The Nursing Care for Substance Use Disorder study explores whether in-person, patient first language training sessions at Penn nursing units and/or weekly educational text messaging affect nurses' attitudes towards patients with substance use disorder. Nurses complete a survey before and after receiving the 6-month intervention to measure changes in attitudes.

This study employs gamification to increase physical activity among Black and Hispanic breast and prostate cancer survivors across three sites: Penn Medicine, City of Hope and Montefiore.

Mental health needs were disproportionately high among health care workers (HCWs) before the COVID-19 pandemic. However, the rapid spread of the disease forced providers to grapple with additional stressors, including longer shifts, shortages of personal protective equipment, increased mortality and morbidity, and isolation. Cobalt is a platform that was developed at Penn Medicine to assist with this challenge. The goal of this research program is to assess the impact of and perhaps increase engagement with the COBALT platform by sending surveys and nudges to create appointments. Based on responses to surveys, employees will get a different nudge depending on PHQ and GAD scores.

The coronaVirus Impact on Birth Equity in the 4th trimester study explores the impact of COVID on birth outcomes. The program involves 10 days of twice daily postpartum BP monitoring followed by twice weekly BP monitoring and weekly weight collection. Participants at Penn and Mt. Sinai locations are enrolled into a high or low risk arm, each with its own unique BP algorithm and escalation pathway.

This study is an open label trial of secukinumab to treat nail psoriasis utilizing W2H to administer patient and provider surveys, collect nail photos, and coordinate study data.

This is the next generation of the Coloprep program. Based on learnings from prior iteration, the program has been updated to include bi-directional text messaging to help answer patient questions. The goal remains the same - improve colonoscopy show-rates and increase adherence to prep required. This update also includes integration to Epic which allows the program to automatically text patients based on their upcoming appointment. The integration also takes into account appointment reschedules and cancellations.

The BRIDGE program texts prediabetic women postpartum to educate them about their risk and motivate them to follow up with PCP to check their HbgA1C.

RCT to motivate patients with anxiety to complete cognitive behavioral therapy (CBT) sessions twice weekly at home via a web app. The study arms use gamification, gamification with social support, and gamification with loss aversion to motivate CBT participation.

HSM WUSTL is a research program exploring the use of HSM at their location. Mothers with preeclampsia receive twice daily blood pressure check-ins through text message for 10 days after delivery. Blood pressure are categorized and escalations are sent to care teams for high/low readings. This program asks participants to complete an end of program survey to provide feedback on the program and the care they received while participating. See more here: https://www.pennmedicine.org/for-patients-and-visitors/find-a-program-or-service/obstetrics/heart-safe-motherhood .

The Nursing Care for Substance Use Disorder study explores whether in-person, patient first language training sessions at Penn nursing units and/or weekly educational text messaging affect nurses' attitudes towards patients with substance use disorder. Nurses complete a survey before and after receiving the 6-month intervention to measure changes in attitudes.

SMART-HABITS is a crossover trial exploring the use of mHealth to improve self-management among pre-chronic kidney disease (CKD) patients. All participants receive FitBit step count monitoring with reminders. Half of the participants start with blood pressure monitoring using an Omron blood pressure cuff and crossover to texting in their blood pressures, and half do the opposite. Additionally, all participants receive educational messaging and information about social support resources.

This program screens patients through text to see if they are eligible and interested in scheduling their upcoming spondyloarthritis appointment via telemedicine.

Oncology patients spend a large proportion of their time attending in person clinical appointments. In TIME, a text-based intervention to minimize the time burden of routine clinical care, participants complete e-triage by text message. If cleared, they need not attend an office visit prior to their infusion appointment, reducing their travel time and number of in person appointments.

The intent of this study is to further explore the effect of collaboration and charity on increasing physical activity within families. The study specifically intends to test two interventions: 1) Gamification - using points to move participants up and down levels based on activity tracked through a Fitbit device, 2) Charity - using points to donate money to charity each week. Teams (cohorts) are created based on family members and the goal is to increase family physical activity.

Directional trial to explore effectiveness of gamification to improve physical activity in Alzheimers patients. The project will be using points to move participants up and down levels (such as silver and bronze). Participants will be enrolled remotely or in-person.

The Symptom Assessment Management program captures patient-reported outcomes (PROs) to understand how IV or Oral chemotherpay treatments impact the patient's quality of life (QOL). The program's extensive PRO algorithm was developed based on PRO-CTCAE grading and severity. Patients receive the PRO survey over text after their first treatment appointment multiple times over a 2-6 months to guage the impact on their QOL. This in turn can drive clinical decisions.

