The overarching goal of the Brigham and Women’s Hospital / Harvard Medical School Roybal Center for Therapeutic Optimization using Behavioral Science is to develop principle-driven interventions to enhance the evidence-based use of prescription medications. The Center is directed by C4HDS Executive Director, Niteesh Choudhry, MD, PhD, and is overseen by an Executive Committee that includes Jerry Avorn, MD (BWH/Harvard), Punam Keller, PhD (Dartmouth), Wendy Wood, PhD (USC), Elad Yom-Tov, PhD (Microsoft Research Labs), and Ted Robertson, MPA (ideas42).

roybal projects

The Roybal Center for Therapeutic Optimization Using Behavioral Science is supported by National Institute on Aging, Grant # P30AG064199.

To see our Roybal affiliated publications, visit Roybal Publications.

The structure and activities of the BWH Roybal Center are based on 4 key principles:

a multi-disciplinary approach integrating collaborators with expertise in medication use, theory-based behavioral science, implementation research, and data science
the testing of principle-driven interventions in real-world settings
the explicit testing of mechanisms of action for each intervention
the use of novel analytic methods and technological approaches to gain a deeper understanding of behavior and to facilitate the creation of interventions that are both personalized but applicable to population health improvement

The NIA’s Division of Behavioral and Social Research supports several Roybal Centers across the nation, as well as a Coordinating Center.

Reinforcement learning to personalize message framing for health habits (REINFORCE)

Key Personnel: Julie Lauffenburger, PharmD, PhD; Elad Yom-Tov, PhD, MA; Punam Keller, PhD, MBA; Marie McDonnel, MD; Robert Glynn, PhD, ScD; Niteesh Choudhry, MD, PhD

This project conducted a randomized trial to evaluate the effectiveness of using reinforcement learning, a machine-learning based approach, to optimize and personalize medication adherence health communication for patients with diabetes.

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Using Cues and Rewards in Patients with Arthritis and Rheumatic Disease

Key Personnel: Candace Feldman, MD, MPH, ScD; Wendy Wood, PhD; Ted Robertson, MPA; Nancy Haff, MD, MPH; Julie Lauffenburger, PharmD, PhD; Niteesh Choudhry, MD, PhD

This project evaluated the effectiveness of the cue-reward-repetition method to promote medication-taking habit formation for patients with rheumatic conditions.

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Personalizing intervention to reduce clinical inertia in the treatment of hypertension

Key Personnel: Nancy Haff, MD, MPH; Wendy Wood, PhD; Elad Yom-Tov, PhD; Daniel Horn, MD; Melissa Hoover, PharmD, RPh, BCGP; Greg Low, RPh, PhD; Julie Lauffenburger, PharmD, PhD; Massimiliano Russ, PhD; Niteesh Choudhry, MD, PhD

This project is testing the impact of social norming and social marketing on clinical inertia for hypertension and seeks to empirically identify the relationship between patient features, physician behavioral characteristics and intervention responsiveness.

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Novel application of simulation for providers to overcome the hot-cold empathy gap in high-risk medication prescribing

Key Personnel: Julie Lauffenburger, PharmD, PhD; Matthew DiFrancesco, MD; Ted Robertson, MPA; Maxwell Coll, MD; Nancy Haff, MD, MPH; Jerry Avorn, MD; Niteesh Choudhry, MD, PhD

This project sought to evaluate whether a simulation-based approach could address the hot-cold empathy gap and improve the prescribing of medications such as antipsychotics and benzodiazepines to hospitalized older adults.

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Use of construal level theory to inform messaging to increase vaccination against COVID-19

Key Personel: Nancy Haff, MD, MPH; Niteesh Choudhry, MD, PhD; Punam Keller, PhD, MBA; Ted Robertson, MPA; Daniel Horn, MD; Julie Lauffenburger, PharmD, PhD

This randomized trial tested the effects of "how" versus "why” message framing on COVID-19 booster vaccination rates using electronically delivered communication.

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Leveraging social networks to control hypertension after ischemic stroke

This project aims to determine the effects of a social networks intervention versus individual hypertension counseling on blood pressure control for patients discharged after ischemic stroke.

Key Personnel: Amar Dhand, MD, DPhil; Nancy Haff, MD, MPH; Niteesh Choudhry, MD, PhD

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Breaking implicit bias habits: An individuation pilot to promote equity in rheumatic disease care

Key Personnel: Candace Feldman, MD, MPH, ScD; Nao Hagiwara, PhD; Sara Shoenfeld, MD; Niteesh Choudhry, MD, PhD

The goal of this project is to test the efficacy of an individuation-based intervention among rheumatologists and racially discordant patients at two large, multisite practices to improve racial and SES equity in receipt of high-quality care.

Refinement and adaption of reinforcement learning to personalize behavioral messaging for healthy habits

This project aims to adapt and test the impact of the reinforcement learning intervention tested in the REINFORCE trial to a diverse community setting.

Key Personnel: Julie Lauffenburger, PharmD, PhD; Michael Fischer, MD, MA; Julien Dedier, MD, MPH; Jennifer Trieu, MD; Niteesh Choudhry, MD, PhD

Addressing diffusion of responsibility and prescribing burden to improve use of diabetes medications

Key Personnel: Nancy Haff, MD, MPH; Daniel Horn, MD; Wendy Wood, PhD; Ted Robertson, MPA; Niteesh Choudhry, MD, PhD

This project is testing whether an intervention targeting diffusion of responsibility with and without additional resources to reduce the administrative burden of prescribing improves the use of evidence-based medications for diabetes in primary care.

Refinement and testing of recruitment methodology for behavioral medication adherence intervention using behavioral science-based approaches

Key Personnel: Niteesh Choudhry, MD, PhD; Alexander Chaitoff, MD, MPH; Michael Fischer, MD, MA; Punam Keller, MBA, PhD; Julie Lauffenburger, PharmD, PhD; Ian Kronish, MD, MPH

This project aims to test whether incorporating construal-level and prospect theories will facilitate patient engagement in a multi-component pharmacist intervention developed as part of the NIH Stage IV STIC2IT trial.

Social norms, messengers, and processing fluency to increase hypertension medication adherence

Key Personnel: Ted Robertson, MPA; Punam Keller, PhD; Linda Chung, PharmD, MBA, BCACP; Niteesh Choudhry, MD, PhD

This large NIH Stage III study aims to test whether social norms, messenger effects, and processing fluency improve hypertension medication adherence among Medicare Advantage beneficiaries.

roybal projects

Reinforcement learning to personalize message framing for health habits (REINFORCE)

Using Cues and Rewards in Patients with Arthritis and Rheumatic Disease

Personalizing intervention to reduce clinical inertia in the treatment of hypertension

Novel application of simulation for providers to overcome the hot-cold empathy gap in high-risk medication prescribing

Use of construal level theory to inform messaging to increase vaccination against COVID-19

Leveraging social networks to control hypertension after ischemic stroke

Breaking implicit bias habits: An individuation pilot to promote equity in rheumatic disease care

Refinement and adaption of reinforcement learning to personalize behavioral messaging for healthy habits

Addressing diffusion of responsibility and prescribing burden to improve use of diabetes medications

Refinement and testing of recruitment methodology for behavioral medication adherence intervention using behavioral science-based approaches

Social norms, messengers, and processing fluency to increase hypertension medication adherence

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