About

Scott D. Halpern, MD, PhD, M.Bioethics, is the John M. Eisenberg Professor in Medicine at the University of Pennsylvania's Perelman School of Medicine. He is a senior fellow at the Leonard Davis Institute of Health Economics, a fellow at the Institute on Aging within the University of Pennsylvania Health System, and a senior scholar at the Center for Clinical Epidemiology and Biostatistics. Dr. Halpern serves as the director of the Palliative and Advanced Illness Research (PAIR) Center and the Behavioral Economics to Transform Trial Enrollment Representativeness (BETTER) Center at the University of Pennsylvania, as well as the director of the University of Pennsylvania's Patient-Oriented Research and Training to Accelerate Learning (Penn PORTAL). His research expertise encompasses end-of-life decision making, critical care health services research, methodological innovations in randomized trial designs, empirical bioethics, organ transplantation, research ethics, and the allocation of scarce resources. His clinical expertise includes critical care medicine and palliative medicine.

Research topics

• Medicine
• Nursing
• Psychiatry
• Family medicine
• Political Science
• Psychology
• Internal medicine
• Physical therapy
• Intensive care medicine
• Emergency medicine

Selected publications

• Nudging implementation of low tidal volume ventilation: a stepped wedge, cluster randomized trial

  Implementation Science · 2026-05-07

  articleOpen accessSenior author

  BACKGROUND: "Nudges" embedded in the electronic health record (EHR) facilitate desired decisions while preserving autonomy and may provide a scalable strategy to overcome the common implementation barrier of lack of knowledge about a best practice. We sought to test whether EHR-based nudges targeting two intensive care unit (ICU) clinician groups would safely increase evidence-based use of low tidal volume ventilation. METHODS: We performed a stepped-wedge, cluster randomized, hybrid type 3 effectiveness-implementation trial in 12 ICUs from February 2021 to May 2023 to test three nudges targeting clinicians responsible for order entry and respiratory therapists responsible for operationalizing orders and documentation. A default ventilation order auto-populated a low tidal volume setting; an accountable justification order required a free-text justification to order high tidal volume; and an accountable justification flowsheet required a free-text justification to document delivery of high tidal volume. ICUs were randomly assigned to launch one of the two order nudges on a pre-specified date, followed by the flowsheet nudge six months thereafter. The primary outcome was fidelity to low tidal volume ventilation, defined as percentage of time during the first 72 h of ventilation with low tidal volumes. For additional contextual inquiry, we conducted qualitative interviews with ICU clinicians regarding their perspectives on low tidal volume ventilation and study nudges. RESULTS: The primary analysis included 4412 patients. Unadjusted median fidelity to low tidal volume ventilation was 45.7%. Using multivariable mixed effects regression, marginal estimates of fidelity to low tidal volume ventilation ranged from 47.1% to 57.8% across study groups, with no significant differences after Holm adjustment for multiple comparisons. ICUs experienced variable changes with nudges in fidelity to low tidal volume ventilation. Clinician interviews revealed potential explanations for this variability, including the possibility of differential effects by experience level of clinicians and culture of interprofessional collaboration, and influence of the COVID-19 pandemic on familiarity with and use of low tidal volume ventilation. CONCLUSIONS: EHR-based default and accountable justification nudges did not increase utilization of low tidal volume ventilation in a broad population of mechanically ventilated patients; however, nudge effectiveness varied by ICU. TRIAL REGISTRATION: Clinicaltrials.gov, NCT04663802. Registered 10 December 2020, https://clinicaltrials.gov/study/NCT04663802.

  PublisherDOI

• On Anticipation Effect in Stepped Wedge Cluster Randomized Trials

  Statistics in Medicine · 2026-02-01

  article

  In stepped wedge cluster randomized trials (SW-CRTs), the intervention is rolled out to clusters over multiple periods. A standard approach for analyzing SW-CRTs utilizes the linear mixed model, where the treatment effect is only present after the treatment adoption, under the assumption of no anticipation. This assumption, however, may not always hold in practice because stakeholders, providers, or individuals who are aware of the treatment adoption timing (especially when blinding is challenging or infeasible) can inadvertently change their behaviors in anticipation of the forthcoming intervention. We provide an analytical framework to address the anticipation effect in SW-CRTs and study its impact. We derive expectations of the estimators based on a collection of linear mixed models and demonstrate that when the anticipation effect is ignored, these estimators give biased estimates of the treatment effect. We also provide updated sample size formulas that explicitly account for anticipation effects, exposure-time heterogeneity, or both in SW-CRTs and illustrate their impact on study power. Through simulation studies and empirical analyses, we compare the treatment effect estimators with and without adjusting for anticipation, and provide some practical considerations.

