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CDA 15-065 – HSR&D Study

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CDA 15-065
Evaluating Connected Health Approaches to Improving the Health of Veterans
Mitesh S. Patel MD MBA MS
Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA
Philadelphia, PA
Funding Period: October 2016 - September 2020

BACKGROUND/RATIONALE:
Cardiovascular disease is the leading cause of hospitalization, morbidity, and mortality among veterans. Many of the contributing risk factors are health behaviors that occur outside of the health care system and within their everyday lives of veterans such as physical activity, obesity, smoking, and medication adherence. Connected health is a model for using mobile technologies to remotely monitor health outcomes and deploy interventions to change behavior. While connected health devices may help to facilitate the monitoring of behaviors within veterans' everyday lives, they alone may not drive behavior change toward improved health. Insights from behavioral economics can help to design engagements strategies around connected health devices that leverage the fact the individuals tend to be more present-biased, put undue weight on small probabilities, and are heavily influenced by emotions such as regret and loss aversion. The Veterans Health Administration (VHA) is a leader in pioneering connected health technologies to improve the care and health of veterans as exemplified by the VA Center for Connected Health. However, little is known about veterans' experiences and outcomes with these technologies. Without the appropriate design, veterans' use of connected health devices may be subject to multiple challenges and potentially unintended consequences. Given VHA's significant investment in these technologies, the potentially significant impact on veterans nationally, and the alignment with the VHA's Blueprint for Excellence, it is imperative that these approaches are rigorously tested


OBJECTIVE(S):
To address these issues, I will aim to focus on following research objectives: 1) Understand veterans' perspectives of needs, barriers, and opportunities with connected health devices; 2) Evaluate veteran's experiences with Way to Health, a technology platform already being used at the CMCVAMC in Philadelphia to integrate connected health devices and enable automated deployment of behavioral economic interventions; 3) Use Way to Health to test social and financial incentive-based connected health approaches to increase physical activity among veterans to inform an investigator-initiated research proposal.

METHODS:
My first study will use a mixed-methods approach to identify veterans' experiences with mobile and connected health technologies, conduct an 8-week pilot using a connected device for physical activity, and conduct semi-structured interviews to evaluate experiences. These findings will inform my second study, a 20-week randomized clinical trial testing combinations of social and financial incentives to increase physical activity. This work will inform an investigator initiated research proposal for a larger, multisite clinical trial. Insights from this work will be applicable to other health behaviors such as those related to smoking, obesity, and medication adherence.

FINDINGS/RESULTS:
Not yet available.

IMPACT:
My pilot study is one of the first to evaluate veterans' perceptions and experience with connected health devices, specifically using wearable devices to increase physical activity. The findings demonstrate promise for using these technologies if they can be combined with effective behavior change strategies. These insights have informed the design of the clinical trial which will begin enrolling Veterans in early 2019.

PUBLICATIONS:

