About

Mucio Kit Delgado, MD, MS, is an Associate Professor of Emergency Medicine and Epidemiology at the University of Pennsylvania. He serves as the faculty director of the Penn Medicine Nudge Unit, the world’s first behavioral design team embedded within a health system, and is an attending physician in the emergency department at Penn Presbyterian Medical Center. Dr. Delgado is also an associate director at the Center for Health Incentives and Behavioral Economics, co-chair of Penn Medicine's Opioid Task Force, and co-director of Penn PORTAL, one of 16 U.S. Centers of Excellence in learning health system science. His research blends behavioral and data science with insights from practicing emergency medicine in an urban trauma center to guide patients and clinicians toward decisions that enhance personal safety and improve the quality of acute care. He is passionate about leading multidisciplinary teams to address pressing public health problems, including the opioid overdose crisis, COVID-19 pandemic, trauma and firearm injuries, and distracted and alcohol-impaired driving. Dr. Delgado uses a broad set of methodological approaches, including user-centered design, observational comparative effectiveness methods, and pragmatic randomized trials of digital behavioral interventions. His work has led to interventions that have been scaled as the standard of care, and he has received numerous awards and recognitions, including election to the American Society for Clinical Investigation.

Research topics

• Political Science
• Psychology
• Law

Selected publications

• Clinician Views of an Opioid Prescribing Report with Peer Comparisons and Patient-Reported Outcomes

  American Journal of Medical Quality · 2025-02-18

  articleOpen access

  Providing feedback to clinicians on their prescribing is a promising approach to right-sizing opioid prescriptions. The present research investigated the perceived acceptability, appropriateness, helpfulness, and areas for improvement of a monthly report providing surgical clinicians feedback on their postoperative opioid prescribing relative to guidelines, peer prescribing, and patient-reported pills taken, as well as on patient-reported ability to manage pain. Between January and May 2023, surgeons, advanced practice providers, and residents who recently received these reports as part of a health system quality improvement intervention completed a survey (n = 38) or interview (n = 8). Mean (SD) acceptability of the prescribing report was 4.2 (0.8), and appropriateness was 4.2 (0.8); appropriateness varied by clinical role. All features of the report were rated as "very" or "extremely" helpful by a majority of respondents. Interviewees wished for fuller explanations, real-time updates, and improved accuracy. These findings can inform the design of clinician feedback in learning health systems.

  PublisherDOI

• Peer and Patient Feedback to Increase Adherence to Postoperative Opioid Prescribing Guidelines

  JAMA Surgery · 2025-06-11 · 3 citations

  articleSenior author

  Importance: Prescribing more opioids than patients need following surgery is associated with long-term use, misuse, and diversion. Interventions are needed to increase adherence to procedure-specific guidelines while preserving the ability to manage pain. Objective: To test whether providing clinicians monthly feedback with peer comparisons and patient-reported outcomes would increase adherence to postoperative opioid prescribing guidelines. Design, Setting, and Participants: This stepped-wedge cluster randomized clinical trial was conducted at 6 surgical departments or divisions caring for patients undergoing 30 high-volume surgical procedures in a 5-hospital academic health system in Pennsylvania and New Jersey. Surgical clinicians (attending surgeons, advanced practice professionals, and resident physicians) with 5 or more opioid prescriptions per month for eligible procedures during a 3-month period at baseline were eligible for inclusion. Six clinician clusters were randomly assigned to the intervention in 3 steps offset by 2 months. Each step included a 9-month baseline, a 6-month intervention, and a 6-month follow-up. The first step of the intervention began on June 8, 2022. Follow-up concluded in October 2023, and data analysis was performed from November 2023 to April 2024. Intervention: Clinicians were emailed a report on their most frequently performed procedures, which contained a figure of the following mean numbers: pills prescribed relative to guidelines, pills peer clinicians prescribed, and pills patients reported using after a procedure; an additional figure displayed patients' self-reported ability to manage pain. Monthly reports included prescribing trends, peer comparison feedback, and reminders about how many pills patients take and how well patients reported pain management with guideline-adherent prescriptions. Main Outcomes and Measures: The primary outcome was the proportion of guideline-adherent opioid prescriptions; secondary outcomes included patient-reported ability to manage pain (measured on a 0 to 10 scale, with 0 being not at all able), pain score, pills prescribed, pills leftover, and refill rate. Results: A total of 143 surgical clinicians treating 20 557 patients were included (10 069 at baseline, 5382 during the intervention, and 5106 at follow-up). Mean (SD) patient age was 57.0 (15.7) years, and 10 996 patients (53.5%) were female. The baseline guideline adherence rate was 57.2%. During the intervention, adherence increased to 71.8%, with an adjusted intervention effect of 5.3% (95% CI, 2.0%-8.7%). The impact of the intervention increased over time, and adherence remained above baseline at follow-up (74.4%). The largest change was noted for orthopedic procedures of knee, hip, and shoulder arthroplasty. Patient-reported pain and ability to manage pain were unchanged. Conclusions and Relevance: In this stepped-wedge cluster randomized clinical trial, a feedback intervention using peer comparisons and patient-reported data increased opioid guideline adherence without compromising patients' ability to manage pain. Trial Registration: ClinicalTrials.gov Identifier: NCT05358522.