  PublisherDOI

• An external, contemporary evaluation of the Epic End of Life Care Index among hospitalized patients across two large health systems: A retrospective cohort study

  medRxiv · 2026-01-03

  articleOpen access

  ABSTRACT Background The Epic End of Life Care Index (EOLCI) predicts one-year mortality and was developed to improve serious illness care. However, prior external EOLCI evaluations had limited sample sizes, populations, and equity evaluations. In preparation for a multi-system pragmatic clinical trial, we sought to evaluate the EOLCI performance and equity in the trial’s two participating health systems. Objective Evaluate EOLCI model performance overall and across key subgroups. Design/Setting/Patients Retrospective cohort study of patients hospitalized for ≥36 hours in 2022 to 39 hospitals in the Trinity Health and Kaiser Permanente Southern California (KPSC) health systems. Measurements We predicted one-year mortality risk stratified by health system using the EOLCI, a logistic regression model including age, sex, race/ethnicity, ethnicity, insurance, and diagnoses. We evaluated model performance using Scaled Brier Scores (SBS; range -1 to 1; composite measures of calibration and discrimination), calibration plots, and c-statistics. Results Among 116,749 Trinity patients with 154,063 encounters, 12,054 (10.3%) patients died within one year. Among 94,489 KPSC patients with 133,043 encounters, 16,872 (17.9%) died within one year. The SBS was -0.007 at Trinity and 0.178 at KPSC. Calibration was poor for both. Trinity’s discrimination was acceptable/good (c-statistic 0.76, 95% CI 0.76-0.77), and KPSC’s was good/very good (c-statistic 0.81, 95% CI 0.81-0.81). Model performance across subgroups was similar to the overall cohort. Limitations Death data were collected exclusively within Trinity and KPSC, risking outcome misclassification; several subgroup evaluations were limited by small sample sizes. Conclusions An external evaluation of the widely available Epic EOLCI demonstrated adequate to very good discrimination, poor calibration, and equitable performance across sociodemographic characteristics and diagnoses in two of the nation’s largest health systems. Primary funding source PCORI PLACER-2022C3-30553.

  PublisherOA PDFDOI

• Problems with Sensitivity, Accuracy and Bias of the Z51.5 Code as an Indicator of Specialist Palliative Care

  Journal of Pain and Symptom Management · 2026-05-12

  article
  PublisherDOI

• A feasibility study of hospital-wide CAPC training for primary palliative care

  Journal of Pain and Symptom Management · 2026-05-12

  article
  PublisherDOI

• CRT-Estimands Framework: consensus based extension of the ICH E9(R1) addendum for cluster randomised trials

  BMJ · 2026-05-21

  articleOpen access

  In order to assess the relevance of trial results or the appropriate trials methods, interest holders (eg, clinicians, patients, and policy makers) need a clear description of the trial’s research question. To improve clarity and consistency in clinical trials, the International Conference on Harmonisation (ICH) released the ICH E9(R1) addendum, which set out a framework for defining estimands—a precise description of the treatment effect to be estimated. While the ICH E9(R1) addendum has been widely adopted, it primarily focused on individually randomised trials. In contrast, cluster randomised trials, where groups of individuals are randomised, present additional challenges for defining estimands. Therefore, the CRT-Estimands Framework was developed as a consensus based extension of the ICH E9(R1) addendum for cluster randomised trials. This framework provides a set of attributes that should be described when defining estimands in cluster randomised trials, with the objective of improving the clarity of the estimands, and consequently, the research questions, in these trials. This article presents the CRT-Estimands Framework with explanations and examples of how it can be implemented. Adopting the framework will improve the clarity of estimands in cluster randomised trials and facilitate interest holders to make informed decisions from these trials.

