Nudging High Emergency Department Utilizers to Consider Non-emergent Healthcare Resources

Point of ED Discharge Interactive Outreach: High ED Utilizers

The goal of this campaign is to reduce unnecessary ED visits by providing patients who are high ED utilizers (with a visit of any acuity) with alternative resources to manage their health outside of the ED. In this campaign, patients will be randomized to receive one of two types of outreach following discharge aligned with the goal. Outreach may occur via (1) a phone call from a Geisinger Community Health Worker (CHW) or Community Medical Assistant (CMA); current standard practice or (2) an interactive chatbot message providing similar information and questions to those provided by the CHW/CMA. The study team will measure whether ED use differs across patients in different outreach conditions. The study team will also examine whether patients followed through on the message-specific calls to action in the messages differently across conditions.

Study Overview

• Status: Completed
• Conditions: Emergency Service, Hospital
• Intervention / Treatment: Behavioral: Live outreach; Behavioral: Automated interactive messages

• Study Type: Interventional
• Enrollment (Actual): 1126
• 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:

• Geisinger Health Plan insurance or KACO membership
• Any PCP or no PCP
• Visit of any acuity
• 4 or more ED visits in the past 6 months

Exclusion Criteria:

• 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
• Qualifies for more intensive care management due to higher-level category of complexity

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

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: Community Health Worker/Community Medical Assistant Outreach; Patients will receive outreach from a community health worker or a community medical assistant, as is current standard practice, including guidance about ED-alternative resources to encourage care outside of the ED when appropriate.	Behavioral: Live outreach; High ED utilizers will be called (and possibly visited) by a CHW/CMA guiding them through ED-alternative resources.; Other Names: Call
Experimental: SMS Chatbot Messages; Patients will be sent interactive SMS chatbot messages, including guidance about ED-alternative resources to encourage care outside of the ED when appropriate; patients will not receive outreach from a community health worker or community medical assistant.	Behavioral: Automated interactive messages; High ED utilizers will be sent SMS text messages guiding them through ED-alternative resources, with different guidance (including a follow-up phone call from a healthcare worker) depending on patient responses.; Other Names: Text

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Return to ED (Y/N)	Patient had a new Geisinger ED encounter after being discharged	Within 120 calendar days following day of discharge

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Successful Patient Contact (Y/N) - 3 days	At least one successful contact between patient and a CMA, a CHW, or a representative at the monitoring center (Y/N)	Within 3 business days following day of discharge
Successful Patient Contact (Y/N) - 5 days	At least one successful contact between patient and a CMA, a CHW, or a representative at the monitoring center (Y/N)	Within 5 business days following day of discharge
Time to Contact	Time to successful patient contact by monitoring center, CMA, or CHW	Within 30 calendar days following day of discharge
Patient replied via SMS text (Y/N) to Artera chatbot	Patient responded to the Artera chatbot at least once (Y/N)	Within 7 calendar days following first Artera outreach
ED Use (Y/N)	Patient had a new Geisinger ED encounter after being discharged	Within 30 calendar days following day of discharge
ED Use After Outreach (Y/N)	Patient had a new Geisinger ED encounter after receiving outreach	Within 30 calendar days following day of outreach by Artera, CMA, or CHW

Collaborators and Investigators

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

Study record dates

Study Major Dates

• Study Start (Actual): February 3, 2025
• Primary Completion (Actual): September 20, 2025
• Study Completion (Actual): September 20, 2025

Study Registration Dates

• First Submitted: January 29, 2025
• First Submitted That Met QC Criteria: February 7, 2025
• First Posted (Actual): February 11, 2025

Study Record Updates

• Last Update Posted (Actual): March 13, 2026
• Last Update Submitted That Met QC Criteria: March 11, 2026
• Last Verified: March 1, 2026

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Pathologic Processes; Disease Attributes; Pathological Conditions, Signs and Symptoms; Emergencies; Amino Acids, Peptides, and Proteins; Proteins; Biological Factors; Carbohydrates; Equipment and Supplies; Membrane Proteins; Glycoproteins; Glycoconjugates; Antigens; Antigens, Surface; Biomarkers; Cell Adhesion Molecules; Membrane Glycoproteins; Self-Help Devices; Neural Cell Adhesion Molecules; Cell Adhesion Molecules, Neuronal; Antigens, Differentiation, T-Lymphocyte; Antigens, Differentiation; Communication Devices for People with Disabilities; CD56 Antigen
• Other Study ID Numbers: 2024-0686

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