  PublisherDOI

• 317: AN EXPLANATORY MIXED-METHODS STUDY OF “ICU NET BENEFIT” FOR SEPSIS AND ACUTE RESPIRATORY FAILURE

  Critical Care Medicine · 2025-01-01

  article
  PublisherDOI

• Access to Surgical Care After Newly Acquired Insurance Enrollment

  Annals of Surgery · 2025-06-09 · 1 citations

  articleCorresponding

  OBJECTIVE: To evaluate the association between insurance acquisition through a hospital-based linkage program and the utilization of elective and emergency surgical procedures within one year of hospitalization. SUMMARY BACKGROUND DATA: Lack of insurance creates substantial barriers to elective surgical procedures, potentially leading to preventable complications and worsened outcomes. Hospital-based insurance linkage programs may help address these challenges by providing retroactive coverage, but their impact on surgical care utilization remains understudied. METHODS: We used electronic medical records and regional health information exchange data to conduct a retrospective cohort study of Pennsylvania residents aged 18-64 years who were admitted through the emergency department and were uninsured or Medicaid-insured at presentation. Insurance status was categorized as retroactively insured, Medicaid-insured, or uninsured. Multivariable logistic regression was used to compare the odds of undergoing elective, emergent, and any surgical procedure within 12 months of admission among these groups. RESULTS: Among 14,979 patients, elective surgery rates were 18.5% (Medicaid), 15.2% (retroactively insured), and 5.7% (uninsured) (P<0.001). After adjusting for demographic, socioeconomic, and clinical factors, retroactively insured patients had 16% lower odds of elective surgery than Medicaid patients (OR 0.84, 95% CI [0.74-0.95]; P=0.004), while uninsured patients had 68% lower odds (OR 0.32, 95% CI [0.24-0.43]; P<0.001). Emergent surgery rates were similar across groups. CONCLUSIONS: Although patients gaining insurance through linkage had slightly lower elective surgery rates than those with pre-existing Medicaid, they underwent substantially more elective procedures than those who remained uninsured. Insurance linkage programs may help improve access to elective surgery, potentially reducing disparities and supporting health system financial sustainability.

