Nudges in A Learning Health System: Applications to Cardiovascular-Kidney-Metabolic Care

Nudges are behavioral interventions that influence decision-making by subtly altering the choice environment without restricting freedom. Rooted in behavioral economics, they have shown promise in health care by improving adherence to guidelines and promoting preventive behaviors. Learning Health Systems offer infrastructure for implementing nudges at scale through tools like electronic health records and decision support systems. In cardiovascular-kidney-metabolic care, nudges targeting both patients and providers, ranging from defaults and reminders to gamification, have improved prescribing, vaccination rates, and physical activity. Frameworks such as EAST and MINDSPACE guide effective design, emphasizing timing, audience, and framing. Looking ahead, artificial intelligence-powered nudges promise personalized, adaptive interventions that respond to real-time behavior and performance, enhancing scalability and sustainability. By aligning behavioral science with health technology, nudges can help optimize care delivery, reduce variation, and improve outcomes across complex health systems.