel J. Wendler, MD, Saiesh Kalva, Mohan Balachandran, MA, MS, M. Kit Delgado, MD, MS, Christopher K. Snider, MPH, Danielle Flynn, MSN, RN, Roy Rosin, MBA, Raina M. Merchant, MD, MSHP, Joseph Serletti, MD & Kathleen C. Lee, MD

This program challenged a long-standing status quo that required patients to commute to and from the clinic for drain management and removal. High patient satisfaction scores reflected not only this convenience, but also a design that reimagined the delivery of education and clinical services while ensuring a more patient-centric return to independence. CARe, which, in a Covid-19 environment allowed patients to reliably receive uninterrupted postoperative care safely in their homes, has been expanded to additional surgical patient populations across multiple hospitals and home health agencies.


Mar 2, 2021
Covid SAFE: Rapid Implementation of a Saliva-Based SARS-CoV-2 Surveillance Testing Program with Automated Scheduling and Reporting

Allison H. Oakes, PhD, Jonathan A. Epstein, MD, Arupa Ganguly, PhD, Frederic D. Bushman, PhD, Ned C. Haubein, PhD, Christianne Sevinc, MPH, Sarah Fendrich, BA, Ai Leen Oon, BA, Andrew Parambath, BA, MEd, Kayla Clark, BA, Chalanda N. Evans, BS & Mitesh S. Patel, MD, MBA

To safely reopen schools and businesses, widespread surveillance testing for Covid-19 will be necessary. We quickly designed and implemented a surveillance testing program that remotely enrolls participants, uses automated bidirectional text message communications, incorporates symptom monitoring, and automatically reports test results.


Feb 19, 2021
A Mega-Study of Text-Based Nudges Encouraging Patients to Get Vaccinated at an Upcoming Doctor’s Appointment

Katherine L. Milkman, Mitesh S. Patel, Linnea Gandhi, Heather Graci, Dena Gromet, Hung Ho,, Joseph Kay, Timothy Lee, Modupe Akinola, John Beshears, Jon Bogard, Alison Buttenheim, Christopher Chabris, Gretchen B. Chapman, James J. Choi, Hengchen Dai, Craig R. Fox, Amir Goren, Matthew Hilchey, Jillian Hmurovic, Leslie John, Dean Karlan, Melanie Kim, David Laibson, Cait Lamberton, Brigitte C. Madrian, Michelle N. Meyer, Maria Modanu , Jimin Nam, , Renante Rondina, Silvia Saccardo, Maheen Shermohammed, Dilip Soman, Jehan Sparks, Caleb Warren, Megan Weber, Ron Berman, Chalanda Evans, Christopher Snider, Eli Tsukayama, Christophe Van den Bulte, Kevin Volpp, Angela Duckworth

Powered by Way to Health, this study was run at Penn Medicine and Geisinger. In the fall of 2020, close to 50,000 patients received one of 19 different messages prior to a healthy visit to their primary care provider. In the new study, roughly a third of the messages BCFG tested significantly increased flu shot uptake. The top performing message set—designed by Jon Bogard, Craig Fox, Jehan Sparks, and Megan Weber from the University of California at Los Angeles, and Matt Hilchey, Melanie Kim, Dilip Soman, and Renante Rondina from the University of Toronto, in collaboration with BCFG—boosted vaccination rates by 11%.

JAMA Netw Open

Dec 21, 2020
Effect of Remote Monitoring on Discharge to Home, Return to Activity, and Rehospitalization After Hip and Knee Arthroplasty

Shivan J. Mehta, Eric Hume, Andrea B. Troxel, Catherine Reitz, Laurie Norton, Hannah Lacko, Caitlin McDonald, Jason Freeman, Noora Marcus, Kevin G. Volpp, David A. Asch

In this randomized clinical trial of 242 patients, the remote monitoring program did not increase rate of discharge to home after hip and knee arthroplasty, and gamification and social support did not increase activity levels. However, a significant reduction in rehospitalizations among those assigned to the intervention was found.


Dec 3, 2020
Patient Interaction Phenotypes With an Automated Remote Hypertension Monitoring Program and Their Association With Blood Pressure Control: Observational Study

Anahita Davoudi, Natalie S Lee, Corey Chivers, Timothy Delaney, Elizabeth L Asch, Catherine Reitz, Shivan J Mehta, Krisda H Chaiyachati, Danielle L Mowery

The paper identified unique interaction phenotypes among patients engaging with an automated text message platform for remote BP monitoring. Only the minimalist communication style was associated with achieving target BP. Identifying and understanding interaction phenotypes may be useful for tailoring future automated texting interactions and designing future interventions to achieve better BP control.

Am J Kidney Dis.

Nov 16, 2020
Prevention of Urinary Stones With Hydration (PUSH): Design and Rationale of a Clinical Trial

Charles D Scales Jr, Alana C Desai, Jonathan D Harper, H Henry Lai, Naim M Maalouf, Peter P Reese, Gregory E Tasian, Hussein R Al-Khalidi, Ziya Kirkali, Hunter Wessells, Urinary Stone Disease Research Network

The article describes the rationale and design of the Prevention of Urinary Stones with Hydration (PUSH) study, a randomized trial of a multi-component behavioral intervention program to increase and maintain high fluid intake. Participants are randomized (1:1 ratio) to intervention or control arm. The target sample size is 1642 participants.

Med Dec Making

Nov 1, 2020
Using Clinical Trial Data to Estimate the Costs of Behavioral Interventions for Potential Adopters: A Guide for Trialists

Louise B Russell, Laurie A Norton, David Pagnotti, Christianne Sevinc, Sophia Anderson, Darra Finnerty Bigelow, Lauren G Iannotte, Michael Josephs, Ryan McGilloway, Iwan Barankay, Mary E Putt, Peter P Reese, David A Asch, Lee R Goldberg, Shivan J Mehta, Monique S Tanna, Andrea B Troxel, Kevin G Volpp

This article explains how to frame the costing problem, including how to think about costs associated with the control group, and describes methods for collecting data on individual costs: specifications for costing a technology platform that supports the specialized functions required, how to set up a time log to collect data on the time staff spend on implementation, and issues in getting data on device, overhead, and financial incentive costs.


Oct 14, 2020
Association between behavioral phenotypes and response to a physical activity intervention using gamification and social incentives: Secondary analysis of the STEP UP randomized clinical trial

Xisui Shirley Chen , Sujatha Changolkar, Amol S. Navathe, Kristin A. Linn, Gregory Reh, Gregory Szwartz, David Steier, Sarah Godby, Mohan Balachandran, Joseph D. Harrison, Charles A. L. Rareshide, Mitesh S. Patel

Participants often vary in their response to behavioral interventions, but methods to identify groups of participants that are more likely to respond are lacking. In this secondary analysis of a randomized clinical trial, we used baseline characteristics to group participants into distinct behavioral phenotypes and evaluated differential responses to a physical activity intervention. Engagement varies significantly across the identified phenotypes. The hope is to leverage this methodology to improve patient engagement across multiple clinical domains.