The intent of this project is to create a texting algorithm that will support post-operative calls with gyn-oncology patients. Enabling texting communication that would filter the acuity, and would allow over-burdened nursing staff to triage the patients in a more timely way, while still connecting with all of the patients post-operatively. If deployed, we see the scaling across the remainder of our surgical sub-specialties as a possibility.

The intent of this clinical trial is to explore ways to improve the quality and number of serious illness conversations (SICs) with patients with a certain mortality risk or a documented Stage IV diagnosis. The nudges include pre-appointment reminders and a text based survey to both prime the conversation and also gather some of the patient's goals to better inform the upcoming appointment. Patient responses are collected and sent to the appropriate provider's in-basket.

The intent of this study is to explore ways in which drivers could be incentivized to reduce mobile phone usage while driving. The goal being to reduce distracted driving related accidents. The study called for a partnership with Progressive Insurance and integration with its mobile application (managed by TrueMotion) to collect usage information. Multiple techniques such as possible insurance discounts, delivery of a phone mount, pre-commitment pledges, informational reminders, peer comparisons / leaderboards were used and are being evaluated. Initial results seem to indicate at least a couple of those techniques had success during the program and also during the follow-up period.

The intent is to pilot test texting ~150-200 Black patients discharged from the downtown EDs to ask about their experiences with race and equity via short surveys. This is a small, one time pilot to help inform future equity clinical work and research grants.

Healthy Lungs is a PCORI-funded program that aims to improve lung health through a variety of techniques. Participants chosen as a good fit for this program receive free/ low cost tools to improve the health of their lungs and can even earn money. Eligible participants will have been referred for lung cancer screening from four health systems: Penn Medicine (including Lancaster General Health), Geisinger Health System, Kaiser Permanente of Southern California, and Henry Ford Health System. Question about this program should be directed to: [email protected].

The intent of this program being run out of Michigan State University is to improve diabetic patients’ adherence to treatment and thus, increase prevention of cardiovascular disease. A comprehensive series of educational text messages are used to engage patients in their care.

18 week, 2 arm RCT to test ways to promote intermittent fasting among patients who are overweight with high BP. Patients will receive a BP cuff and scale, without integration. Patients will receive daily texts asking if they've fasted for 16 hours, and weekly texts asking for weight and BP

This program monitors pain management and opioid prescriptions for patients after surgery at Penn Medicine. This is a replacement for an existing program with an external vendor. The program implemented on Way to Health eliminates almost all of the manual work requires to run the program. It also adds bi-directional texting conversations with patients post-discharge to gather additional data from patients.

This study will use a randomized, controlled superiority trial to evaluate a hospital-wide initiative to improve counseling for postpartum women who experienced hypertension during their pregnancy or in the immediate postpartum period.

The intent of this study is to help increase the number of serious illness conversations (SICs) and also improve their quality. The program intends to use Fitbits to track physical activity and gather PRO data from cancer patients. The data will be used to create patient specific dashboards that clinicians will use to address the study goals.

The estimated 84 million US adults with prediabetes can significantly reduce their risk of developing type 2 diabetes mellitus (T2DM) by engaging in a Diabetes Prevention Program (DPP) or using metformin. Although these evidence-based clinical preventive services are widely available, very few patients with prediabetes are currently using them. There is thus a critical need to identify ways to increase engagement of patients with prediabetes in strategies to prevent or delay their progression to T2DM. The intent is to try various techniques such as financial incentives (lotteries), self-determination theory (SDT) and tailored messaging to see what works best versus control.

Test the effectiveness of text-based recruitment strategies to increase participation across four R01 funded research trials targeting hard to reach populations such as smokers and people living with HIV.

Text intervention prompting and monitoring participants to share their social media posts and information with their therapists during their scheduled appointments.

To evaluate the effectiveness of behavioral economic approaches to increase patient mobility and reduce mobility disability and postoperative complications.

Implement a novel intervention using mobile technology and social incentives to increase physical activity for women with preeclampsia or gestational hypertension.

Looking at improving mobility in the inpatient setting specifically through goal setting and gamification.

The broad objective of this study is to develop and test a digital health intervention using a behavioral economics framework to increase the amount of time people spend in nature.

Randomized crossover trial of different types of intra-articular injections and financial incentives will also be used to promote adherence to the completion of the patient-reported outcomes.

Test the effectiveness of remote monitoring, automated reminders, performance feedback and incentives among children with asthma.

The overall goal of this study is to test if behavioral economic approaches will reduce apathy, and subsequently, improve goal-directed behavior in Parkinson’s disease.