Journal Articles

  1. Patel MS, Navathe AS, Liao JM. Using Nudges to Improve Value by Increasing Imaging-Based Cancer Screening. Journal of the American College of Radiology : JACR. 2020 Jan 1; 17(1 Pt A):38-41.
  2. Patel MS, Small DS, Harrison JD, Fortunato MP, Oon AL, Rareshide CAL, Reh G, Szwartz G, Guszcza J, Steier D, Kalra P, Hilbert V. Effectiveness of Behaviorally Designed Gamification Interventions With Social Incentives for Increasing Physical Activity Among Overweight and Obese Adults Across the United States: The STEP UP Randomized Clinical Trial. JAMA internal medicine. 2019 Sep 9; 1-9.
  3. Evans CN, Volpp KG, Polsky D, Small DS, Kennedy EH, Karpink K, Djaraher R, Mansi N, Rareshide CAL, Patel MS. 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. Contemporary clinical trials. 2019 Aug 1; 83:53-56.
  4. Sharma S, Guttmann D, Small DS, Rareshide CAL, Jones J, Patel MS, Bekelman JE. Effect of Introducing a Default Order in the Electronic Medical Record on Unnecessary Daily Imaging During Palliative Radiotherapy for Adults With Cancer: A Stepped-Wedge Cluster Randomized Clinical Trial. JAMA oncology. 2019 Jun 27.
  5. Changolkar S, Rareshide CAL, Snider CK, Patel MS. Patient, Physician, and Environmental Predictors of Influenza Vaccination During Primary Care Visits. Journal of general internal medicine. 2020 Feb 1; 35(2):611-613.
  6. Hsiang EY, Mehta SJ, Small DS, Rareshide CAL, Snider CK, Day SC, Patel MS. Association of Primary Care Clinic Appointment Time With Clinician Ordering and Patient Completion of Breast and Colorectal Cancer Screening. JAMA Network Open. 2019 May 3; 2(5):e193403.
  7. Harrison JD, Jones JM, Small DS, Rareshide CAL, Szwartz G, Steier D, Guszcza J, Kalra P, Torio B, Reh G, Hilbert V, Patel MS. 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. Contemporary clinical trials. 2019 May 1; 80:55-60.
  8. Olshan D, Rareshide CAL, Patel MS. Longer-Term Durability of Using Default Options in the Electronic Health Record to Increase Generic Prescribing Rates. Journal of general internal medicine. 2019 Mar 1; 34(3):349-350.
  9. 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. Randomized evaluation of trial acceptability by INcentive (RETAIN): Study protocol for two embedded randomized controlled trials. Contemporary clinical trials. 2019 Jan 1; 76:1-8.
  10. Kim RH, Patel MS. Barriers and Opportunities for Using Wearable Devices to Increase Physical Activity Among Veterans: Pilot Study. JMIR formative research. 2018 Nov 6; 2(2):e10945.
  11. Kim RH, Day SC, Small DS, Snider CK, Rareshide CAL, Patel MS. Variations in Influenza Vaccination by Clinic Appointment Time and an Active Choice Intervention in the Electronic Health Record to Increase Influenza Vaccination. JAMA Network Open. 2018 Sep 7; 1(5):e181770.
  12. Kannan S, Asch DA, Kurtzman GW, Honeywell S, Day SC, Patel MS. Patient and physician predictors of hyperlipidemia screening and statin prescription. The American journal of managed care. 2018 Aug 1; 24(8):e241-e248.
  13. Cotton V, Patel MS. Gamification Use and Design in Popular Health and Fitness Mobile Applications. American Journal of Health Promotion : AJHP. 2019 Mar 1; 33(3):448-451.
  14. Kurtzman GW, Day SC, Small DS, Lynch M, Zhu J, Wang W, Rareshide CAL, Patel MS. Social Incentives and Gamification to Promote Weight Loss: The LOSE IT Randomized, Controlled Trial. Journal of general internal medicine. 2018 Oct 1; 33(10):1669-1675.
  15. Chokshi NP, Adusumalli S, Small DS, Morris A, Feingold J, Ha YP, Lynch MD, Rareshide CAL, 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. Journal of the American Heart Association. 2018 Jun 13; 7(12).
  16. Delgado MK, Shofer FS, Patel MS, Halpern S, Edwards C, Meisel ZF, Perrone J. Association between Electronic Medical Record Implementation of Default Opioid Prescription Quantities and Prescribing Behavior in Two Emergency Departments. Journal of general internal medicine. 2018 Apr 1; 33(4):409-411.
  17. 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. A Randomized, Controlled Trial of Lottery-Based Financial Incentives to Increase Physical Activity Among Overweight and Obese Adults. American Journal of Health Promotion : AJHP. 2018 Sep 1; 32(7):1568-1575.
  18. Wong CA, Miller VA, Murphy K, Small D, Ford CA, Willi SM, Feingold J, Morris A, Ha YP, 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 Dec 1; 171(12):1176-1183.
  19. 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 Nov 21; 167(10):755-757.
  20. 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 Nov 1; 177(11):1586-1593.
  21. Kurtzman G, Dine J, Epstein A, Gitelman Y, Leri D, Patel MS, Ryskina K. Internal Medicine Resident Engagement with a Laboratory Utilization Dashboard: Mixed Methods Study. Journal of hospital medicine. 2017 Sep 1; 12(9):743-746.
  22. Kurtzman GW, Keshav MA, Satish NP, Patel MS. Scheduling primary care appointments online: Differences in availability based on health insurance. Healthcare (Amsterdam, Netherlands). 2018 Sep 1; 6(3):186-190.
  23. 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 Jul 1; 177(7):939-945.
  24. Patel MS, Volpp KG, Small DS, Wynne C, Zhu J, Yang L, Honeywell S, Day SC. Using Active Choice Within the Electronic Health Record to Increase Influenza Vaccination Rates. Journal of general internal medicine. 2017 Jul 1; 32(7):790-795.
  25. Jayakumar KL, Larkin DJ, Ginzberg S, Patel MS. Personal Financial Literacy among US Medical Students. MedEdPublish. 2017 Feb 21; 6(1):doi.org/10.15694/mep.2017.000035.
  26. 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 (Amsterdam, Netherlands). 2016 Dec 1; 4(4):340-345.
  27. Sedrak MS, Patel MS, Ziemba JB, Murray D, Kim EJ, Dine CJ, Myers JS. Residents' self-report on why they order perceived unnecessary inpatient laboratory tests. Journal of hospital medicine. 2016 Dec 1; 11(12):869-872.
Journal Other

  1. Patel MS. CORR Insights®: Small Social Incentives Did Not Improve the Survey Response Rate of Patients Who Underwent Orthopaedic Surgery: A Randomized Trial. Clinical orthopaedics and related research. 2019 Jul 1; 477(7):1657-1658.
  2. Greysen SR, Patel MS. Why Mobility Matters in the Hospital. Annals of internal medicine. 2019 Mar 19; 170(6):429-430.
  3. Greysen SR, Patel MS. Web Exclusive. Annals for Hospitalists Inpatient Notes - Bedrest Is Toxic-Why Mobility Matters in the Hospital. Annals of internal medicine. 2018 Jul 17; 169(2):HO2-HO3.
  4. Patel MS, Volpp KG, Asch DA. Nudge Units to Improve the Delivery of Health Care. The New England journal of medicine. 2018 Jan 18; 378(3):214-216.
  5. Patel MS, Asch DA, Volpp KG. Framing Financial Incentives to Increase Physical Activity Among Overweight and Obese Adults. [Letter to the Editor]. Annals of internal medicine. 2016 Oct 18; 165(8):600.
Magazine/Popular Press Articles

  1. Patel MS, Robertson T. Getting to Optimal: Generic Drugs and Electronic Health Records (Guest Commentary). Forbes Magazine. 2016 Oct 25; 1-2.


DRA: Diabetes and Related Disorders
DRE: Technology Development and Assessment, Prevention, Treatment - Preclinical
Keywords: none
MeSH Terms: none

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