Influenza Vaccination, Health Promotion, Health Behavior, Risk Reduction
Conditions
Keywords
Flu Vaccine, Choice Architecture, Machine Learning, Perceived Credibility
Brief summary
The purpose of this study is to test which modalities (mailed letter, short message service \[SMS\] text, or patient portal messages) are most effective for encouraging flu shots in high-risk patients.
Detailed description
The Centers for Disease Control (CDC) 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. Flu shots are particularly important for patients at high risk of experiencing severe outcomes. During the 2020-21 and 2021-22 flu seasons, the study team sent messages to Geisinger patients in the top 10% of risk for flu and complications according to an artificial intelligence algorithm. Messages that told patients they were at high risk significantly increased their likelihood of getting vaccinated. The present study will extend previous work by testing which modality or modalities are most effective at boosting flu shot rates in patients at high risk. In previous campaigns, patients received messages via all communication modalities patients were eligible for (mailed letter, SMS text, and/or patient portal message). In this study, patients will be randomized to receive high-risk messages in one or more modalities.
Interventions
BEHAVIORALLetter
Mailed letter about flu vaccination
BEHAVIORALPatient portal
Patient portal message about flu vaccination
BEHAVIORALSMS
SMS about flu vaccination
Sponsors
Geisinger Clinic
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
SINGLE (Caregiver)
Masking description
Providers who prescribe vaccination and diagnose conditions will not be randomized to study arms or informed of patient assignment. Although patients will not be explicitly informed which arm they have been randomized to, they will be aware of the messages they receive.
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Included 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) * Aged 18 or older * In the top 10% of risk for flu and flu complications, according to Medial's flu complications machine learning algorithm (which operates on coded EHR data) * Has a Geisinger PCP assigned as of August 2022 * Has had an encounter in the last 2 years as of August 2022
Exclusion criteria
\- Cannot be contacted via any of the communication modalities (e.g., letter, patient portal, SMS) being used in the study, either due to insufficient/missing contact information in the EHR or because they opted out of all modalities
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Flu vaccination | 4 weeks after the first messages are sent in the study | Flu vaccination within 4 weeks of the first message send date |
Other
| Measure | Time frame | Description |
|---|---|---|
| Likely flu diagnosis | Up to 8 months | Received a high confidence flu diagnosis (with positive 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 first message send date through April 30, 2023). Note that likely flu is a superset of the high confidence flu diagnoses. |
| Flu complications | Up to 11 months | Diagnosed with flu-related complications (yes/no) from the first message send date through July 31, 2023. |
| 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 first message send date through April 30, 2023). |
| Hospitalizations | Up to 11 months | Number of hospitalizations from the first message send date through July 31, 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 first message send date through April 30, 2023). |
| ER visits | Up to 11 months | Number of ER visits from the first message send date through July 31, 2023. |
Countries
United States
Outcome results
None listed