Influenza
Conditions
Keywords
Vaccination, Health Promotion, Health Behavior, Reminder Systems, Economics, Behavioral
Brief summary
The purpose of this study is to assess, prospectively, the effect on flu vaccination rates of a pre-visit questionnaire that asks patients to indicate their preferences for a flu shot. Responses to the questionnaire will also be shown to clinicians via additional text in an existing flu shot alert. The investigators hypothesize that the pre-visit questionnaire will lead to increased flu vaccination compared with standard practices.
Detailed description
The CDC (Centers for Disease Control and Prevention) recommends a flu vaccination to everyone aged 6+ months, with rare exception; almost anyone can benefit from the vaccine, which can reduce illnesses, missed work, hospitalizations, and death. One barrier to vaccination is a lack of cues to action, which could be overcome by asking patients for a pre-visit commitment to get a flu shot and additional reminders for the clinician to act on this commitment. Eligible patients will be randomized to either receive or not receive a one-item, pre-visit questionnaire about the flu shot (that will show responses to clinicians in an existing flu shot alert).
Interventions
BEHAVIORALPrecommitment Nudge
Ask participants to commit to a decision about getting a flu shot
BEHAVIORALSalience
Additional text and icon in the flu shot alert makes the pre-visit questionnaire response salient to the clinician, which could facilitate action or further discussion with the patient
Sponsors
Geisinger Clinic
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
SINGLE (Subject)
Masking description
Patient-participants will not be explicitly told about the different arms, although clinician-participants will see the different arms and may notice these differences.
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
Patient Inclusion Criteria: * On a list of active Geisinger patients (all patients on this list attended at least one primary care appointment at Geisinger between 10/1/2008 and 4/13/2022, and either had a Geisinger primary care provider assigned as of April 2022, or were in the Electronic Health Record \[EHR\] since at least September 2021 and had at least one encounter in 2020-2022) * Has an upcoming flu shot-eligible outpatient visit with a provider * Has activated Geisinger's patient portal * Has not yet received a flu vaccine at the time the questionnaire became available, according to the EHR Clinician Inclusion Criteria * Any Geisinger clinician who sees patient-participants in our study for a flu shot-eligible outpatient visit
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Count of patients with a flu vaccination | Up to 21 days | Patient received a flu vaccine (yes/no) between the day questionnaires became available for the patient's first scheduled flu-shot-eligible appointment and 7 days following the appointment. Questionnaires were available 14 days prior to the appointment date for appointments scheduled at least 14 days in advance. Questionnaires were available on the day the appointment was scheduled for appointments scheduled less than 14 days in advance. Note that control patients did not receive a flu shot questionnaire, but they may have received other questionnaires from the health system 14 days before their appointment. We will conduct subgroup analyses for people who had responded to MyGeisinger pre-visit messages in the previous year and those who did not. |
Other
| Measure | Time frame | Description |
|---|---|---|
| Count of patients with a likely flu diagnosis | Up to 8 months | Received a high confidence flu diagnosis (with positive polymerase chain reaction \[PCR\]/antigen/molecular test) and/or likely flu diagnosis (as assessed via International Classification of Disease \[ICD\] codes or Tamiflu administration or positive PCR/antigen/molecular test) (yes/no) during the 2022-23 flu season (from the patient's appointment date through April 30, 2023) Note that likely flu is a superset of the high confidence flu diagnoses |
| Count of patients with flu complications | Up to 8 months | Diagnosed with flu-related complications (yes/no) during the 2022-23 flu season (from the patient's appointment date through April 30, 2023) |
| ER visits | Up to 11 months | Number of ER visits from the patient's message appointment date through July 31, 2023 |
| Count of patients with a high confidence flu diagnosis | Up to 8 months | Patient received a flu diagnosis via a positive polymerase chain reaction \[PCR\]/antigen/molecular test (yes/no) during the 2022-23 flu season (from the patient's appointment date through April 30, 2023) |
| COVID-19 vaccination rates | Up to 8 months | Received at least one COVID-19 vaccination (yes/no) during the 2022-23 flu season (from the patient's appointment date through April 30, 2023) |
| Count of patients with a flu vaccination during the 2022-2023 season | Up to 8 months | Patient receives a flu vaccine (yes/no) during the 2022-23 flu season (from the patient's appointment date through April 30, 2023) |
| Hospitalizations | Up to 11 months | Number of hospitalizations from the patient's message appointment date through July 31, 2023 |
Countries
United States
Outcome results
None listed