Using active choice and peer comparisons to increase statin prescription rates


Cardiovascular disease is the leading cause of morbidity and mortality in the United States. Statins are effective medications for reducing the risk of cardiovascular events. However, nearly 50 percent of patients who meet evidence-based guidelines for statins have never been prescribed one.


We designed an innovative population health approach to increase statin prescriptions. We randomly assigned primary care physicians (PCPs) to a control arm or one of two intervention arms. The PCPs in both intervention arms were given access to an active choice dashboard with lists of their patients who met guidelines for being on a statin but had not been prescribed one. They were also given a set of options and asked to decide whether or not to order a statin. In one of the intervention arms, PCPs also received peer comparison feedback on their statin prescribing rate compared to other peer physicians at Penn Medicine.


Over two months, PCPs in the control arm prescribed statins for 2.6 percent of their patients, while PCPs who had access to an active choice dashboard prescribed statins to 6.7 percent of their patients. The most effective arm was the one that provided PCPs with access to an active choice dashboard and peer comparison feedback, with 8.0 percent of patients receiving a statin prescription. Our findings demonstrate the potential of using insights from behavioral economics in highly automated systems to nudge physicians toward guideline-concordant prescribing.

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