Tele-Dermatology Recruitment During COVID-19: An Application of Behavioral Economic Principles

In the ever-changing state of healthcare during the recent COVID-19 pandemic, our system has innovated rapidly using tele-dermatology in acute and chronic patient management. To combat barriers such as low patient enrollment, behavioral economics theories were implemented. Underlying principles in choice architecture, include choice inertia, the way in which humans favor the status quo; and choice overload, where humans fail to make an optimal choice when presented with multiple options. Using these theories, we modified support-staff scripts in our dermatology clinic used when rescheduling appointments. Our baseline script group allowed for patients to choose from a list of options whereas our improvement script applied behavioral economic principles and used tele-dermatology as the default. This quality improvement initiative was employed with the hypothesis that the “improvement” group would lead to an increase in tele-dermatology enrollment over an 8-week period. Our results showed the odds of patients accepting tele-dermatology were statistically significantly higher among those with Script 2, compared with Script 1. This also demonstrated clinical significance for our institution, showing the effect behavioral economics has on patient enrollment in tele-dermatology, which will serve as an asset during the COVID-19 pandemic and beyond. Limitations include small sample size, single institution, and two behavioral economic strategies were assessed in combination.