Telehealth, Health Behavior
Conditions
Keywords
Behavioral Economics, Patient Portal
Brief summary
The purpose of the current study is to test whether sending email communications in a timely manner - when patients have laboratory results available to view on the myGeisinger patient portal - increases enrollment in the portal.
Detailed description
Online patient portals are convenient tools that improve patient access to healthcare services while often reducing burden to both patients and providers. However, many patients have not enrolled in such portals, including Geisinger's patient portal, known as myGeisinger. The purpose of the current study is to test whether sending myGeisinger enrollment information in a timely manner - when the benefits of enrolling are most readily available - increases enrollment. Specifically, messages will be timely in terms of lab test results having just been made available online, with the added benefit that patients can view their results prior to receiving them via mail. Unenrolled patients who recently had a laboratory procedure ordered and whose results are now ready for sharing will be informed via email that their lab results are available. At the same time, these patients will be reminded that these results can be viewed online through myGeisinger. The primary outcome measure of interest, myGeisinger enrollment rates, will be compared between the emailed population and a control group that similarly has lab results available but will not be contacted. In addition, two different versions of the email communication will be tested. One will highlight that the patient will have to go through a sign-up process before viewing test results (in the service of transparency). The other will provide a presumed direct link to view those results, via a button that potentially serves as a pre-commitment step to undergo the registration process (foot in the door effect). Secondary analyses will assess differences in enrollment rates as well as unsubscribe rates between the email versions. Exploratory analyses will further examine differences in the rates at which patients opened and clicked on enrollment links within the two emails. Statistical analyses will employ generalized linear models with a binary distribution and log-link function.
Interventions
Sponsors
Geisinger Clinic
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
SINGLE (Subject)
Masking description
Participants (i.e., patients) will not be informed specifically of their assignment to different arms throughout the study.
Intervention model description
Every day within the designated study period, an email will be sent to patients who 1) fulfill inclusion criteria, 2) have been randomized to one of the email conditions (rather than the control group), and 3) have not already been randomized to a study condition on a previous day (i.e. no patient will be emailed for this study twice).
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Geisinger patient for whom a lab was ordered within 30 days prior to email date * Patient's lab test result released day before email date
Exclusion criteria
* Patient already enrolled in myGeisinger * Patient has already declined myGeisinger
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Enrollment - Timely Email (Combined Email Arms) vs. no Intervention | 1 week post-intervention | Patient enrolled in myGeisinger (yes / no) |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Enrollment - Email Including a Get Started Button vs. a View Results Button | 1 week post-intervention | Patient enrolled in myGeisinger (yes / no) |
| Email Opened - Email Including a Get Started Button vs. a View Results Button | 1 week post-intervention | Email was opened (yes / no) |
| Link Clicked - Email Including a Get Started Button vs. a View Results Button | 1 week post-intervention | Link / button to start the enrollment process was clicked (yes / no) |
| Unsubscribed - Email Including a Get Started Button vs. a View Results Button | 1 month post-intervention | Patient unsubscribed from these email communications (yes / no) |
| Enrollment - Timely Email (Combined Email Arms) vs. no Intervention | 1 month post-intervention | Patient enrolled in myGeisinger (yes / no) |
Countries
United States
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Control Patients do not receive an email | 1,669 |
| Timely Nudge - View Results Patients are emailed about myGeisinger when they have a lab result ready to view. The email includes a View My Lab Results button, which encourages them to click as a pre-commitment step that then brings them to the myGeisinger sign-up page.
Timely: Email
Foot-in-the-door: Email | 1,671 |
| Timely Nudge - Get Started Patients are emailed about myGeisinger when they have a lab result ready to view. The email includes a Get Started With myGeisinger button that is transparent about the next step in the process, before the patient can view test results.
