- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT06057727
Behavioral Economics to Improve Flu Vaccination Using EHR Nudges (BE IMMUNE)
February 21, 2024 updated by: Shivan J Mehta, University of Pennsylvania
BE IMMUNE: Behavioral Economics to IMprove and Motivate Vaccination Using Nudges Through the EHR
This study will be a multisite, cluster randomized, pragmatic trial to evaluate the effectiveness of personalized nudges to clinicians and patients, relative to a control, to increase flu vaccination rates among older adults in accordance with CDC guidelines.
This will include clinician and patient level nudge interventions, with an additional, intensified nudge intervention for patients identified as high risk for not receiving a flu vaccine.
Among the intervention clinics, patients will receive pre-visit text message reminders about the flu vaccine, and clinicians will receive a default pended order in the visit encounter in the EHR, along with monthly peer comparison feedback about their flu vaccine completion rate.
Patients identified as high risk for noncompletion will be individually randomized to receive an additional bidirectional text message nudge or the standard text messaging.
Study Overview
Status
Active, not recruiting
Conditions
Detailed Description
Many older adults are at risk of illness, hospitalization, and death from vaccine-preventable diseases.
More than half of older adults in the United States are not vaccinated for flu which has remained relatively constant over the past decade, and there are racial, ethnic, and socioeconomic disparities in care.
In this study, we will evaluate personalized nudges to clinicians and patients to help increase flu vaccination rates during primary care visits among older adults, with a particular focus on population subgroups at high risk for vaccine noncompletion.
In a partnership between Penn Medicine and University of Washington (UW) Medicine, this will be a 6-month, multisite, cluster randomized, pragmatic trial with an additional intensification arm for high-risk patients.
Study Type
Interventional
Enrollment (Actual)
80215
Phase
- Not Applicable
Contacts and Locations
This section provides the contact details for those conducting the study, and information on where this study is being conducted.
Study Contact
- Name: Shivan Mehta, MD,MBA,MSHP
- Phone Number: 215-898-9807
- Email: Shivan.Mehta@pennmedicine.upenn.edu
Study Contact Backup
- Name: Caitlin McDonald, MPH
- Email: cmcdona@pennmedicine.upenn.edu
Study Locations
-
-
Pennsylvania
-
Philadelphia, Pennsylvania, United States, 19104
- University of Pennsylvania Health System
-
-
Washington
-
Seattle, Washington, United States, 98195
- University of Washington
-
Contact:
- Andrew White, MD
- Phone Number: 999-999-9999
- Email: andwhite@uw.edu
-
Contact:
- Chaylin Couzens, MPH
- Phone Number: 999-999-9999
- Email: ccouzens@uw.edu
-
Principal Investigator:
- Joshua Liao, MD
-
-
Participation Criteria
Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.
Eligibility Criteria
Ages Eligible for Study
- Adult
- Older Adult
Accepts Healthy Volunteers
No
Description
Patient Inclusion Criteria:
All patients must meet the following criteria to be eligible:
- Age >50 years
- A scheduled new or return (non-urgent/sick) primary care appointment at one of the study practices at the Penn Medicine, UW Medicine, or Sutter Health
- Have not received their annual flu vaccine during the active intervention period (September- February)
- Eligible to receive the flu vaccine
For the high risk intensification nudge, at least one of the following criteria must be met to be considered high risk and randomized to receive the intensification nudge:
- Age ≥ 70 years
- Living in a lower income community (lowest quartile, zip-code based)
- Did not receive a flu vaccine in the previous calendar year
- Self-identifies as Non-Hispanic Black
Patient Exclusion Criteria:
- Have a documented allergy to flu vaccine
- Have a flu vaccine exclusion modifier in Health Maintenance
- Have opted out of research according to individual site guidelines and policies
- Have no phone number (home or mobile) listed in their chart
Clinician Inclusion Criteria:
Clinicians must meet the following criteria to be eligible to receive peer comparison feedback:
- Practicing physician (MD, DO) or advanced practice provider (NP, PA) with the exception of residents and fellows
- Have a minimum patient panel of at least 50 patients, and
- Practicing at a clinical site randomized to receive the clinic-level nudge interventions.