Jul 21, 2020
Remote Monitoring of Patients with Covid-19: Design, implementation, and outcomes of the first 3,000 patients in COVID Watch

Anna U. Morgan, MD, MSc, MSHP, Mohan Balachandran, MA, MS, David Do, MD, Doreen Lam, BA, Andrew Parambath, BA, MEd, Krisda H. Chaiyachati, MD, MPH, MSHP, Nancy M. Bonalumi, DNP, RN, CEN, FAEN, Susan C. Day, MD, MPH, Kathleen C. Lee, MD & David A. Asch, MD, MBA

An innovation team at the University of Pennsylvania Health System demonstrates how an automated text-messaging system can remotely monitor patients with confirmed or suspected Covid-19 at home and quickly support worsening patients with human care.

JAMA Netw Open

Feb 7, 2020
Smartphones vs Wearable Devices for Remotely Monitoring Physical Activity After Hospital Discharge

Mitesh Patel, MD, MBA, MS; Daniel Polsky, PhD; Kevin Volpp, MD, PhD; Edward H. Kennedy, PhD; Dylan S. Small, PhD; Chalanda Evans; Charles Rareshide

According to a new Penn Medicine Study, doctors who track their patients’ physical activity might have more luck doing it with smartphones than wearable fitness devices. “Most people with smartphones take them everywhere they go. Since carrying the phone is already a built-in habit, it makes it much easier to use the device to track activity levels,” says Mitesh Patel, the director of Penn Medicine’s Nudge Unit.

Jan 14, 2020
Patient Phenotypes Help Explain Variation in Response to a Social Gamification Weight Loss Intervention

Jeffrey Leinert, MS, PhD, Mitesh Patel, MD, MBA, MS

Latent class analysis was used to identify patient sub-groups that were successfully impacted by the study intervention. Three groups of participants were identified: “Kin teams,” “Distant teams,” and “Married teams.” “Kin teams” lost more weight after the intervention in the gamification and gamification with PCP sharing arms. The “Distant teams” lost similar amounts of weight in all 3 arms but did not keep it off during maintenance. The “Married teams” lost the most weight across all 3 arms and kept it off following the intervention.


Dec 12, 2019
Mobility and outcomes for validated evidence - Incentive trial (MOVE IT): Randomized clinical trial study protocol

Heather M.Greysen, Catherine Reale, Ashley Mercedes, Mitesh S. Patel, Dylan Small, Christopher Snider, Charles Rareshide, Scott D. Halpern, S. Ryan Greysen

The objective in the Mobility and Outcomes for Validated Evidence – Incentive Trial (MOVE IT) study is to examine the impact of a gamification intervention with social support that uses insights from behavioral economics to increase physical activity among general medical and oncology patients in the 13- weeks post-hospital discharge using a wearable device to track physical activity.


Oct 28, 2019
3 Ways Health Care Leaders Can Encourage Experimentation

David A. Asch, MD, MBA, Kevin B. Mahoney, DBA, Roy Rosin, MBA

Successful innovation requires experimentation—following many of the same pathways of the successful science that has brought us CAR-T cell therapy and CRISPR. But health care change requires we tinker with the health care system we depend on, affecting critical resources organizations understandably protect. To support the people determined to drive change quickly, we need to find ways to bend institutional norms safely.

Am J ObGyn

Sep 15, 2019
Text message remote monitoring reduced racial disparities in postpartum blood pressure ascertainment

Adi Hirshberg, MD; Mary D.Sammel, ScD; Sindhu K.Srinivas, MD, MSCE

Although nonblack women attended in-office (usual care) postpartum blood pressure checks twice as often as black women, the use of a text-based monitoring system resulted in overall higher compliance (>90%) in both race groups and no racial differences in blood pressure ascertainment. Given that most strokes and maternal morbidity from pregnancy-related hypertension occur within 10 days of delivery, text messaging has the potential to be an innovative way to engage hypertensive women of all races equally shortly after delivery and may be further evaluated as a means to reduce disparities in other aspects of postpartum care.


Sep 9, 2019
Effectiveness of Behaviorally Designed Gamification Interventions With Social Incentives for Increasing Physical Activity Among Overweight and Obese Adults Across the United States

Mitesh S. Patel, MD, MBA, MS; Dylan S. Small, PhD; Joseph D. Harrison, BS; Michael P. Fortunato, BA; Ai Leen Oon, BA; Charles A. L. Rareshide, MS; Gregory Reh, MS; Gregory Szwartz, MS; James Guszcza, PhD; David Steier, PhD; Pameljit Kalra, MS; Victoria Hilbert, MPH, RD

Small changes to the design of gamification can lead to important differences in effectiveness - In this randomized clinical trial of 602 overweight and obese adults from 40 states across the United States, gamification interventions with support, collaboration, and competition significantly increased physical activity compared with the control group during the 24-week intervention. The competition arm had the greatest increase in physical activity from baseline during the intervention; during the 12-week follow-up, physical activity was lower in all arms, but remained significantly greater in the competition arm than in the control arm.


Aug 30, 2019
An Automated Text Message Navigation Program Improves the Show Rate for Outpatient Colonoscopy

Nadim Mahmud, MD, MS, MPH, Sahil D. Doshi, MD, Mary S. Coniglio, MBA, Michelle Clermont, MD, Donna Bernard, MSN, Catherine Reitz, MPH, Vandana Khungar, MD, MSc, David A. Asch, MD, MBA, Shivan J. Mehta, MD, MBA, MSHP

Background. Numerous barriers to outpatient colonoscopy completion exist, causing undue procedure cancellations and poor bowel preparation. We piloted a text message navigation program to improve colonoscopy adherence. Method. We conducted a prospective study of patients aged 18 to 75 years scheduled for outpatient colonoscopy at an urban endoscopy center in April 2018. An intervention arm consisting of bidirectional, automated text messages prior to the procedure was compared with a usual care arm. We enrolled 21 intervention patients by phone and randomly selected 50 controls. Outcomes included colonoscopy appointment adherence, bowel preparation quality, and colonoscopy completion. Results. The arms had similar demographics and comorbidities. Intervention patients had higher colonoscopy appointment adherence (90% vs. 62%, p = 0.049). There were no significant differences in preparation quality or procedure completeness. Poststudy surveys indicated high patient satisfaction and perceived usefulness of the program. Conclusion. A bidirectional, automated texting navigation program improved colonoscopy adherence rates as compared with usual care.


Aug 8, 2019
Electronic Pill Bottles or Bidirectional Text Messaging to Improve Hypertension Medication Adherence (Way 2 Text): a Randomized Clinical Trial

Shivan J. Mehta, Kevin G. Volpp, Andrea B. Troxel, Susan C. Day, Raymond Lim, Noora Marcus, Laurie Norton, Sophia Anderson, David A. Asch

Despite good measured adherence, neither feedback with electronic pill bottles nor bidirectional text messaging about medication adherence improved blood pressure control. Adherence to prescribed medications was not improved enough to affect BP control or it was not the primary driver of poor control.