Timely: Email
Transparency: Email | 1,669 |
| Total | 5,009 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 | FG002 |
|---|---|---|---|---|
| Evaluated Patients | Lost to Follow-up | 0 | 1 | 2 |
Baseline characteristics
| Characteristic | Control | Timely Nudge - View Results | Timely Nudge - Get Started | Total |
|---|---|---|---|---|
| Age, Categorical <=18 years | NA Participants | NA Participants | NA Participants | NA Participants |
| Age, Categorical >=65 years | NA Participants | NA Participants | NA Participants | NA Participants |
| Age, Categorical Between 18 and 65 years | NA Participants | NA Participants | NA Participants | NA Participants |
| Race and Ethnicity Not Collected | — | — | — | 0 Participants |
| Sex: Female, Male Female | NA Participants | NA Participants | NA Participants | NA Participants |
| Sex: Female, Male Male | NA Participants | NA Participants | NA Participants | NA Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk | EG002 affected / at risk |
|---|---|---|---|
| deaths Total, all-cause mortality | 0 / 0 | 0 / 0 | 0 / 0 |
| other Total, other adverse events | 0 / 0 | 0 / 0 | 0 / 0 |
| serious Total, serious adverse events | 0 / 0 | 0 / 0 | 0 / 0 |
Outcome results
Primary
Enrollment - Timely Email (Combined Email Arms) vs. no Intervention
Patient enrolled in myGeisinger (yes / no)
Time frame: 1 week post-intervention
Population: Patients who were randomized and for whom there was a record in the EHR.
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Control | Enrollment - Timely Email (Combined Email Arms) vs. no Intervention | 65 Participants |
| Timely Nudge | Enrollment - Timely Email (Combined Email Arms) vs. no Intervention | 361 Participants |
p-value: <0.00195% CI: [2.2805876, 3.9211066]Regression, Logistic
Secondary
Email Opened - Email Including a Get Started Button vs. a View Results Button
Email was opened (yes / no)
Time frame: 1 week post-intervention
Population: Patients who were delivered an email (i.e. email did not bounce back) and for whom there was a record in the EHR.
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Control | Email Opened - Email Including a Get Started Button vs. a View Results Button | 654 Participants |
| Timely Nudge | Email Opened - Email Including a Get Started Button vs. a View Results Button | 617 Participants |
p-value: 0.57195% CI: [0.8242111, 1.1124918]Regression, Logistic
Secondary
Enrollment - Email Including a Get Started Button vs. a View Results Button
Patient enrolled in myGeisinger (yes / no)
Time frame: 1 week post-intervention
Population: Patients who were delivered an email (i.e. email did not bounce back) and for whom there was a record in the EHR.
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Control | Enrollment - Email Including a Get Started Button vs. a View Results Button | 190 Participants |
| Timely Nudge | Enrollment - Email Including a Get Started Button vs. a View Results Button | 159 Participants |
p-value: 0.15495% CI: [0.9404654, 1.4759445]Regression, Logistic
Secondary
Enrollment - Timely Email (Combined Email Arms) vs. no Intervention
Patient enrolled in myGeisinger (yes / no)
Time frame: 1 month post-intervention
Population: Patients who were randomized and for whom there was a record in the EHR.
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Control | Enrollment - Timely Email (Combined Email Arms) vs. no Intervention | 141 Participants |
| Timely Nudge | Enrollment - Timely Email (Combined Email Arms) vs. no Intervention | 488 Participants |
p-value: <0.00195% CI: [1.5220654, 2.2589975]Regression, Logistic
Secondary
Link Clicked - Email Including a Get Started Button vs. a View Results Button
Link / button to start the enrollment process was clicked (yes / no)
Time frame: 1 week post-intervention
Population: Patients who were delivered an email (i.e. email did not bounce back) and for whom there was a record in the EHR.
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Control | Link Clicked - Email Including a Get Started Button vs. a View Results Button | 494 Participants |
| Timely Nudge | Link Clicked - Email Including a Get Started Button vs. a View Results Button | 307 Participants |
p-value: <0.00195% CI: [1.5692523, 2.1957769]Regression, Logistic
Secondary
Unsubscribed - Email Including a Get Started Button vs. a View Results Button
Patient unsubscribed from these email communications (yes / no)
Time frame: 1 month post-intervention
Population: Patients who were delivered an email (i.e. email did not bounce back) and for whom there was a record in the EHR.
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Control | Unsubscribed - Email Including a Get Started Button vs. a View Results Button | 2 Participants |
| Timely Nudge | Unsubscribed - Email Including a Get Started Button vs. a View Results Button | 2 Participants |