Healthy Ideas Exchange

描述（由申请人提供） 翻译后摘要：贝克尔和梅曼写道：“病人的依从性已成为最好的记录，但最不了解，健康行为。”“最近的研究发现，美国大约一半的儿童和成人接受推荐的护理，在提高我们系统的护理质量方面还有很多工作要做。由于不遵守率为20- 30%，这意味着每年有超过1.8亿次医疗就诊，患者不遵守医疗建议。虽然许多干预措施试图提高依从率，但大约有一半失败了。传统的随机对照试验没有解决对依从性至关重要的动机问题;它们通过随机化过程均匀分布患者的动机水平。 对于该项目，我们建议创建一个名为“健康想法交换”的选择架构，该架构将使用智能手机和平板电脑通过网络实施（例如，iPad）。在交易所中，用户将选择挂钩，他们喜欢的东西，如玩视频游戏，并将其与奖励联系起来，当他们完成了所需的健康行为或坚持治疗方案时。我们将从游戏世界中吸取教训，这些教训对于吸引用户、在游戏中提供乐趣、保持客户或玩家忠诚度至关重要，然后将它们与期望的健康行为联系起来。如今，82%的成年人拥有移动终端;拥有移动的设备的人中有38%使用它们上网，34%的成年人在手机上玩游戏。少数民族的这一数字高于白人。从这种增加的流动性，钩可以提供在任何设置，而不必等待久坐的生活方式的发展。在交易所中，用户也将受到推动，这是选择架构的一个方面，它以可预测的方式改变人们的行为，而不会禁止任何选择或显著改变他们的经济激励。我们可以通过在选择和福利之间提供更好的映射来推动人们减肥，例如，”“史密斯先生，你在跑步机上跑步把一包胡萝卜烧焦了。随着旋转练习，你将燃烧总共5奥利奥饼干。“”交换中心将与国际移民组织的信念保持一致，即以病人为中心应该是我们医疗保健系统的核心，而不是外围的附加设施。短期内，我们将确定人们在交换中心使用的不同病人群体之间的挂钩（例如，按年龄、种族、社会经济地位、居住地点）来评估他们的偏好。我们还将监测人们在他们选择的钩子中停留多长时间，以及钩子和助推的哪些方面激励了他们。我们的健康结果将包括多少百分比的患者保持在目标体重范围内，持续多长时间，参与的患者中有多少比例的哮喘症状较少，以及有多少老年患者感觉不那么抑郁或改善了认知或身体功能。对于长期结果，我们将着眼于医疗保健系统的成本节约和这种创新的传播。 公共卫生相关性：“患者依从性已成为最好的记录，但最不了解，健康行为，”需要创新思维。在这个项目中，我们提议创建一个名为“健康创意交流”的选择架构，用户可以选择他们喜欢的挂钩（有奖励的游戏），并获得推动，以帮助激励他们改变行为。通过网络使用智能手机和平板电脑（例如，iPad），将与IOM的信念一致，即以病人为中心应该是我们医疗保健系统的核心，而不是外围附加物。

DESCRIPTION (Provided by the applicant) Abstract: Becker and Maiman wrote ""patient compliance has become the best documented, but least understood, health behavior."" Recent studies have found that about half of children and adults in the US receive recommended care, leaving much work to be done in improving the quality of care in our system. With a non-adherence rate of 20-30%, this represents over 180 million medical visits per year where patients are not following medical advice. While many interventions have tried to improve adherence rates, roughly half have failed. Traditional randomized control trials do not address the motivation issue so critical to adherence; they evenly distribute patients' motivation levels via the randomization process. For this project, we propose the creation of a choice architecture called the Healthy Ideas Exchange which will be implemented via the Web using Smartphones and tablets (e.g., iPad). In the Exchange, users will choose hooks, something they enjoy such as playing video games and link them to rewards when they accomplish a desired healthy behavior or adherence with a therapeutic regimen. We will draw lessons from the gaming world that are important to draw in users, provide enjoyment during play, and maintain customer or player loyalty, and then link them to desired health behaviors. Today, 82% of adults have a mobile device; 38% of those with mobile devices use them to go online, and 34% of adults play games on their cell phones. These numbers are higher for minorities than Whites. From this increased mobility, hooks can be offered in any setting without having to wait for a sedentary lifestyle to develop. In the Exchange, users will also be exposed to nudges, which are aspects of the choice architecture that alter people's behavior in a predictable way without forbidding any options or significantly changing their economic incentives. We can nudge people looking to lose weight by providing better mapping between choice and welfare, e.g., ""Mr. Smith, your run on the treadmill burned a pack of carrots. With the spinning exercises, you will burn a total of 5 Oreo cookies."" The Exchange will be consistent with the IOM's belief that patient-centeredness should be central to our health care system, rather than a peripheral add-on. In the short-run, we will identify the hooks people use in the Exchange among different patient populations (e.g., by age, race, socio-economic status, resident location) to assess their preferences. We will also monitor how long individuals stay engaged in a hook that they choose and what aspects of the hook and nudges motivate them. Our health outcomes will include what percent of patients stay within their target weight and for how long, what proportion of engaged patients have fewer asthma symptoms, and how many elderly patients feel less depressed or have improved cognitive or physical functioning. For long-term outcomes, we will be looking at cost-savings to the healthcare system and the diffusion of this innovation. Public Health Relevance: "Patient compliance has become the best documented, but least understood, health behavior," and requires innovative thinking. For this project, we are proposing the creation of a choice architecture called the Healthy Ideas Exchange where users will choose the hooks (games with rewards) they enjoy and be presented with nudges to help motivate them for behavioral change. The Exchange, implemented via the Web using Smartphones and tablets (e.g., iPad), will be consistent with the IOM's belief that patient-centeredness should be central to our health care system, rather than a peripheral add-on.