Aug 5, 2019
Prediction using a randomized evaluation of data collection integrated through connected technologies (PREDICT): Design and rationale of a randomized trial of patients discharged from the hospital to home

Chalanda N.Evans, Kevin G.Volpp, Daniel Polsky, Dylan S. Small, Edward H.Kennedy, Kelsey Karpink, Rachel Djaraher, Nicole Mansi, Charles A.L.Rareshide, Mitesh S.Patel

Daily behaviors play a significant role in individuals' longer-term health [4,5]. However, most readmission prediction models do not include data about these behaviors. Our trial has demonstrated that collecting these types of data is feasible. The use of wearable technology allowed for remote monitoring of patient generated physical activity data which provided reliable data, was easy to use, and scaled. The findings from this study will help to understand the ways in which these data sources can improve the identification of patients at high-risk of hospital readmission.


May 22, 2019
Heart Safe Motherhood: Applying Innovation Methodology for Improved Maternal Outcomes

Adi Hirshberg, MD, Katy Mahraj, MSI, Sindhu K. Srinivas, MD, MSCE

Postpartum preeclampsia contributes to a substantial portion of maternal morbidity and mortality in the United States. We used innovation methodology to develop a text-based surveillance system using Way To Health known as Heart Safe Motherhood to target this clinical problem and define a new approach to care delivery.


May 7, 2019
Improving Health Care by Gamifying It

Mitesh Patel, MD, MBA, Stacey Chang, Kevin Volpp, MD, PhD

Our group is using gamification to help patients with uncontrolled diabetes, heart disease, and cancer. We have found that incorporating principles from behavioral economics is not hard or expensive, but instead requires attention to detail. Subtle changes to program design and communications can have an outsized impact on how patients behave. That’s why embedding behavioral insights into gamification could represent a significant opportunity to improve health and wellbeing.


May 1, 2019
Social incentives to encourage physical activity and understand predictors (STEP UP): Design and rationale of a randomized trial among overweight and obese adults across the United States

Joseph D. Harrison, Jeremy M. Jones, Dylan S. Small, Charles A.L. Rareshide, Gregory Szwartz, David Steier, James Guszcza, Pameljit Kalra, Brian Torio, Gregory Reh, Victoria Hilbert, Mitesh S. Patel

This was a four-arm, randomized, controlled trial of 602 overweight and obese adults to evaluate the effectiveness of gamification interventions that leverage insights from behavioral economics to enhance either supportive, competitive, or collaborative social incentives. Daily step counts are monitored using wearable devices that transmit data to the study platform. Participants established a baseline step count, selected a step goal increase, and then were randomly assigned to control or one of three interventions for a 24-week intervention and 12-week follow-up period. To understand predictors of strong or poor performance, we had participants complete validated questionnaires on a range of areas including their personality, risk preferences, social network, and habits relating to physical activity, eating, and sleep. Trial enrollment was conducted in partnership with Deloitte Consulting and included employees from 40 states across the US. The STEP UP Trial represents a scalable model and interventions found to be effective could be deployed more broadly to increase physical activity.


Jan 25, 2019
Enhanced recovery after elective spinal and peripheral nerve surgery: pilot study from a single institution

Zarina S. Ali, Tracy M. Flanders, Ali K. Ozturk, Neil R. Malhotra, Lena Leszinsky, Brendan J. McShane, Diana Gardiner, Kristin Rupich, H. Isaac Chen, James Schuster, Paul J. Marcotte, Michael J. Kallan, M. Sean Grady, Lee A. Fleisher and William C. Welch

Enhanced recovery after surgery (ERAS) protocols address pre-, peri-, and postoperative factors of a patient’s surgical journey. The authors sought to assess the effects of a novel ERAS protocol on clinical outcomes for patients undergoing elective spine or peripheral nerve surgery. total of 201 patients underwent surgical care via an ERAS protocol and were compared to a total of 74 patients undergoing traditional perioperative care (control group). The 2 groups were similar in baseline demographics. Intravenous opioid medications postoperatively via patient-controlled analgesia was nearly eliminated in the ERAS group (0.5% vs 54.1%, p < 0.001). This change was not associated with an increase in the average or daily pain scores in the ERAS group. At 1 month following surgery, a smaller proportion of patients in the ERAS group were using opioids (38.8% vs 52.7%, p = 0.041). The ERAS group demonstrated greater mobilization on postoperative day 0 (53.4% vs 17.1%, p < 0.001) and postoperative day 1 (84.1% vs 45.7%, p < 0.001) compared to the control group. Postoperative Foley use was decreased in the ERAS group (20.4% vs 47.3%, p < 0.001) without an increase in the rate of straight catheterization (8.1% vs 11.9%, p = 0.51).

JAMA Netw Open.

Dec 12, 2018
Cost-effectiveness of Financial Incentives for Patients and Physicians to Manage Low-Density Lipoprotein Cholesterol Levels

Ankur Pandya, PhD; David A. Asch, MD, MBA; Kevin G. Volpp, MD, PhD; Stephen Sy, MS; Andrea B. Troxel, ScD; Jingsan Zhu, MBA; Milton C. Weinstein, PhD; Meredith B. Rosenthal, PhD; Thomas A. Gaziano, MD, MSc

This study suggests that the financial incentives shared between patients and physicians for LDL-C level control meet conventional standards of cost-effectiveness, but these results appeared to be sensitive to assumptions about the durations of LDL-C level reductions and years of intervention costs included, as well as to the choice of time horizon.


Dec 4, 2018
The Healthy Weigh study of lottery-based incentives and environmental strategies for weight loss: Design and baseline characteristics.

Glanz K, Shaw PA, Hoffer K, Chung A, Zhu J, Wu R, Huang QE, Choi JR, Volpp KG

Identifying effective strategies for treating obesity is a clinical challenge and a public health priority. This study demonstrated that multi-site employee-based recruitment for a weight-control intervention study is feasible but may need additional time for coordination between diverse environments.


Nov 8, 2018
Randomized evaluation of trial acceptability by INcentive (RETAIN): Study protocol for two embedded randomized controlled trials.

Krutsinger DC, McMahon J, Stephens-Shields AJ, Bayes B, Brooks S, Hitsman BL, Lubitz SF, Reyes C, Schnoll RA, Ryan Greysen S, Mercede A, Patel MS, Reale C, Barg F, Karlawish J, Polsky D, Volpp KG, Halpern SD

The most common and conceptually sound ethical concerns with financial incentives for research participation are that they may (1) represent undue inducements by blunting peoples' perceptions of research risks, thereby preventing fully informed consent; or (2) represent unjust inducements by encouraging enrollment preferentially among the poor. Neither of these concerns has been shown to manifest in studies testing the effects of incentives on decisions to participate in hypothetical randomized clinical trials (RCTs), but neither has been assessed in real RCTs.

Ann Am Thorac Soc.