Design a scalable model for capturing patient level data to develop, implement, and evaluate EMR defaults to “right-size” opioid prescribing for acute painful episodes and routine surgical procedures.

Test the effectiveness of remote monitoring of glucose plus lottery financial incentives among low-income patients suffering from diabetes.

This pilot will answer questions important to the feasibility of conducting a well-powered randomized controlled trial to improve adherence among African American HIV patients within the US who have suboptimal adherence using CVS and Aetna claims data to identify such patients, CVS/Aetna communications channels to enroll them, and incentives to achieve high levels of ongoing participation.

Testing how financial incentives and gamification can improve moderate-to-vigorous physical activity.

Pilot grant to test feasibility of incentivizing various behaviors and outcomes associated with gestational weight gain.

Testing a 2x2x2x2x2 factorial design to optimize components for a sleep extension intervention for children.

Test the effectiveness of a mobile app to replace in person therapy sessions and to track physical health through an activity tracker among depressed adults older than 50 years.

Test the effectiveness of a mindfulness app among youth 13-22 years old. This will be a three arm trial leveraging gamification and supportive social incentives approaches.

A simple observational study with a very small group of VA patients with Parkinsons (30 odd). Patients will register their fitbits and collect movement and MVPA data over 2 weeks. Intent is to figure out if this patient population would actually use it and if the data provides any insight.

Investigate how social supports, automated alerts, and their combination improve medication adherence.

Randomized crossover trial of different types of intra-articular injections in osteoarthritic patients. Monitor physical activity and patient-reported outcomes over 3 months after each injection. Financial incentives will also be used to promote adherence to the completion of the patient-reported outcomes.

Test the effectiveness of a pledge system and nudge messaging to purchase naloxone within one week of training. Population is staff and patrons of Free Library of Phila.

SMS Conversations intervention, assessing participants use of medication, pain and other symptoms via survey. 3 arms have been designed - control, intervention and intervention plus incentive. Deployed at the VA for opioid patients.

Assessing long-term recovery and potential for connection with trauma patients after injury through Survey administration, bi-directional texts, and sleep tracking (Fitbits). We propose to conduct pilot research for a remote monitoring intervention to improve long- term injury recovery.

A multi-site, RCT that will evaluate the effectiveness of trained pre-med post-baccalaureate health coaches in chronic disease management. Our primary outcomes are changes in weight, physical activity, dietary choices, and patient engagement throughout the 16-week intervention. In our proof of concept (n=22), participants increased their physical activity by an average of 60 minutes per week, responded to 70% of messages, and lost 4.6% their bodyweight over 16 weeks.

The purpose of this study is to determine how goal-setting in the context of gamification affects habit formation for physical activity among participants who are overweight or obese. We plan to use the gamification features of the Way to Health platform and the step tracking feature of to test the impact of two separate goal-setting features including 1. actively choosing a step goal versus being assigned a step goal and 2. being asked to immediately meet that goal versus being asked to make incremental changes towards that goal over an 8 week period.

As part of this project, we will be using the Way to Health platform to send/receive text messages to adolescents and will be using financial incentives.

Compares different methods of data collection from wearable devices to develop enhanced risk prediction models for changes in glycemic control among pre-diabetic adults.

Test effectiveness of social incentive-based gamification intervention to increase physical activity among overweight and obese veterans. VA funding Withings device BMI stratification participation incentives only potentially 4 week ramp Arms: 1. Control- just device (60) 2. Supportive social incentive (60) 3. Supportive social incentive + $ (60)

Randomized crossover trial of different types of intra-articular injections (population: osteoarthritis at the VA). W2H to be used to monitor physical activity (activity monitors) and patient-reported outcomes over the 3 months after each injection. Financial incentives will also be used to promote adherence to the completion of the patient-reported outcomes.

Adolescents will be randomized to 1 of 3 financial incentive groups: (1) reward-based, with each adolescent receiving incremental $15-45 payments submitted into a virtual account when program benchmarks for the Quitline are achieved (maximum $150); (2) loss-framed, with $150 deposited into a virtual account, with $15-45 losses deducted from the account for each benchmark not achieved, with withdrawal only allowed at the end of the study; and (3) no financial incentive. The Quitline is funded by the Pennsylvania Department of Health and staffed by trained cessation counselors available 24 hours a day, 7 days a week.