  PublisherDOI

• Comparison of inpatient subspecialty care delivery models: Clinical outcomes and racial disparities in dedicated versus consultative pulmonary care

  Journal of Hospital Medicine · 2025-05-23

  articleOpen access

  BACKGROUND: Subspecialty inpatient care is associated with improved outcomes in various clinical settings. However, clinical outcomes and racial disparities between dedicated inpatient pulmonary care and general medicine services with pulmonary consultation remain unknown. OBJECTIVE: To compare clinical outcomes between dedicated and consultative inpatient pulmonary care and evaluate whether racial disparities in outcomes differ by care model. METHODS: Retrospective cohort study of 1072 self-identified Black and White adults admitted to dedicated pulmonary or general medicine services with pulmonary consultation (April 2017-February 2020) at an academic medical center. Exposures included the care model, race, and the interaction between the two. Outcomes included hospital length of stay (LOS; modeled as risk of discharge alive using competing risk models), hospital readmissions, and outpatient pulmonary follow-up. We performed multivariable regression models with interaction terms adjusted for demographics, comorbidities, clinical severity, and pulmonary diagnosis. RESULTS: Dedicated pulmonary service patients had shorter LOS (subdistribution hazard ratio [SHR]: 1.38, 95% confidence interval [CI]: 1.14-1.67, p = .001) and improved 90-day outpatient follow-up (odds ratio [OR]: 1.63, 95% CI: 1.07-2.49, p = .023). The interaction between care model and race demonstrated significantly lower odds of 30-day follow-up among Black patients admitted to the dedicated service versus those with consultations; no other significant racial disparities in outcomes were demonstrated. CONCLUSIONS: Dedicated pulmonary inpatient care was associated with shorter hospital LOS and higher 90-day outpatient follow-up without significant racial disparities in most outcomes. Hospitals could consider pilot-testing dedicated inpatient pulmonary care models, as more work is needed to validate these findings in broader settings.

  PublisherOA PDFDOI

• Evaluating the Science of Diversity in Clinical Trials: Design and Goals of an American Heart Association Strategic Focused Research Network

  Journal of the American Heart Association · 2025-09-25 · 1 citations

  articleOpen access

  BACKGROUND: Clinical trials serve as the key evidence that shapes guideline recommendations and clinical practice. Despite long-standing recommendations by regulatory and funding organizations for representative trial enrollment, the underinclusion of women and individuals from diverse racial and ethnic populations in cardiovascular and dementia clinical trials persists. This undermines trust in research, threatens basic principles of fairness, and may limit the generalizability of trial results to broad patient populations. METHODS: To better understand how to foster more inclusive cardiovascular trial participation, the American Heart Association launched a Strategically Focused Research Network (SFRN) to study the Science of Diversity in Clinical Trials in 2022. The SFRN includes 5 Network Centers operating from Johns Hopkins University ("IMPACT"), Stanford University ("DIVERSE"), University of California Los Angeles ("iDIVERSE"), University of Southern California/Howard University ("ATRIL"), and the University of Pennsylvania ("BETTER"). Each Center is a partnership that includes an institution focused on the education of Black, Hispanic, American Indian, Native Hawaiian/Pacific Islander, and/or non-White students. Each Center has multiple projects with actionable results and is training at least 3 dedicated postdoctoral fellows. Additionally, a 6th Center ("TRAIN") led by faculty at Stanford and Morehouse Universities is facilitating formal fellowship training across the Centers. CONCLUSIONS: Projects are ongoing and all 6 Centers are working on collaborative initiatives. These Centers are expected to provide valuable insights into clinical trial participation, including innovative conceptual frameworks to inform the diversification of clinical trial participation and novel recruitment and retention strategies that can be broadly disseminated.

  PublisherDOI

• Disease and Race‐Based Differences in Inpatient Palliative Care Consultation in Cancer and Noncancer Serious Illnesses

  Journal of the American Geriatrics Society · 2025-05-07 · 2 citations

  articleOpen access

  BACKGROUND: Guidelines recommend timely palliative care consultation (PCC) for hospitalized patients with serious illness, but adherence to such guidelines and variability in access are not well described. METHODS: Prospective cohort study from March 21, 2016 to August 8, 2018 during the usual care period of a cluster-randomized trial at 11 hospitals in 8 US states. We included adults age 45 and older with cancer, chronic obstructive pulmonary disease (COPD), dementia, heart failure, or kidney failure. Exposures included diagnoses, demographics, and hospital characteristics, and outcomes included predicted probability and timing of PCC. RESULTS: Among 40,074 inpatient encounters (median age 72 years [IQR 62-82], 46.9% male, 22.7% Black, 4.6% Hispanic), the most common serious illness was heart failure (66.0%), followed by COPD (39.3%), kidney failure (12.4%), cancer (12.3%), and dementia (11.6%). The overall rate of PCC was 11.6% (95% CI 11.3%-11.9%), ranging across hospitals from 4.2% (95% CI 3.3%-5.3%) to 23.3% (95% CI 19.6%-27.4%). Patients with dementia (20.6%, 95% CI 19.4%-21.7%) and cancer (19.5%, 95% CI 18.5%-20.7%) received PCC the most, and those with kidney failure the least (8.2%, 95% CI 7.5%-9.0%). Median time to PCC after admission was 3 days (IQR 1-6); patients with heart failure, COPD, and kidney failure received PCC 1 day later at the median compared to cancer and dementia. Predictors of increased odds of receiving PCC included being Black or Asian (aOR 1.12, 95% CI 1.02-1.23; aOR 1.67, 95% CI 1.31-2.12, respectively) and being admitted to a hospital with a higher overall rate of PCC orders (aOR 1.11, 95% CI 1.08-1.13). CONCLUSION: PCC was underutilized overall and varied substantially in frequency and timing across hospitals, diseases, and patient race. These findings underscore the need to implement standardized approaches to improve adherence to guideline-recommended PCC.