Oct 5, 2018
Financial Incentives Promote Smoking Cessation Directly, Not by Increasing Use of Cessation Aids.

Harhay MO, Troxel AB, Brophy C, Saulsgiver K, Volpp KG, Halpern SD

Financial Incentives Promote Smoking Cessation Directly, Not by Increasing Use of Cessation Aids

J Urol

Aug 1, 2018
Ecological Momentary Assessment of Factors Associated with Water Intake Among Adolescents with Kidney Stone Disease.

Tasian GE, Ross M, Song L, Audrain-McGovern J, Wiebe D, Warner SG, Henderson B, Patel A, Furth SL.

Unawareness of water volume consumed and low responsiveness to the perceived need to drink more were associated with low water intake. Interventions that help adolescents recognize when and identify how to increase water intake may be effective in reducing stone recurrence.

Med Care

Jul 24, 2018
Comparison of Pharmacy Claims and Electronic Pill Bottles for Measurement of Medication Adherence Among Myocardial Infarction Patients.

Mehta SJ, Asch DA, Troxel AB, Lim R, Lewey J, Wang W, Zhu J, Norton L, Marcus N, Volpp KG.

Pharmacy claims data provide useful but not complete data for medication adherence monitoring. New wireless technologies have the potential to provide additional data about clinical outcomes.


Jul 12, 2018
Social Incentives and Gamification to Promote Weight Loss: The LOSE IT Randomized, Controlled Trial

Kurtzman GW, Day SC, Small DS, Lynch M, Zhu J, Wang W, Rareshide CAL, Patel MS.

Using digital health devices to track behavior with a partner led to significant weight loss through 36 weeks, but the gamification interventions were not effective at promoting weight loss when compared to control.


Jun 21, 2018
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

Neel P. Chokshi, Srinath Adusumalli, Dylan S. Small, Alexander Morris, Jordyn Feingold, Yoonhee P. Ha, Marta D. Lynch, Charles A.L. Rareshide, Victoria Hilbert and Mitesh S. Patel

ACTIVE REWARD was a 24‐week home‐based, remotely monitored, randomized trial with a 16‐week intervention (8‐week ramp‐up incentive phase and 8‐week maintenance incentive phase) and an 8‐week follow‐up. Patients used wearable devices to track step counts and establish a baseline. Patients in control received no other interventions. Loss‐framed financial incentives with personalized goal setting significantly increased physical activity among ischemic heart disease patients using wearable devices during the 16‐week intervention, and effects were sustained during the 8‐week follow‐up.

JMIR For Res

Jun 11, 2018
Barriers and Opportunities for Using Wearable Devices to Increase Physical Activity Among Veterans: Pilot Study

Rebecca H Kim, MD, MPH ; Mitesh S Patel, MD, MBA, MS

Veterans engaged in using wearable devices at high rates

Nutr & Diab

May 25, 2018
Article | OPEN | Published: 25 May 2018 Financial incentive strategies for maintenance of weight loss: results from an internet-based randomized controlled trial

William S. Yancy Jr., Pamela A. Shaw, Lisa Wesby, Victoria Hilbert, Lin Yang, Jingsan Zhu, Andrea Troxel, David Huffman, Gary D. Foster, Alexis C. Wojtanowski & Kevin G. Volpp

Compared with the active control of daily texting based on daily home weighing, lottery-based and direct monetary incentives provided no additional benefit for weight loss maintenance. Or in other words, texting and reminders were equally effective as financial incentives.


May 23, 2018
A Pragmatic Trial of E-Cigarettes, Incentives, and Drugs for Smoking Cessation

Scott D. Halpern, M.D., Ph.D., Michael O. Harhay, Ph.D., Kathryn Saulsgiver, Ph.D., Christine Brophy, Andrea B. Troxel, Sc.D., and Kevin G. Volpp, M.D., Ph.D.

The study randomly assigned 6006 smokers employed by 54 companies to one of four smoking-cessation interventions or to usual care. In this pragmatic trial of smoking cessation, financial incentives added to free cessation aids resulted in a higher rate of sustained smoking abstinence than free cessation aids alone. Among smokers who received usual care (information and motivational text messages), the addition of free cessation aids or e-cigarettes did not provide a benefit.

BMJ Qual Saf.

Apr 27, 2018
Comparing standard office-based follow-up with text-based remote monitoring in the management of postpartum hypertension: a randomised clinical trial

Hirshberg A, Downes K, Srinivas S

Text-based monitoring is more effective in obtaining blood pressures and meeting current clinical guidelines in the immediate postdischarge period in women with pregnancy-related hypertension compared with traditional office-based follow-up.

J Gen Intern Med

Mar 15, 2018
Partners and Alerts in Medication Adherence: A Randomized Clinical Trial

Kessler JB, Troxel AB, Asch DA, Mehta SJ, Marcus N, Lim R, Zhu J, Shrank W, Brennan T, Volpp KG

Automated alerts were effective at improving medication adherence. Assigning a medication adherence partner did not statistically significantly affect adherence rates.

Am J Health Promot.

Jan 2, 2018
A Randomized, Controlled Trial of Lottery-Based Financial Incentives to Increase Physical Activity Among Overweight and Obese Adults

Patel MS, Volpp KG, Rosin R, Bellamy SL, Small DS, Heuer J, Sproat S, Hyson C, Haff N, Lee SM, Wesby L, Hoffer K, Shuttleworth D, Taylor DH, Hilbert V, Zhu J, Yang L, Wang X, Asch DA

Combined lottery incentives were most effective in increasing physical activity

Ann Intern Med

Nov 21, 2017
Using Wearable Devices and Smartphones to Track Physical Activity: Initial Activation, Sustained Use, and Step Counts Across Sociodemographic Characteristics in a National Sample

Mitesh S. Patel, MD, MBA, MS; Luca Foschini, PhD; Gregory W. Kurtzman, BA; Jingsan Zhu, MBA, MS; Wenli Wang, MS; Charles A.L. Rareshide, MS; Susan M. Zbikowski, PhD

Describes rates of initial use of activity trackers, sustained use after 6 months, and step counts across different sociodemographic characteristics from a wellness program offered across the United States.

JAMA Intern Med.

Nov 18, 2017
Effect of a Game-Based Intervention Designed to Enhance Social Incentives to Increase Physical Activity Among Families The BE FIT Randomized Clinical Trial

Mitesh S. Patel, MD, MBA, MS; Emelia J. Benjamin, MD, ScM; Kevin G. Volpp, MD, PhD; Caroline S. Fox, MD, MPH; Dylan S. Small, PhD; Joseph M. Massaro, PhD; Jane J. Lee, PhD; Victoria Hilbert, MPH, RD; Maureen Valentino, BA; Devon H. Taylor, MPH; Emily S. Manders, BS; Karen Mutalik, BS; Jingsan Zhu, MBA, MS; Wenli Wang, MS; Joanne M. Murabito, MD, ScM

Gamification designed to leverage insights from behavioral economics to enhance social incentives significantly increased physical activity among families in the community.