  PublisherDOI

• A national randomized field experiment testing the impact of simulated usage-based insurance programs on driver safety

  Accident Analysis & Prevention · 2025-11-28

  articleOpen accessSenior author

  Many motor vehicle crashes are due to risky driving behaviors measurable by smartphone telematics applications. These apps are deployed by usage-based insurance (UBI) programs to estimate crash risk and price policies, incentivizing customers to drive safer. A preregistered randomized controlled trial (NCT06101251) tested whether a simulated UBI program improved driver safety, and whether being assigned or choosing focused goals yielded further improvement. Adult drivers (n = 1,449) were recruited nationally with social media advertisements. After a 6-week baseline period, participants were randomly assigned to one of four groups for a 12-week intervention: 1) Observation (control); 2) Standard Feedback (weekly texts about four risky behaviors, $100 incentive); 3) Assigned Goal (weekly texts about algorithmically assigned focus behavior and goal, $100 incentive); 4) Chosen Goal (weekly texts about self-chosen focus behavior and goal, $100 incentive). Post-intervention, participants were monitored for 6 more weeks. The primary outcome was a 0-100 score for overall safety (100 = safest). Standard Feedback (covariate-adjusted difference, 2.0 [95 % CI, 1.2-2.7]; P < 0.001), Assigned Goal (2.7 [95 % CI, 2.0-3.5]; P < 0.001), and Chosen Goal (2.2 [95 % CI, 1.4-3.0]; P < 0.001) had higher safety scores than control during the intervention period and at follow-up. Differences between treatment groups were not significant after adjusting for number of comparisons, Ps > 0.10. Treatment groups had significant relative reductions in speeding (11 %-13 %, depending on group), hard braking (16 %-21 %), and rapid acceleration (16 %-25 %), Ps < 0.01. The kind of feedback and incentives offered by UBI programs can cause sustained improvements in driver safety.

  PublisherDOI

• Effect of smartphone breathalyzer feedback on willingness to drive in moderately intoxicated individuals: A randomized trial.

  Psychology of Addictive Behaviors · 2025-08-14

  articleOpen accessSenior author

  OBJECTIVE: The present study examined the impact of smartphone breathalyzer feedback on individuals' decisions to drive when they are moderately intoxicated. Although the legal driving limit for blood alcohol concentration (BAC) in the United States is < 0.08%, crash risk begins to increase at moderate BACs ≥ 0.04%. METHOD: We conducted a laboratory-based, randomized controlled trial in 20 adult drivers aged 21-39 with a history of binge drinking. Participants were given sex- and weight-based doses of alcohol over 90 min with a target peak BAC of 0.10%. Smartphone breathalyzer measurements were taken every 15 min until the participant's BAC declined to 0.03%. Ten participants received feedback on their BAC readings, while the other 10 were blinded to BAC readings. After each measurement, participants were asked to rate on 10-point scales how much they were intoxicated, able to drive, and willing to drive. RESULTS: s < .001. CONCLUSIONS: Being aware of their BAC may make drinkers more willing to drive up to the legal BAC limit of 0.08%, despite being in a range associated with increased crash risk. We recommend that breathalyzer apps provide salient feedback about the risks of driving with a BAC in the moderately intoxicated range. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

  PublisherDOI

• Behavioral Interventions for Increasing Seat Belt Use and Decreasing Distracted Driving Using Telematics: A National Randomized Trial

  American Journal of Public Health · 2025-03-13 · 2 citations

  articleOpen accessSenior author

  Objectives. To test low-cost, scalable interventions designed to encourage seat belt use (primary outcome) and discourage handheld phone use while driving. Methods. A randomized controlled trial assigned 1139 consenting General Motors‒connected vehicle customers in the United States to 1 of 4 groups for a 10-week intervention: (1) control, (2) behavioral engagement, (3) behavioral engagement plus raffle, and (4) behavioral engagement plus shared pot. Behavioral engagement involved education, personalized tips, a “wish outcome obstacle plan” exercise, and weekly feedback about buckling and handheld-free streaks. Participants in the behavioral engagement plus raffle group also earned a chance at a $125 prize each week they had a buckling or handheld-free streak. Those in the behavioral engagement plus shared pot group earned an equal share of this prize for each streak. The intervention was delivered virtually in spring 2023. Results. Participants in the behavioral engagement plus shared pot group had a higher buckling rate (91.3%) than those in the behavioral engagement plus raffle (89.5%), behavioral engagement (89.4%), or control (88.3%) groups—differences that remained significant at follow-up. Handheld phone use did not differ significantly. Conclusions. A behavioral intervention with a shared pot incentive could be delivered at scale to reduce injuries and deaths associated with vehicular crashes. Trial Registration. ClinicalTrials.gov identifier: NCT05469477. ( Am J Public Health. 2025;115(5):758–768. https://doi.org/10.2105/AJPH.2024.307980 )

