Breast Cancer, Colorectal Cancer, Diabetes Mellitus, Pneumonia, Pneumococcal
Conditions
Brief summary
Primary care visits are a key aspect of clinical care focused on helping patients to close care gaps related to preventive care such as vaccination, diabetes testing, statin therapy and cancer screening. However, less than 50% of care gaps are closed during these visits and new approaches are needed to prime patients for a discussion during these visits. In this study, the study team will evaluate a health system initiative that uses text messaging to patients in days preceding a primary care visit to prime patients to be amenable to ordering of vaccination, diabetes testing, cancer screening, and statin prescribing.
Detailed description
The United States Preventive Services Task Force has recommended tests and treatments for vaccination, diabetes testing, statin therapy, and cancer screening. These preventive services have been demonstrated to reduce illness and improve quality of care. Yet, more than 50% of open care gaps go unaddressed during primary care visits. Nudges are subtle changes to the way information is framed or choices are offered that can have a significant impact on behavior. In a previous randomized clinical trial, text messages sent to patients prior to primary care visits increased vaccination by up to 11% relative to control. The most effective message told patients the influenza vaccine was reserved for you, and sent two text messages to patients in the 3 days preceding a primary care appointment.
Interventions
BEHAVIORALText message nudge
The text message nudge will be sent to patients 3 days and 1 day prior to a visit with the primary care practices and notify them of up to 3 care gaps based on electronic health record data. Care gaps will be selected based on availability and ranked in this order: influenza vaccination, pneumococcal vaccination, breast cancer screening, colorectal cancer screening, hemoglobin A1 testing, or statin therapy.
Sponsors
Mitesh Patel
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
DOUBLE (Investigator, Outcomes Assessor)
Intervention model description
This study will use a randomized clinical trial to evaluate a health system initiative to improve care gap closure. We will randomly assign primary care practices that use AthenaClinicals electronic health record at the following locations at Ascension's health system: Alabama-Birmingham, Kansas-Wichita, Tennessee-Nashville, Texas-Austin, and Texas-Waco. These practices will have the opportunity to opt-out from the program before randomization occurs.
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
* Age 18 or older * Have documented consent to communicate electronically * Have a visit scheduled with a primary care practice * Have at least one open care gap among those in the intervention
Exclusion criteria
* No phone number on file to send text messages
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Care gap order rate | By the end of the day of the primary care visit | The proportion of open care gaps that have a test or treatment ordered to address them |
Other
| Measure | Time frame | Description |
|---|---|---|
| Care gap completion rate | Within 3 months of the primary care visit | The proportion of open care gaps that have a test or treatment completed to address them. Exploratory and only if data is available |
Countries
United States
Outcome results
None listed