JAMA Pediatr.

Oct 17, 2017
Effect of Financial Incentives on Glucose Monitoring Adherence and Glycemic Control Among Adolescents and Young Adults With Type 1 Diabetes

Charlene A. Wong, MD, MSHP; Victoria A. Miller, PhD; Kathryn Murphy, PhD; Dylan Small, PhD; Carol A. Ford, MD; Steven M. Willi, MD; Jordyn Feingold, MAPP; Alexander Morris, BS; Yoonhee P. Ha, MSc, MPhil; Jingsan Zhu, MS, MBA2; Wenli Wang, MS2; Mitesh S. Patel, MD, MBA, MS2

In a randomized clinical trial including 90 adolescents and young adults with poorly controlled type 1 diabetes, daily financial incentives improved glucose monitoring in the intervention group (50.0%) vs the control group (18.9%) but did not affect their glycemic control. Financial incentives showed promise for improving glucose monitoring behaviors among adolescents and young adults with type 1 diabetes


Sep 15, 2017
Physician attitudes toward participating in a financial incentive program for LDL reduction are associated with patient outcomes

Tianyu Liu, David A.Asch, Kevin G.Volpp, Jingsan Zhu, Wenli Wang, Andrea B. Troxel, Aderinola Adejare, Darra D. Finnerty, Karen Hoffer, Judy A. Shea

PCPs participating in a P4P program generally agree with the concept of financial incentives and are open to sharing incentives between physicians and patients. Physician beliefs about incentives may have an influence on patient outcomes, particularly in a shared incentive setting, but more research is needed to elucidate the exact nature of this interaction.

JAMA Intern Med.

Jun 26, 2017
Effect of Electronic Reminders, Financial Incentives, and Social Support on Outcomes After Myocardial Infarction: The HeartStrong Randomized Clinical Trial

Kevin G. Volpp, MD, PhD; Andrea B. Troxel, ScD6; Shivan J. Mehta, MD, MBA, MSHP; Laurie Norton, MA; Jingsan Zhu, MS, MBA; Raymond Lim, MA; Wenli Wang, MS; Noora Marcus, MA; Christian Terwiesch, PhD; Kristen Caldarella, MHA; Tova Levin, MBA; Mike Relish, MA; Nathan Negin, MD; Aaron Smith-McLallen, PhD; Richard Snyder, MD; Claire M. Spettell, PhD; Brian Drachman, MD; Daniel Kolansky, MD; David A. Asch, MD, MBA

In this randomized clinical trial of 1509 patients following acute myocardial infarction, there were no statistically significant differences between study arms in time to first rehospitalization for a vascular event or death, medication adherence, or cost.

J Beh Med

Jun 21, 2017
Time to selected quit date and subsequent rates of sustained smoking abstinence

George L. Anesi, Scott D. Halpern, Michael O. Harhay, Kevin G. Volpp, Kathryn Saulsgiver

In efforts to combat tobacco dependence, most smoking cessation programs offer individuals who smoke the choice of a target quit date. However, it is uncertain whether the time to the selected quit date is associated with participants’ chances of achieving sustained abstinence. In a pre-specified secondary analysis of a randomized clinical trial of four financial-incentive programs or usual care to encourage smoking cessation (Halpern et al. in N Engl J Med 372(22):2108–2117, doi:10.1056/NEJMoa1414293, 2015), study participants were instructed to select a quit date between 0 and 90 days from enrollment. Among those who selected a quit date and provided complete baseline data (n = 1848), we used multivariable logistic regression to evaluate the association of the time to the selected quit date with 6- and 12-month biochemically-confirmed abstinence rates. In the fully adjusted model, the probability of being abstinent at 6 months if the participant selected a quit date in weeks 1, 5, 10, and 13 were 39.6, 22.6, 10.9, and 4.3%, respectively.


Jun 15, 2017
Patients' Views of a Behavioral Intervention Including Financial Incentives

Judy A. Shea, PhD; Aderinola Adejare, BA; Kevin G. Volpp, MD, PhD; Andrea B. Troxel, ScD; Darra Finnerty, MPH; Karen Hoffer, BS; Thomas Isaac, MD, MPH, MBA; Meredith Rosenthal, PhD; Thomas D. Sequist, MD, MPH; and David A. Asch, MD, MBA

Patients who enrolled in a trial to lower low-density lipoprotein cholesterol spoke positively of the multifaceted intervention: pillbox monitoring and financial incentives were socially acceptable


May 8, 2017
Moderating Effects of Patient Characteristics on the Impact of Financial Incentives

Meredith B. Rosenthal, Andrea B. Troxel, Kevin G. Volpp, Walter F. Stewart, Thomas D. Sequist, James B. Jones, AnneMarie G. Hirsch, Karen Hoffer, Jingsan Zhu, Wenli Wang, Amanda Hodlofski, Darra Finnerty, Jack J. Huang, David A. Asch

Patient characteristics can have a significant impact on response to incentives and other interventions

Am J Prev Med.

Mar 1, 2017
A Trial of Financial and Social Incentives to Increase Older Adults' Walking

Kristin A.HarkinsBA, Jeffrey T.Kullgren MD, MS, MPH; Scarlett L.Bellamy ScD; Jason Karlawish MD; Karen Glanz PhD, MPH

Incentive schemes that use donations to a charity of choice, personal financial incentives, or a combination of the two can each increase older adults’ initial uptake of increased levels of walking.

Am. J. Kidney Dis.

Mar 1, 2017
Automated Reminders and Physician Notification to Promote Immunosuppression Adherence Among Kidney Transplant Recipients: A Randomized Trial

Peter P. Reese, MD, MSCE, Roy D. Bloom, MD, Jennifer Trofe-Clark, PharmD, Adam Mussell, MA, Daniel Leidy, BA, Simona Levsky, BS, Jingsan Zhu, MS, MBA, Lin Yang, MS, Wenli Wang, MS, Andrea Troxel, ScD, Harold I. Feldman, MD, MSCE, Kevin Volpp, MD, PhD

Provider notification and customized reminders appear promising in helping patients achieve better medication adherence, but these strategies require evaluation in trials powered to detect differences in clinical outcomes

J Gen Intern Med

Mar 1, 2017
Patient and Partner Feedback Reports to Improve Statin Medication Adherence: A Randomized Control Trial

Ashok Reddy, Tiffany L. Huseman, Anne Canamucio, Steven C. Marcus, David A. AschK, evin Volpp, Judith A. Long

Simple nudges such as reminders and feedback reports to either a patient or a partner may facilitate improved medication adherence.

J of Clin Out Mgmt.

