Nudge Units to Improve the Delivery of Health Care

Abstract

The final common pathway for the application of nearly every advance in medicine is human behavior.No matter how effective a drug, how protective a vaccine, or how targeted a therapy may be, a clinician usually has to prescribe it, and a patient accept and use it as directed, for it to improve health.Clinicians' and patients' environments influence their decisions about taking these actions, and the seemingly subtle design of information and choices can have outsize effects on our behavior.When the "choice architecture" is designed to influence behavior in a predictable way but without restricting choice, it is often called a "nudge."Key information and important choices are constantly being presented in health care. 1 Consider the way in which a physician offers influenza vaccination, or the default settings in electronic health records (EHRs) for the duration of a new opioid prescription.Yet often, these frames or default options are selected haphazardly, without attention to shared goals of overcoming common barriers to vaccination or balancing pain relief against addiction risk.