Nudging High-acuity Emergency Department Patients to Schedule a Follow-up Visit

Nudging High-acuity Emergency Department Patients to Schedule a Follow-up Visit With a Primary Care Provider or Specialist Following Discharge to Decrease Emergency Department Utilization

The goal of this campaign is to reduce unnecessary emergency department (ED) visits by encouraging patients with high acuity visits to follow up with an appropriate primary care provider (PCP) or specialist and therefore obtain appropriate care outside of the ED. In this campaign, patients will be assigned to receive or not receive outreach following ED discharge that is aligned with the goal. Outreach will occur via a text message and information added to the patient's after visit summary, and will include a contact number to schedule and hyperlink to allow self-scheduling. The study will assess whether ED use differs across patients in different outreach conditions. It will also examine whether patients followed through on the calls to action in the messages differently across conditions.

Study Overview

• Status: Completed
• Conditions: Emergency Service, Hospital
• Intervention / Treatment: Behavioral: Information about scheduling a follow-up appointment

Detailed Description

Enrollment will conclude when either 7500 participants have been enrolled or after 120 days, whichever occurs first.

• Study Type: Interventional
• Enrollment (Actual): 6814
• Phase: Not Applicable

Contacts and Locations

Study Locations

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

Participation Criteria

Eligibility Criteria

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

Description

Inclusion Criteria:

• >= 18 years of age
• ED visit rated as high acuity (level L2 or L3)
• Discharged from ED in past 24 hours
• Attributed to a Geisinger PCP in Community Medicine Service Line

Exclusion Criteria:

• Have an appointment scheduled within 7 days following discharge with a primary care provider or specialist
• Institutionalized
• Cannot be contacted via the communication modality being used in the study (i.e., SMS), due to insufficient/missing contact information in the electronic health record or because the patient opted out
• Admitted to hospital
• Eloped from ED
• Left ED without being seen
• Deceased prior to messaging

Study Plan

How is the study designed?

Design Details

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

Number of Arms

3

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
No Intervention: Control; This arm will receive no intervention outside of usual care.
Experimental: Experimental: Schedule Follow-Up Visit - 1 message; This arm will receive a text message (at 1 day post-ED discharge) and information added to the patient's after visit summary providing a number and patient portal hyperlink via which to schedule an ED follow-up appointment.	Behavioral: Information about scheduling a follow-up appointment; Text message(s) will be sent following discharge from the emergency department, along with an after visit summary.; Other Names: Text messages; Information
Experimental: Experimental: Schedule Follow-Up Visit - 2 messages; This arm will receive text messages (at 1 day and 8 days post-ED discharge) and information added to the patient's after visit summary providing a number and patient portal hyperlink via which to schedule an ED follow-up appointment.	Behavioral: Information about scheduling a follow-up appointment; Text message(s) will be sent following discharge from the emergency department, along with an after visit summary.; Other Names: Text messages; Information

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Return to ED	ED visit (yes/no)	within 120 days following day of discharge

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
PCP/specialist appointment attended	PCP or specialist appointment attended	within 7 days following day of discharge
PCP/specialist appointment attended	PCP or specialist appointment attended	within 14 days following day of discharge
PCP/specialist appointment attended	PCP or specialist appointment attended	within 30 days following day of discharge
PCP/specialist appointment attended	PCP or specialist appointment attended	within 60 days following day of discharge
PCP/specialist appointment made	PCP or specialist appointment made	within 7 days following day of discharge
PCP/specialist appointment made	PCP or specialist appointment made	within 14 days following day of discharge
PCP/specialist appointment made	PCP or specialist appointment made	within 30 days following day of discharge
PCP/specialist appointment made	PCP or specialist appointment made	within 60 days following day of discharge

Collaborators and Investigators

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

Study record dates

Study Major Dates

• Study Start (Actual): August 9, 2024
• Primary Completion (Actual): April 6, 2025
• Study Completion (Actual): April 6, 2025

Study Registration Dates

• First Submitted: July 8, 2024
• First Submitted That Met QC Criteria: August 1, 2024
• First Posted (Actual): August 2, 2024

Study Record Updates

• Last Update Posted (Estimated): June 5, 2025
• Last Update Submitted That Met QC Criteria: June 4, 2025
• Last Verified: June 1, 2025

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Pathologic Processes; Disease Attributes; Emergencies
• Other Study ID Numbers: 2024-0412

Drug and device information, study documents

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