Feb 1, 2017
Rapid-Cycle Innovation Testing of Text-Based Monitoring for Management of Postpartum Hypertension

Adi Hirshberg,MD, Marianne D. Bittle,MSN,RNC–OB, Matthew VanDerTuyn,MID, Katy Mahraj,MSI, David A. Asch,MD,MBA, Roy Rosin,MBA, Ian Bennett,MD,PhD, Sindhu K. Srinivas,MD,MSCE

Our results suggest that remote blood pressure monitoring via text message communication engages patients and shows promise as a convenient and effective means of hypertension surveillance in the immediate postpartum period, in accordance to ACOG guidelines


Dec 6, 2016
Physician attitudes toward participating in a financial incentive program for LDL reduction are associated with patient outcomes

Tianyu Liu, David A.Asch, Kevin G.Volpp, Jingsan Zhu, Wenli Wang, Andrea B.Troxel, Aderinola Adejare, Darra D.Finnerty, Karen Hoffer, Judy A.Shea

In primary care practices, shared financial incentives for physicians and patients, but not incentives to physicians or patients alone, resulted in a statistically significant difference in reduction of LDL-C levels at 12 months. This reduction was modest, however, and further information is needed to understand whether this approach represents good value


Nov 4, 2016
A randomized trial of lottery‐based incentives and reminders to improve warfarin adherence: the Warfarin Incentives (WIN2) Trial

Stephen E. Kimmel, Andrea B. Troxel, Benjamin French, George Loewenstein, Jalpa A. Doshi, Todd E. H. Hecht, Mitchell Laskin, Colleen M. Brensinger, Chris Meussner, Kevin Volpp

Automated reminders led to the largest improvements in anticoagulation control, although without impacting measured adherence. Lottery‐based reminders improved measured adherence but did not lead to improved anticoagulation control.

JAMA Cardiol.

Oct 1, 2016
Participation Rates With Opt-out Enrollment in a Remote Monitoring Intervention for Patients With Myocardial Infarction

Shivan J. Mehta, MD, MBA, MSHP; Andrea B. Troxel, ScD; Noora Marcus, MA; Christina Jameson, BS; Devon Taylor, BS; David A. Asch, MD, MBA; Kevin G. Volpp, MD, PhD

For low-risk interventions, opt-out approaches can improve the efficiency of recruitment, expand the intervention to those who are otherwise less likely to participate, and increase generalizability of clinical trials to a broader population.

Ann Intern Med.

Sep 19, 2016
The design and conduct of Keep It Off - An online randomized trial of financial incentives for weight-loss maintenance

Pamela A Shaw, William S Yancy, Jr, Lisa Wesby, Victoria Ulrich, Andrea B Troxel, David Huffman, Gary D Foster, Kevin Volpp

Obesity continues to be a serious public health challenge. Rates are increasing worldwide, with nearly 70% of the US adults overweight or obese, leading to increased clinical and economic burden. While successful approaches for achieving weight loss have been identified, techniques for long-term maintenance of initial weight loss have largely been unsuccessful. Financial incentive interventions have been shown in several settings to be successful in motivating participants to adopt healthy behaviors.


Sep 1, 2016
Rationale and design of a randomized trial of automated hovering for post-myocardial infarction patients: The HeartStrong program

Andrea B. Troxel, ScD; Andrea B. Troxel, ScD; Andrea B. Troxel, David A. Asch, MD, MBA, Shivan J. Mehta, MD, MBA, MSHP, Laurie Norton, MA, Devon Taylor, BS, Tirza A. Calderon, MPH, Raymond Lim, MA, Jingsan Zhu, MS, MBA, Daniel M. Kolansky, MD, Brian M. Drachman, MD, Kevin G. Volpp, MD, PhD

Coronary artery disease is the single leading cause of death in the United States, and medications can significantly reduce the rate of repeat cardiovascular events and treatment procedures. Adherence to these medications, however, is very low.

Am J Health Promot.

Jul 15, 2016
A Randomized Trial of Social Comparison Feedback and Financial Incentives to Increase Physical Activity

Mitesh S. Patel, MD, MBA, MS, Kevin G. Volpp, MD, PhD, Roy Rosin, MBA, Scarlett L. Bellamy, ScD, Dylan S. Small, PhD, Michele A. Fletcher, CPA, Rosemary Osman-Koss, BS, Jennifer L. Brady, MA, RD, LDN, Nancy Haff, MD, Samantha M. Lee, BSE, Lisa Wesby, MS, Karen Hoffer, BS, David Shuttleworth, MS, Devon H. Taylor, BS, Victoria Hilbert, MPH, RD, Jingsan Zhu, MBA, MS, Lin Yang, MS, Xingmei Wang, MS, David A. Asch, MD, MBA

Social comparison to the 50th percentile with financial incentives was most effective for increasing physical activity.


Jul 15, 2016
Individual Versus Team-Based Financial Incentives to Increase Physical Activity: A Randomized, Controlled Trial

Mitesh S. Patel, David A. Asch, Roy Rosin, Dylan S. Small, Scarlett L. Bellamy, Kimberly Eberbach, Karen J. Walters, Nancy Haff, Samantha M. Lee, Lisa Wesby, Karen Hoffer, David Shuttleworth, Devon H. Taylor, Victoria Hilbert, Jingsan Zhu, Lin Yang, Xingmei Wang, Kevin G. Volpp

Financial incentives rewarded for a combination of individual and team performance were most effective for increasing physical activity.

Am J Health Promot.

Jul 1, 2016
A Randomized Controlled Trial of Employer Matching of Employees? Monetary Contributions to Deposit Contracts to Promote Weight Loss

Jeffrey T. Kullgren, MD, MS, MPH, Andrea B. Troxel, ScD, George Loewenstein, PhD, Laurie A. Norton, MA, Dana Gatto, BS, Yuanyuan Tao, MS, Jingsan Zhu, MS, MBA, Heather Schofield, MS, PhD, Judy A. Shea, PhD, David A. Asch, MD, MBA, Thomas Pellathy, PhD, Jay Driggers, MBA, Kevin G. Volpp, MD, PhD

Participation in deposit contracts to promote weight loss was low, and matching deposits did not increase participation. For deposit contracts to impact population health, ongoing participation will need to be higher.

Ann Intern Med.

Apr 1, 2016
Two Randomized Controlled Pilot Trials of Social Forces to Improve Statin Adherence among Patients with Diabetes

Peter P. Reese, Judd B. Kessler, Jalpa A. Doshi, Joelle Friedman, Adam S. Mussell, Caroline Carney, Jingsan Zhu, Wenli Wang, Andrea Troxel, Peinie Young, Victor Lawnicki, Swapnil Rajpathak, Kevin Volpp

Medication nonadherence is an important obstacle to cardiovascular disease management.

J Health Econ

Jan 15, 2016
Habit formation in children: Evidence from incentives for healthy eating.

Loewenstein G, Price J, Volpp K

Over a 3- or 5-week period, students received an incentive for eating a serving of fruits or vegetables during lunch. Relative to an average baseline rate of 39%, providing small incentives doubled the fraction of children eating at least one serving of fruits or vegetables. Two months after the end of the intervention, the consumption rate at schools remained 21% above baseline for the 3-week treatment and 44% above baseline for the 5-week treatment. These findings indicate that short-run incentives can produce changes in behavior that persist after incentives are removed.