Study Plan
This section provides details of the study plan, including how the study is designed and what the study is measuring.
How is the study designed?
Design Details
- Primary Purpose: Health Services Research
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Double
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
No Intervention: Control
Clinics randomized to the control arm will receive standard of care.
|
|
Experimental: Intervention Arm
Clinics randomized to the intervention arm will receive the toolkit of clinician and patient facing nudges.
Patient nudges will be pre-visit text message reminders (standard messaging content).
Clinician nudges will be monthly peer comparison feedback and default pended orders.
|
Patients will be sent text message reminders 3 days and 24 hours prior to their scheduled primary care visit.
The messages will inform the patient that a flu shot has been reserved for them at their upcoming appointment and encouraging the patient to ask their provider about receiving the vaccine.
A default pended order for the flu vaccine will be pended to the patient's upcoming primary care encounter and will be visible to the provider during the visit encounter.
Clinical staff will have the option of signing the order or dismissing it if they deem it inappropriate for a given patient.
Each month, clinicians will be sent an email containing what percent of their eligible patients received the flu vaccine and how that compares to other peer clinicians in the intervention.
|
Experimental: High Risk Intensification Arm
Patients in the intervention clinics identified as high risk for noncompletion of the flu vaccine will be randomized 1:1 to receive the high risk intensification arm or remain in the standard intervention arm.
Patients in the high risk intensification arm will receive an additional bidirectional texting component.
|
Patients will be sent text message reminders 3 days and 24 hours prior to their scheduled primary care visit.
The messages will inform the patient that a flu shot has been reserved for them at their upcoming appointment and encouraging the patient to ask their provider about receiving the vaccine.
A default pended order for the flu vaccine will be pended to the patient's upcoming primary care encounter and will be visible to the provider during the visit encounter.
Clinical staff will have the option of signing the order or dismissing it if they deem it inappropriate for a given patient.
Each month, clinicians will be sent an email containing what percent of their eligible patients received the flu vaccine and how that compares to other peer clinicians in the intervention.
High risk patients randomized to receive the high risk intensification nudge will receive a bidirectional text messaging component prior to their visit.
This intervention will query the patient about common questions or concerns about receiving the flu vaccine.
If the patient responds, it will provide additional educational materials based on the patient's specific concern(s).
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Proportion of patients who receive the flu vaccine at the visit
Time Frame: 4 days from enrollment, at the eligible visit
|
The primary outcome is flu vaccination completion during the first eligible primary care visit.
|
4 days from enrollment, at the eligible visit
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Proportion of patients who receive the flu vaccine within 3 months after the visit
Time Frame: 3 months
|
The secondary outcome is flu vaccination completion within 3 months after the first eligible primary care visit.
|
3 months
|
Collaborators and Investigators
This is where you will find people and organizations involved with this study.
Sponsor
Investigators
- Principal Investigator: Shivan Mehta, MD,MBA,MSHP, University of Pennsylvania
Study record dates
These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.
Study Major Dates
Study Start (Actual)
September 25, 2023
Primary Completion (Actual)
February 20, 2024
Study Completion (Estimated)
May 20, 2024
Study Registration Dates
First Submitted
September 18, 2023
First Submitted That Met QC Criteria
September 25, 2023
First Posted (Actual)
September 28, 2023
Study Record Updates
Last Update Posted (Estimated)
February 23, 2024
Last Update Submitted That Met QC Criteria
February 21, 2024
Last Verified
February 1, 2024
More Information
Terms related to this study
Other Study ID Numbers
- 851838
- R33AG068945 (U.S. NIH Grant/Contract)
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
NO
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
No
Studies a U.S. FDA-regulated device product
No
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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