Funded Pilot Projects

2019-2020 Funded Pilot Projects

Reinforcement Learning to Personalize Message Framing for Health Habits

Highly influential in motivating behavior change is how information is framed. However, the impact of framing is almost certainly highly individual and moreover difficult to identify or provide tailored framing at scale. Reinforcement learning (RL) is an advanced analytic method that discovers each individual’s pattern of responsiveness by observing their actions and then implements a personalized strategy to optimize behaviors. In contrast to other approaches using previously-collected data, RL algorithms learn in real-time and personalize for specific patients. This pilot study will have three phases: 1) patient interviews to help design the text messages, 2) a small pragmatic trial to determine the feasibility and effectiveness of using reinforcement learning on patient adherence to diabetes medications using the text messages designed in Phase 1, and 3) the identification of clusters of responsiveness to text messages using predictive analytics and post-hoc data from the trial. The trial’s proposed outcomes will be adherence (primary) and disease control. Pilot Study Team:

  • Julie Lauffenburger, PharmD, PhD, Assistant Professor at Harvard whose work focuses on optimizing medication use.
  • Punam Keller, PhD, Professor at Dartmouth, whose work focuses on health communication to patients and healthcare providers.
  • Elad Yom-Tov, PhD, principal researcher at Microsoft Research Labs with expertise in advanced analytics and prior experience applying RL to motivate patients with diabetes to exercise.
  • Marie McDonnell, MD, a practicing endocrinologist and Chief of the Diabetes Section in the Division of Endocrinology, Diabetes, and Hypertension at BWH and Harvard Medical School.
  • Niteesh Choudhry, MD, PhD, Professor at Harvard.

Use of Cues and Rewards in Patients with Arthritis and Rheumatic Disease to Improve Medication Adherence

Non-adherence to evidence-based prescription medications results in preventable morbidity and mortality for middle-aged and older adults. For example, in the case of arthritis, which is the most common cause of disability in the US and the 4th most common condition among Medicare beneficiaries, adherence to evidence-based treatments is extremely poor and contributes to racial/ethnic, socioeconomic, and gender disparities. Numerous interventions have been tested to help patients adhere to their prescribed therapies but even the most effective of these approaches have been only modestly effective and when removed, adherence often falls back to baseline. Taking medications intended for daily use, like those to prevent or treat chronic conditions, is a repetitive action that has great similarity with other behaviors that must be performed consistently, such as regular exercise, healthy eating and hand washing. In these cases, people who act consistently do so out of habit. Wendy Wood and colleagues have proposed that habit formation has three central components: behavioral repetition, associated context cues, and rewards. The principle-driven repetition-cue-reward model has obvious applicability to the daily repetitive activity of medication taking but has not been tested for this behavior nor adapted as an intervention for patients in real-world care settings. Accordingly, we will conduct a two-phase NIH Stage I pilot study that will adapt the “cue-reward” methodology to improve adherence to rheumatic disease medications. This pilot study will have two phases: 1) observation of adherence patterns and 2) intervention development and testing using a registry randomized cross-over trial. The trial’s proposed effectiveness outcome will be adherence, but we will also measure the acceptability, adoption, perceived appropriateness, fidelity, and feasibility of the intervention. Pilot Study Team:

  • Candace Feldman, MD, ScD, Assistant Professor at Harvard and Rheumatologist
  • Wendy Wood, PhD, Professor of Psychology and Business at the University of Southern California
  • Ted Robertson, Managing Director of ideas42
  • Niteesh Choudhry, MD, PhD, Professor at Harvard.

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