  PublisherOA PDFDOI

• Awaiting insurance coverage: Medicaid enrollment and post-acute care use after traumatic injury

  The Journal of Trauma: Injury, Infection, and Critical Care · 2025-01-30 · 3 citations

  article

  BACKGROUND: Lack of insurance after traumatic injury is associated with decreased use of postacute care and poor outcomes. Insurance linkage programs enroll eligible patients in Medicaid at the time of an unplanned admission. We hypothesized that Medicaid enrollment would be associated with increased use of postacute care, but also with prolonged hospital length of stay (LOS) while awaiting insurance authorization. METHODS: We linked trauma registry and EMR data to identify patients ages 18 years to 64 years admitted from 2017 to 2021 to a Level I trauma center. Patients admitted without insurance and retroactively insured (RI) during hospitalization were compared with patients with established Medicaid (MI) and those remaining uninsured (UI). We measured postacute care use including home health care, rehabilitation, and skilled nursing facilities. We tested the association between insurance status and discharge disposition and LOS (primary outcome) using multivariable negative binomial regression. Direct costs were compared between groups. RESULTS: We compared 494 RI patients to 1706 MI and 148 UI patients. Retroactively insured patients had longer hospitalization (median LOS [interquartile range], 4 days [2-9 days]) than other groups (MI, 4 [2-8] and UI 2 [1-3]), p < 0.001). Retroactively insured patients were more likely to be discharged with home health care and to inpatient rehabilitation than UI patients ( p < 0.001). After adjusting for injury and management characteristics, RI was associated with longer LOS compared with MI for patients discharged to inpatient facilities ( p < 0.001). Median costs for RI patients discharged to a facility were $10,284 higher than MI patients, ranging from $8,582 for Injury Severity Score <9 to $51,883 for Injury Severity Score ≥25. CONCLUSION: Enrollment in Medicaid after traumatic injury is associated with postacute care use, but the current enrollment process may delay discharge. Streamlining insurance enrollment and permitting discharge with pending application status could reduce unnecessary hospital days, saving costs and improving improve patient experience. LEVEL OF EVIDENCE: Prognostic and Epidemiological; Level IV.

  PublisherDOI

• 1084 Opioid Prescribing Guidelines for Neurosurgical Patients: A Multi-Site Analysis of Guideline Implementation and Monitoring With an Automated Text-messaging Platform

  Neurosurgery · 2025-03-14

  article

  INTRODUCTION: Evidence-based opioid prescribing guidelines have resulted in reductions in postoperative prescription size without offsetting increases in patient-initiated refills. While there is extensive literature detailing postoperative opioid usage and guideline implementation in other specialties, data for neurosurgical patients have been limited to date. METHODS: We conducted a prospective study of postoperative opioid use and patient-reported outcomes for 1,215 elective spine and peripheral nerve neurosurgical cases between December 2018 and March 2022, with the implementation of prescribing guidelines in February 2021 at three hospital sites within an academic health system. Opioid prescribing guideline development was based on patient-reported opioid consumption behaviors monitored using an automated two-way text messaging platform. RESULTS: The aggregate response rate to the automated text-messaging system was 48.2% throughout the study period. Prior opioid use, median household income of patient ZIP code, and operative procedure were identified as significant independent estimators of likelihood to respond to opioid-use questions (p&lt;0.05). There were significant reductions in the mean postsurgical opioid prescription for thoracolumbar laminectomies and fusions (p&lt;0.001) after guideline implementation. There was no difference in mean cumulative postsurgical opioid consumption by operative procedure after guideline implementation. Prior opioid use (OR: 1.91, SD: 0.50, p&lt;0.05) and mean pain score (OR: 1.16, SD: 0.06, p&lt;0.01) were significant predictors of elevated opioid use. Pain scores did not significantly differ at postoperative Month 3 by operative procedure. CONCLUSIONS: Opioid prescribing guideline development for neurosurgical cases that is informed by patient-reported opioid behaviors may reduce opioid volume prescribed by operative procedure and the total volume of unused opioid medication retained by patients.

