Reducing Emergency Department Utilization With an After Visit Summary Nudge Toward Alternative Care Options

Decreasing utilization of the Emergency Department (ED) is a priority for the system. Often, ED visits can be avoided if patients contact Geisinger first to get appropriate direction for their concern or are otherwise better informed about reasons to visit the ED vs. urgent care or primary care facilities. The study team is working to reduce ED utilization by including additional information in adult outpatient After Visit Summaries (AVSs). The study will involve will involve A/B testing different AVS versions, including 1) a version that encourages patients to contact Geisinger via different contact methods, 2) a version that includes a map to the patient's closest ConvenientCare location and accompanying information about ConvenientCare, and 3) a version that includes a self-triage guide. A control group will receive the current standard AVS. Analysis results will be assessed to determine which version is most effective at reducing ED use.

Study Overview

• Status: Completed
• Conditions: Behavior, Health
• Intervention / Treatment: Behavioral: Contact information; Behavioral: Urgent care map; Behavioral: Self-triage chart

• Study Type: Interventional
• Enrollment (Actual): 239841
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Amir Goren, PhD; Phone Number: 570-214-4395; Email: agoren@geisinger.edu

Study Locations

• United States
  • Pennsylvania
    • Danville, Pennsylvania, United States, 17822
      • Geisinger Clinic
      • Contact: Amir Goren, PhD
      • Contact: Gail Rosenbaum, PhD

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Age 18+
• Has a Geisinger Primary Care Physician assigned
• Completes an outpatient office visit or telemedicine appointment at Geisinger

Exclusion Criteria:

• The AVS was not printed according to the EHR, and the patient does not have an active MyGeisinger patient portal account, so they do not have a way to view the AVS

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Prevention
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

4

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Contact us first; Patients in this arm will receive the standard AVS, plus information on how to contact Geisinger if they need medical attention.	Behavioral: Contact information; Information on how to contact Geisinger if the patient needs care
Experimental: Contact us first + urgent care map; Patients in this arm will receive the standard AVS, plus information on how to contact Geisinger if they need medical attention, plus a map to their nearest Geisinger urgent care location and additional information about urgent care.	Behavioral: Contact information; Information on how to contact Geisinger if the patient needs care; Behavioral: Urgent care map; A map of the patient's nearest Geisinger urgent care location, with information about urgent care
Experimental: Contact us first + urgent care map + self-triage; Patients in this arm will receive the standard AVS, plus information on how to contact Geisinger if they need medical attention, plus a map to their nearest Geisinger urgent care location and additional information about urgent care. This arm will also receive a self-triage chart, with common reasons patients go to the ED and situations where seeking alternative care might be appropriate.	Behavioral: Contact information; Information on how to contact Geisinger if the patient needs care; Behavioral: Urgent care map; A map of the patient's nearest Geisinger urgent care location, with information about urgent care; Behavioral: Self-triage chart; A chart demonstrating what to do in response to several common conditions where the patient might be compelled to visit the ED
No Intervention: Standard practice; Patients in this arm will receive the current standard practice AVS.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Inappropriate ED visits	Visited the ED inappropriately (y/n) We will apply the NYU algorithm (Ballard et al., 2010) to determine whether an ED visit is inappropriate.	In the 30 days following the appointment

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Urgent care visits	Visited urgent care (y/n)	In the 30 days following the appointment
Calls	Called Geisinger (y/n)	In the 30 days following the appointment
Patient portal messages	Sent a patient portal message (y/n)	In the 30 days following the appointment

Collaborators and Investigators

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

Study record dates

Study Major Dates

• Study Start (Actual): April 3, 2023
• Primary Completion (Actual): December 11, 2023
• Study Completion (Actual): December 11, 2023

Study Registration Dates

• First Submitted: March 8, 2023
• First Submitted That Met QC Criteria: March 27, 2023
• First Posted (Actual): March 28, 2023

Study Record Updates

• Last Update Posted (Actual): February 26, 2024
• Last Update Submitted That Met QC Criteria: February 22, 2024
• Last Verified: February 1, 2024

More Information

Terms related to this study

• Keywords: Emergency Department Use; Urgent Care Use
• Additional Relevant MeSH Terms: Pathologic Processes; Disease Attributes; Emergencies
• Other Study ID Numbers: 2022-0340

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. This will include the essential data and code needed to replicate the analysis that yielded reported findings.
• IPD Sharing Time Frame: By the paper's online publication date. Data will remain available for as long as the Open Science Framework hosts it.
• IPD Sharing Access Criteria: The data on the Open Science Framework will be open to anyone requesting that information.
• IPD Sharing Supporting Information Type: STUDY_PROTOCOL; SAP; 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