Using active choice and peer comparisons to increase statin prescription rates

Opportunity

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% of patients who meet evidence-based guidelines for statins have never been prescribed one.

Approach

We designed an innovative population health approach to increase statin prescriptions. We randomly selected primary care physicians (PCPs) to be in 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 that 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 how their statin prescribing rate compared to other peer physicians at Penn Medicine.

Impact

Over a two-month period, primary care physicians (PCPs) in the usual care arm prescribed statins for 2.6% of their patients.  PCPs in the arm receiving access to an active choice dashboard prescribed statins to 6.7% of their patients. The most effective arm was PCPs who received access to the active choice dashboard, and peer comparison feedback with 8.0% of their patients prescribed a statin (P <0.01). 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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