Harnessing Behavioral Economics to Accelerate Implementation in Rehabilitation.

Abstract: The rehabilitation field is advancing in the implementation of evidence-based practices (EBPs) into clinical care. Significant gaps remain, however, due to the complexity of patient populations and interventions, and resource intensive implementation strategies. Further, implementation strategies are often designed for how clinicians ought to behave not how they actually behave. Translating EBPs into practice requires behavior change among clinicians within organizational constraints. Behavioral economics is a field that combines insights from economics and psychology to explain human decision making and its impact on behavior. Nudges are strategies that are rooted in behavioral economic principles and guide decision-making without restricting choice. Nudges seek to make the optimal choice the easiest choice, without increasing clinician burden. This paper explores five applications from prior work that may accelerate implementation of EBP in the rehabilitation field: (1) embedding nudges within the electronic health record, (2) developing clinical decision support tools, (3) framing of performance feedback, (4) aligning nudges with existing workflows, and (5) applying the Easy-Attractive-Social-Timely (EAST) Framework to ensure nudges are appropriately designed for the clinician and setting. Lastly, we discuss the special considerations of designing a nudge to avoid unintended consequences such as increased clinician burnout or alert fatigue.