Use Way to Health to track and promote longer sleeping habits among adolescents. Interested in using social normatives on top of loss framed incentives. 4 arms- control, normative feedback (team), loss framed incentive, loss + normative $50 incentive text messages and sleep hygiene tips

Use Way to Health to track step counts, heart rate and intensity in patients with cardiovascular disease. Wants to build this remote monitoring into clinical practice. Fitbit Charge 2- low, moderate, vigorous activity Goals and targets Text feedback

Collecting and studying the impact of patient reported outcomes on satisfaction and survivorship. Targeted at patients with advanced non-small cell lung cancer initiating chemotherapy, includes symptom assessment and provider alerts

Studying the impact of activity on breast cancer patients. Incentives and gamification techniques are also being tested.

Complex study focused on reducing occurrence of kidney stones via hydration. Study includes devices, incentives, choose your own path and multiple other models.

Larger trial building on Livebetter Phase 1. Focused on automated hovering of cirrhosis and liver transplant patients

Intent of the trial is to assist depressed adults with primary care treatment. W2H is used to automate the trial with respect to randomization, measurement of medication adherence via electronic pill bottle, and distribution of financial incentives to patients.

Test effectiveness of reminders and recovery tips in reducing readmissions following Gynecologic Oncology surgery.

Use W2H to track mobility and examine how it relates to nurse mobility assessment scores; W2H would be used to passively collect data via wearable. Partnered with Scott Halpern for testing $ in enrollment - now looking at cancer patients as well- recruiting from Cancer floors - enrollment incentives Control- mobility assessment Intervention- told mobility score and mobility assessment 1 daily feedback message Target for intervention arm participants: Participants in the intervention arm will have a weekly step goal that increases from baseline by 10% each week of the intervention (12 weeks) with a maximum of 10,000 steps

The purpose of this study is to assess the acceptability of the W2H patient portal in patients seeking AD treatment. The W2H portal will include data from the following: PH indices from the Withings health monitor and nursing assessments, responses to electronic momentary assessment (eMA) text messaging prompts, self-report and clinician-interview AD symptom ratings, and cognitive/psychophysiological assessments.

The proposed pilot program will develop a bidirectional W2H SMS medication adherence platform to tailor patient specific medication reminders and medication assistance inquiries. 50 patients with a diagnosis of depression and anxiety prescribed ≥1 medication for that disorder (i.e. the intervention group) will be enrolled. Using propensity score matching, study patients will be matched.

Leverage the W2H platform to develop and evaluate a new hypertension service-delivery model that is integrated with routine clinical care at Penn Family Care (PFC), an academic family medicine practice in West Philadelphia. Among patients with poorly controlled HTN, we will assess the effects of monitoring blood pressure and medication adherence with feedback to the patient and to the clinical practice, as needed if out of control. We will also compare the impact of providing feedback to a social support partner with what we call facilitated cheer leading.

Test effectiveness of reminders and recovery tips in reducing readmissions following Orthopaedic surgery.

Compare the efficacy of two 6-month mhealth-based interventions to promote treatment adherence among young adults post kidney transplant or spinal bifida.

Test effectiveness of weekly check ins and appt reminders in reducing over utilization of healthcare services

Participants receive a smartphone breathalyzer to provide feedback on their estimated blood alcohol level. The intervention compares loss- and gain-framed messages that make the consequences of drinking and driving more salient to standard messages not to drink and drive.

Use W2H to develop a protocol to efficiently recruit and enroll pediatric and adult concussion patients from the ED, and monitor and integrate their data in real time daily. The primary outcome is the mean proportion of participant days that the 2000-step goal was achieved for each group for each day of the study.

Intent of the study is to increase physical activity to decrease post-operative morbidity for radical cystectomy patients

The primary goal of this pilot study will be to determine whether one incentive (loss aversion) is better than no incentive in increasing step counts and maintaining an increased level of physical activity among RA patients. The primary outcome will be percent of days meeting goal during the intervention period.

Test effectiveness of reminders and recovery tips in reducing readmissions following colorectal surgery.

Test effectiveness of automated hovering of scale and medication adherence with daily lotteries to improve outcomes for UPHS CHF patients. The goal of the proposed project is to conduct a pragmatic randomized controlled trial testing a new approach to chronic disease management combining wireless monitoring devices and behavioral economic engagement incentives to reduce rehospitalization rates among patients with Congestive Heart Failure (CHF) recently hospitalized at the University of Pennsylvania Health System (UPHS).

Test effectiveness of improving cholesterol levels among participants who are at high risk of CVD and who have elevated LDL cholesterol levels by testing process versus outcomes financial incentives. The primary outcome will be change in LDL cholesterol over 12 months. Last day of intervention is 4/14/2018. End of follow up period is 10/11/2018.