  PublisherDOI

• Adaptive decision support for addiction treatment to implement initiation of buprenorphine for opioid use disorder in the emergency department: protocol for the ADAPT Multiphase Optimization Strategy trial

  BMJ Open · 2025-02-01 · 3 citations

  articleOpen access

  INTRODUCTION: Despite the current opioid crisis resulting in tens of thousands of deaths every year, buprenorphine, a medication that can reduce opioid-related mortality, withdrawal, drug use and craving, is still underprescribed in the emergency department (ED) for treatment of opioid use disorder (OUD). The EMergency department-initiated BuprenorphinE for opioid use Disorder (EMBED) trial introduced a clinical decision support (CDS) tool that improved the proportion of ED physicians prescribing buprenorphine but did not affect patient-level rates of buprenorphine initiation. The present trial aims to build on these findings by optimising CDS use through iterative improvements, refined interventions and clinician feedback to enhance OUD treatment initiation in EDs. METHODS AND ANALYSIS: The Adaptive Decision support for Addiction Treatment (ADAPT) trial employs the Multiphase Optimization Strategy (MOST) framework to refine a multicomponent CDS tool designed to facilitate buprenorphine initiation for OUD in ED settings. Using a pragmatic, learning health system approach in three phases, the trial applies plan-do-study-act cycles for continuous CDS refinement. The CDS will be updated in the preparation phase to reflect new evidence. The optimisation phase will include a 2×2×2 factorial trial, testing the impact of various intervention components, followed by rapid, serial randomised usability testing to reduce user errors and enhance CDS workflow efficiency. In the evaluation phase, the optimised CDS package will be tested in a randomised trial to assess its effectiveness in increasing ED initiation of buprenorphine compared with the original EMBED CDS. ETHICS AND DISSEMINATION: The protocol has received approval from our institution's institutional review board (protocol #2000038624) with a waiver of informed consent for collecting non-identifiable information only. Given the minimal risk involved in implementing established best practices, an independent study monitor will oversee the study instead of a Data Safety Monitoring Board. Findings will be submitted to ClinicalTrials.gov, published in open-access, peer-reviewed journals, presented at national conferences and shared with clinicians at participating sites through email notification. TRIAL REGISTRATION NUMBER: NCT06799117.

  PublisherOA PDFDOI

Recent grants

• Reducing Risky Teen Cellphone Use While Driving Using Behavioral Economics, Technology, and Epidemiology

  NIH · $675k · 2017–2021

Frequent coauthors

• Ruiying Xiong

  Hospital of the University of Pennsylvania

  66 shared

• Carlos A. Camargo

  Harvard University

  64 shared

• Juan Carlos C. Montoy

  University of California, San Francisco

  61 shared

• Adit A. Ginde

  University of Colorado Denver

  61 shared

• Catherine C. McDonald

  Philadelphia University

  60 shared

• Douglas J. Wiebe

  University of Michigan–Ann Arbor

  52 shared

• Scott D. Halpern

  University of Pennsylvania

  40 shared

• Elinore J. Kaufman

  University of Pennsylvania

  39 shared

Awards & honors

• Academy Health Publication-of-the-Year Award
• Society for Medical Decision Making Lee Lusted Prize for Out…
• Penn Medicine Marjorie A. Bowman New Investigator Research A…
• Pennsylvania Impact Award from City & State PA
• Elected to the American Society for Clinical Investigation