Am J Respir Crit Care Med

Jan 15, 2016
Heterogeneity in the Effects of Reward- and Deposit-based Financial Incentives on Smoking Cessation

Scott D. Halpern, Benjamin French, Dylan S. Small, Kathryn Saulsgiver, Michael O. Harhay, Janet Audrain-McGovern, George Loewenstein, David A. Asch, and Kevin G. Volpp

Heterogeneity among smokers in their acceptance and response to different forms of incentives suggests potential benefits of targeting behavior-change interventions based on patient characteristics.

Hlth Aff

Jan 15, 2016
Premium-Based Financial Incentives Did Not Promote Workplace Weight Loss In A 2013–15 Study

Mitesh S. Patel, David A. Asch, Andrea B. Troxel, Michele Fletcher, Rosemary Osman-Koss, Jennifer Brady, Lisa Wesby, Victoria Hilbert, Jingsan Zhu, Wenli Wang, and Kevin G. Volpp

The apparent failure of the incentives to promote weight loss suggests that employers that encourage weight reduction through workplace wellness programs should test alternatives to the conventional premium adjustment approach by using alternative incentive designs, larger incentives, or both.

Health Aff

Jan 1, 2016
Premium-Based Financial Incentives Did Not Promote Workplace Weight Loss In A 2013-15 Study.

Mitesh S. Patel, David A. Asch, Andrea B. Troxel, Michele Fletcher, Rosemary Osman-Koss, Jennifer Brady, Lisa Wesby, Victoria Hilbert, Jingsan Zhu, Wenli Wang, and Kevin G. Volpp

The apparent failure of the incentives to promote weight loss suggests that employers that encourage weight reduction through workplace wellness programs should test alternatives to the conventional premium adjustment approach by using alternative incentive designs, larger incentives, or both.


Nov 10, 2015
Effect of Financial Incentives to Physicians, Patients, or Both on Lipid Levels

David A. Asch, MD; Andrea B. Troxel, ScD; Walter F. Stewart, PhD, MPH; Thomas D. Sequist, MD, MPH; James B. Jones, PhD; AnneMarie G. Hirsch, PhD, MPH; Karen Hoffer, BS; Jingsan Zhu, MBA; Wenli Wang, MS; Amanda Hodlofski, MPH; Antonette B. Frasch, MD; Mark G. Weiner, MD; Darra D. Finnerty, BS; Meredith B. Rosenthal, PhD; Kelsey Gangemi, MPH; Kevin G. Volpp, MD, PhD

In primary care practices, shared financial incentives for physicians and patients, but not incentives to physicians or patients alone, resulted in a statistically significant difference in reduction of LDL-C levels at 12 months. This reduction was modest, however, and further information is needed to understand whether this approach represents good value

Am J Health Promot.

Oct 31, 2015
Stages of Change and Patient Activation Measure Scores in the Context of Incentive-Based Health Interventions

Becker NV, Asch DA, Kullgren JT, Bellamy SL, Sen AP, Volpp KG.

To determine if two widely used behavioral change measures-Stages of Change (SoC) and Patient Activation Measure (PAM)-correlate with each other, are affected by financial incentives, or predict positive outcomes in the context of incentive-based health interventions.

Ann Allergy Asthma Immunol

Sep 1, 2015
A behavioral economics intervention to encourage epinephrine- carrying among food-allergic adults: a randomized controlled trial

Carolyn C. Cannuscio, ScD, Roxanne Dupuis, MSPH, Amy Graves, BA, Jane W. Seymour, MPH, Sarah Kounaves, MSc, Emily Strupp, BA, Damien Leri, MSEd, Rosemary Frasso, PhD, David Grande, MD, Zachary F. Meisel, MD

Adolescents and young adults with food allergies are at increased risk of adverse events, including death from anaphylaxis. Epinephrine is the cornerstone of emergency response, yet few individuals with serious food allergies consistently carry their emergency medication. A mixed-methods randomized controlled trial in young adults with food allergies investigated the carrying of epinephrine auto-injectors using financial incentives plus text message reminders vs text message reminders alone. Epinephrine carriage was assessed 10 times during the 49-day intervention using rapid-reply cell phone photographs plus daily code words. Although the intervention and control groups reported favorable impressions of text message-based reminder systems, the intervention group performed significantly better than the control group on a photograph-based measurement of epinephrine carriage.


Aug 1, 2015
Web-Based Access to Positive Airway Pressure Usage with or without an Initial Financial Incentive Improves Treatment Use in Patients with Obstructive Sleep Apnea

Samuel T. Kuna, MD; David Shuttleworth Luqi Chi, MD; Sharon Schutte-Rodin, MD; Eliot Friedman, MD; Hengyi Guo; Sandeep Dhand, MD; Lin Yang, MS; Jingsan Zhu, MS, MBA; Scarlett L. Bellamy, ScD; Kevin G. Volpp, MD, PhD; David A. Asch, MD, MBA

Positive airway pressure adherence is significantly improved by giving patients Web access to information about their use of the treatment. Inclusion of a financial incentive in the first week had no additive effect in improving adherence.

Am J Health Promot.

Jun 15, 2015
The role of behavioral economic incentive design and demographic characteristics in financial incentive-based approaches to changing health behaviors: a meta-analysis.

Haff N, Patel MS, Lim R, Zhu J, Troxel AB, Asch DA, Volpp KG.

Financial incentives designed using concepts from behavioral economics were effective for promoting health behavior change. There were no large and consistent relationships between the effectiveness of financial incentives and observable demographic characteristics. Second-order examinations of incentive structure suggest potential relationships among the effectiveness of financial incentives, incentive structure, and the demographic characteristics of race and income.

N Engl J Med

May 28, 2015
Randomized Trial of Four Financial-Incentive Programs for Smoking Cessation

Scott D. Halpern, M.D., Ph.D., Benjamin French, Ph.D., Dylan S. Small, Ph.D., Kathryn Saulsgiver, Ph.D., Michael O. Harhay, M.P.H., Janet Audrain-McGovern, Ph.D., George Loewenstein, Ph.D., Troyen A. Brennan, M.D., J.D., David A. Asch, M.D., M.B.A., and Kevin G. Volpp, M.D., Ph.D.

Reward-based programs were much more commonly accepted than deposit-based programs, leading to higher rates of sustained abstinence from smoking. Group-oriented incentive programs were no more effective than individual-oriented programs

Am J Health Promot

May 1, 2015
The Role of Behavioral Economic Incentive Design and Demographic Characteristics in Financial Incentive-Based Approaches to Changing Health Behaviors: A Meta-Analysis

Haff N, Patel MS, Lim R, Zhu J, Troxel AB, Asch DA, Volpp KG.