  PublisherOA PDFDOI

• What matters most? A discrete choice experiment assessing preferences for dementia treatment outcomes

  Alzheimer s & Dementia · 2025-12-01

  articleOpen access

  BACKGROUND: Persons living with dementia (PWD) and their family care partners may have different priorities when considering new dementia treatments. We sought to determine the relative importance of several different outcome domains when considering choosing a hypothetical dementia treatment. METHOD: We conducted a discrete choice experiment (DCE) among PWD and family care partners administered online and facilitated by a trained research coordinator. Participants were recruited from memory centers in Pennsylvania, Wisconsin, and Michigan. In each DCE task, participants were asked to choose one of two hypothetical dementia treatments that would produce variable benefits across multiple outcome domains. The full DCE, conducted with care partners, consisted of eight forced-choice tasks assessing respondent preferences within six attributes: brain function, distressing symptoms, physical function, home time, family caregiver stress, and socialization and engagement. Participating PWD were shown an abbreviated version of the DCE consisting of six tasks with a random subset of four of the six attributes. Data were analyzed using mixed effects logistic regression models to assess how each attribute influenced likelihood of selecting a treatment option. Participant comprehension, reasoning, and reactions to the DCE were solicited throughout and documented in field notes. Field notes were subsequently analyzed using constant comparison techniques to identify relevant themes. RESULT: We surveyed 201 participants (154 care partners; 47 PWD; Table 1). Across all participants, the highest priority outcomes were relief in distressing symptoms and increasing home time (OR=0.66, 95% CI=0.61-0.71 and OR=0.66, 95% CI=0.61-0.71). When comparing utilities across PWD and care partners, PWD more highly valued increasing home time, improving physical function, reducing family caregiver stress, and increasing patient socialization and engagement compared to family care partners (Figure). Qualitative analysis revealed key themes regarding participant decision making processes and attitudes towards the DCE experience (Table 2). CONCLUSION: Increasing home time is an important treatment outcome for PWD and family care partners. Prioritization of other treatment outcomes vary across these key stakeholder subgroups. Participation in a DCE assessing treatment outcomes as a communication process was valued by patients and care partners, suggesting its potential utility as a communication aid or values elicitation tool.

  PublisherOA PDFDOI

Recent grants

• NIH Grant K08HS018406

  NIH · $763k · 2014

• Default palliative care consultation for seriously ill hospitalized patients

  NIH · $2.9M · 2015–2021

• NIH Grant R01CA159932

  NIH · $3.0M · 2016

• Benefits of ICU admission for patients with acute respiratory failure or sepsis: A mixed-methods study across 26 hospitals

  NIH · $3.0M · 2017–2022

• Training in Critical Care Health Policy Research

  NIH · $7.6M · 2010–2030

Frequent coauthors

• Sydney E. S. Brown

  University of Michigan–Ann Arbor

  114 shared

• David A. Asch

  109 shared

• Robert D. Truog

  Harvard University

  106 shared

• Michael O. Harhay

  105 shared

• Nicole B. Gabler

  Wilmington University

  94 shared

• Meeta Prasad Kerlin

  University of Pennsylvania

  93 shared

• Gary E. Weissman

  California University of Pennsylvania

  79 shared

• Elizabeth Cooney

  University College Cork

  71 shared

Labs

• Halpern LabPI

Awards & honors

• John M. Eisenberg, M.D. Professor in Medicine
• Senior Fellow, Leonard Davis Institute of Health Economics,…
• Fellow, Institute on Aging, University of Pennsylvania Healt…
• Senior Scholar, Center for Clinical Epidemiology and Biostat…
• Director, Palliative and Advanced Illness Research (PAIR) Ce…