Decreasing ED Utilization by Nudging Patients to Call Their Providers

Decreasing ED Utilization by Nudging Patients to Call Their Provider or Triage Nurse After Women's Health Procedures

In the present study, patients will be sent a message shortly after completing a medical procedure that informs or reminds them that they can reach out to Geisinger, and how to do it, if they have any medical issues or concerns. Researchers will assess if such messages make patients more likely to contact Geisinger with post-procedure medical concerns and decrease emergency department utilization.

Study Overview

• Status: Completed
• Conditions: Emergency Treatment; Telephone Hotlines
• Intervention / Treatment: Behavioral: message; Behavioral: provider; Behavioral: tele-nurse

Detailed Description

Decreasing emergency department (ED) over-utilization is a priority for healthcare systems across the country. Patients uncertain about a medical issue routinely end up in the ED when less costly and time-consuming alternatives could have addressed their concern. If patients reach out to healthcare facilities rather than heading directly to the ED, they can often be directed toward resources better suited to their concerns than the ED.

Geisinger is thus working to encourage patients to contact healthcare providers if any concerns arise and patients are uncertain about where to go for care. Patients who have recently had a medical procedure may be particularly valuable to encourage, as they routinely have concerns related to the procedure and discharge can serve as a useful touch-point to remind the patient where they can go for questions or concerns.

In the present study, patients will be sent a patient portal message shortly after completing any Women's Health medical procedure. The message will inform or remind patients how they can reach Geisinger if they have any medical issues or concerns. The purpose of this study is to assess if such messages make patients more likely to contact Geisinger with medical concerns and, in turn, decrease unnecessary ED utilization. This study will A/B test 2 messages, encouraging patients to either call their recent provider directly or to call a tele-nurse hotline, and will assess if these messages perform better than a control group that will not be sent any such message.

Generalized linear models will examine the primary study outcomes as a function of the study arms (between-subjects).

• Study Type: Interventional
• Enrollment (Actual): 11546
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United States
  • Pennsylvania
    • Danville, Pennsylvania, United States, 17822
      • Geisinger

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child; Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Patient had a procedure in Women's Health within the study period (including both surgical and in-office procedures as well as baby delivery)
• Patient is enrolled in myGeisinger, Geisinger's patient portal

Exclusion Criteria:

• If procedure was labor that resulted in fetal demise or stillborn.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Health Services Research
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Double

Number of Arms

3

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
No Intervention: Control; No intervention control group
Experimental: Nudge: call provider; This group will receive a patient portal message the morning after completing their procedure. The message will encourage patients to call their recent Women's Health provider (with appropriate phone number listed) if any questions or concerns arise about their healthcare.	Behavioral: message; patient portal message; Behavioral: provider; nudging calling the patient's provider
Experimental: Nudge: call tele-nurse; This group will receive a patient portal message the morning after completing their procedure. The message will encourage patients to call Geisinger's nurse triage hotline (with appropriate phone number listed) if any questions or concerns arise about their healthcare.	Behavioral: message; patient portal message; Behavioral: tele-nurse; nudging calling the tele-nurse

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Phone calls	Proportion of patients who call the tele-nurse or their provider within 30 days of their appointment	18 months or as long as it takes to reach N=17,300, whichever occurs first
ED utilization	Proportion of patients who visit the ED within 30 days of their appointment	18 months or as long as it takes to reach N=17,300, whichever occurs first

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Phone calls	Proportion of patients who call the tele-nurse or their provider within 30 days of their appointment	12 months
ED utilization	Proportion of patients who visit the ED within 30 days of their appointment	12 months
Phone calls - surgical patients only	Proportion of patients who call the tele-nurse or their provider within 30 days of their appointment	18 months or as long as it takes to reach N=17,300, whichever occurs first
ED utilization - surgical patients only	Proportion of patients who visit the ED within 30 days of their appointment	18 months or as long as it takes to reach N=17,300, whichever occurs first
Phone calls - surgical patients only	Proportion of patients who call the tele-nurse or their provider within 30 days of their appointment	12 months
ED utilization - surgical patients only	Proportion of patients who visit the ED within 30 days of their appointment	12 months

Collaborators and Investigators

• Sponsor: Geisinger Clinic
• Investigators: Principal Investigator: Amir Goren, PhD, Geisinger Clinic

Study record dates

Study Major Dates

• Study Start (Actual): November 16, 2021
• Primary Completion (Actual): June 15, 2023
• Study Completion (Actual): June 15, 2023

Study Registration Dates

• First Submitted: September 23, 2020
• First Submitted That Met QC Criteria: September 23, 2020
• First Posted (Actual): September 29, 2020

Study Record Updates

• Last Update Posted (Actual): July 18, 2023
• Last Update Submitted That Met QC Criteria: July 14, 2023
• Last Verified: July 1, 2023

More Information

Terms related to this study

• Keywords: Patient Portal; Behavioral Economics
• Additional Relevant MeSH Terms: Pathologic Processes; Disease Attributes; Emergencies
• Other Study ID Numbers: 2020-0849

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES
• IPD Plan Description: Data with no personally identifiable information will be made available to other researchers on the Open Science Framework for transparency.
• IPD Sharing Time Frame: The data will become available after publication of study results in a scientific journal and will be available as long as the Open Science Framework hosts the data.
• IPD Sharing Access Criteria: The data on the Open Science Framework will be open to anyone requesting that information.
• IPD Sharing Supporting Information Type: ANALYTIC_CODE

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No