Evaluate the use of behavioral economics to design financial incentives to promote health behavior change and to explore associations with demographic characteristics


Feb 10, 2015
Accuracy of Smartphone Applications and Wearable Devices for Tracking Physical Activity Data

Meredith A. Case, BA; Holland A. Burwick; Kevin G. Volpp, MD, PhD; Mitesh S. Patel, MD, MBA, MS

Many smartphone applications and wearable devices were accurate for tracking step counts. Data from smartphones were only slightly different than observed step counts, but could be higher or lower. Wearable devices differed more and 1 device reported step counts more than 20% lower than observed. Step counts are often used to derive other measures of physical activity, such as distance or calories burned. Underlying differences in device accuracy may be compounded in these measures.


Feb 10, 2015
Accuracy of Smartphone Applications and Wearable Devices for Tracking Physical Activity Data

Meredith A. Case, BA; Holland A. Burwick; Kevin G. Volpp, MD, PhD; Mitesh S. Patel, MD, MBA, MS

The objective of this study was to evaluate the accuracy of smartphone applications and wearable devices compared with direct observation of step counts, a metric successfully used in interventions to improve clinical outcomes.


Feb 3, 2015
Wearable Devices as Facilitators, Not Drivers, of Health Behavior Change

Mitesh S. Patel, MD, MBA, MS; David A. Asch, MD, MBA; Kevin G. Volpp, MD, PhD

The notion is that by recording and reporting information about behaviors such as physical activity or sleep patterns, these devices can educate and motivate individuals toward better habits and better health. The gap between recording information and changing behavior is substantial, however, and while these devices are increasing in popularity, little evidence suggests that they are bridging that gap.

Health Educ Behav.

Oct 1, 2014
A Mixed Methods Randomized Controlled Trial of Financial Incentives and Peer Networks to Promote Walking among Older Adults

Jeffrey T. Kullgren, MD, MS, MPH, Kristin A. Harkins, BA,d Scarlett L. Bellamy, ScD, Amy Gonzales, PhD, Yuanyuan Tao, MS, Jingsan Zhu, MS, MBA, Kevin G. Volpp, MD, PhD, David A. Asch, MD, MBA, Michele Heisler, MD, MPA, and Jason Karlawish, MD

Financial incentives and peer networks could be delivered through eHealth technologies to encourage older adults to walk more.

J Gen Intern Med

Feb 13, 2014
Financial Incentives for Home-Based Health Monitoring: A Randomized Controlled Trial

Aditi P. Sen, Taylor B. Sewell, E. Brooks Riley, Beth Stearman, Scarlett L. Bellamy, Michelle F. Hu, Yuanyuan Tao, Jingsan Zhu, James D. Park, George Loewenstein, David A. Asch, Kevin G. Volpp

Home wireless device monitoring could play an important role in improving the health of patients with poorly controlled chronic diseases, but daily engagement rates among these patients may be low.

Ann Intern Med

Apr 2, 2013
Individual vs. Group-Based Incentives for Weight Loss: A Randomized, Controlled Trial

Jeffrey T. Kullgren, MD, MS, MPH, Andrea B. Troxel, ScD, George Loewenstein, PhD, David A. Asch, MD, MBA, Laurie A. Norton, MA, Lisa Wesby, MS, Yuanyuan Tao, MS, Jingsan Zhu, MS, MBA, and Kevin G. Volpp, MD, PhD

Test the effectiveness of two financial incentive designs for promoting weight loss among obese employees


Jul 15, 2012
On the Way to Health

David A. Asch, MD, Kevin G. Volpp, MD, PhD

This Issue Brief describes the development and use of a new web-based IT platform, Way to Health, to deliver and evaluate behavioral interventions to improve health.


Jul 5, 2012
Automated Hovering in Health Care — Watching Over the 5000 Hours

David A. Asch, M.D., M.B.A., Ralph W. Muller, M.A., and Kevin G. Volpp, M.D., Ph.D.

Even patients with chronic illness might spend only a few hours a year with a doctor or nurse, but they spend 5000 waking hours each year engaged in everything else — including deciding whether to take prescribed medications or follow other medical advice, deciding what to eat and drink and whether to smoke, and making other choices about activities that can profoundly affect their health.

Am J Health Promot.

Apr 15, 2012
Effectiveness of Financial Incentives for Longer-Term Smoking Cessation: Evidence of Absence or Absence of Evidence?

Andrea B. Troxel, ScD and Kevin G. Volpp, MD, PhD

This study highlights that in the context of smoking cessation we have much to learn about the effectiveness of incentives; what is clear is that the current literature provides inadequate evidence to make a determination. More adequately powered studies that test variations in incentive design, magnitude, and payment schedule are needed to determine the effectiveness of this approach in increasing the rate of smoking cessation.

Ann Intern Med

Mar 1, 2012
Peer Mentoring and Financial Incentives to Improve Glucose Control in African American Veterans: A Randomized, Controlled Trial

Judith A. Long, MD, Erica C. Jahnle, BA, Diane M. Richardson, PhD, George Loewenstein, PhD, and Kevin G. Volpp, MD, PhD

Compared to whites, African Americans have a greater incidence of diabetes, decreased control, and higher rates of micro-vascular complications. A peer mentorship model could be a scalable approach to improving control in this population and reducing disparities in diabetic outcomes.

Ann Intern Med.

Mar 1, 2012
Peer Mentoring and Financial Incentives to Improve Glucose Control in African American Veterans: A Randomized, Controlled Trial

Judith A. Long, MD, Erica C. Jahnle, BA, Diane M. Richardson, PhD, George Loewenstein, PhD, and Kevin G. Volpp, MD, PhD

The objective of this study was to determine whether peer mentors or financial incentives are superior to usual care in helping African American Veterans improve their glycosylated hemoglobin (HbA1c) levels which was validated.


Jan 15, 2012
Commitment contracts as a way to health

Scott D Halpern, David A Asch, Kevin G Volpp

In summary, there is great conceptual strength to the idea that commitment contracts can provide a way to health for the millions of people struggling to modify health behaviours that they themselves recognise as harmful. However, before they are implemented we need a careful assessment of key design features.


Feb 12, 2009
A Randomized, Controlled Trial of Financial Incentives for Smoking Cessation

Kevin G. Volpp, M.D., Ph.D., Andrea B. Troxel, Sc.D., Mark V. Pauly, Ph.D., Henry A. Glick, Ph.D., Andrea Puig, B.A., David A. Asch, M.D., M.B.A., Robert Galvin, M.D., M.B.A., Jingsan Zhu, M.B.A., Fei Wan, M.S., Jill DeGuzman, B.S., Elizabeth Corbett, M.L.S., Janet Weiner, M.P.H., and Janet Audrain-McGovern, Ph.D.

In this study of employees of one large company, financial incentives for smoking cessation significantly increased the rates of smoking cessation.

BMC Hlth Srv Res

Mar 14, 2008
A test of financial incentives to improve warfarin adherence

Kevin G Volpp, George Loewenstein, Andrea B Troxel, Jalpa Doshi, Maureen Price, Mitchell Laskin and Stephen E Kimmel

A daily lottery-based financial incentive demonstrated the potential for significant improvements in missed doses of warfarin and time out of INR range.