Preventive Reminder Ordering AssistanCe Via Texting for Improved Visit Encounters
ConditionBehavior, Health
Trial statusNot yet recruiting
Trial phaseNot applicable
Trial typeInterventional
Biological sexAll
Age18+
SponsorUniversity of Pennsylvania
About this trial
A substantial portion of the United States population remains overdue for key screenings, despite availability and insurance coverage of preventive health services. Barriers for completion and remaining up to date with screening include patients not remaining actively engaged with their care team, time constraints during office visits, and operational strain. This project aims to implement and evaluate a primary care visit-based program that harmonizes multiple preventive health and chronic disease management care gaps, reduces staff burden, and improves ordering and subsequent patient follow through on completion of overdue care gaps.
In this study, we will evaluate nudges to clinicians and patients to help increase screening completion for multiple care gaps identified as high priority by primary care, including imaging (Mammogram, DEXA) and labs (Diabetes Management (Hemoglobin A1C, Basic Metabolic Panel, and Urine Microalbumin), Hepatitis C, and Lipids). This will be a 6 month, stepped-wedge, pragmatic trial conducted at Penn Medicine.
Eligibility criteria
This trial does not accept healthy volunteersQualifiers
18 years or older
A scheduled new or return (non-urgent/sick) primary care visit at one of the study practices
Overdue for at least one of the included care gaps according to Health Maintenance: Mammogram, DEXA, Hemoglobin A1C, Basic Metabolic Panel, Urine Microalbumin, Lipids, Hepatitis C
Last eligible office visit was greater than or equal to 3 months ago
Disqualifiers
None
Trial design
Design model
Sequential
Treatments tested in this trial
Pre-visit and post-visit patient messaging
BehavioralThe patient nudges will be delivered by a series of one to three text messages. Patients will receive the pre-visit text message 2 days prior to their scheduled primary care visit. This message will remind them that they are overdue for their preventive care imaging and/or labs and encourage them to speak with their provider about screening completion during their upcoming appointment. All patients who complete their primary care visit and whose provider signed at least one of their pended orders will be sent post-visit text messages 7 and 14 days after completion, if they have not yet scheduled or completed their overdue labs and/or imaging. The messages delivered at 7 and 14 days will remind patients that appointments for lab and imaging are available for them and provide phone number(s) to call for scheduling and a link to complete scheduling online. Patients will also have the option to engage with a bi-directional support menu via text message.
Default pended order
BehavioralThe default pended orders will be automatically placed into the patient's primary care visit encounter via a custom Epic extension for each included care gap (mammogram, DEXA, hemoglobin A1C, basic metabolic panel, urine microalbumin, lipids, and Hepatitis C) that the patient is overdue for according to their Health Maintenance status. Clinical staff will have the option of signing the order or dismissing it if they deem it inappropriate for a given patient.
EHR communication
BehavioralAn electronic health record (EHR) communication will be visible to the provider and entire care team during the visit encounter. This smart data element (SDE) communication will display in the patient's EHR encounter as a section in pre-charting, check-in, and rooming, and will notify the clinician and care team that a pre-visit communication was sent to the patient regarding their overdue status for their preventive care imaging and/or labs.
Treatment groups
16,416 Participants
are divided into 2 treatment groupsGroup A: Control ConditionNo intervention 0 interventions
Group B: Active InterventionExperimental treatment 3 interventions
Trial outcomes
Primary outcomes
1
Mammogram Screening Completion (3 months)
The primary outcome is the proportion of patients overdue who complete a mammogram within 3 months after the first eligible primary care visit.
Time frame
Within 3 months after first eligible primary care visit.2
Hepatitis C Screening Completion (3 months)
The primary outcome is the proportion of patients overdue who complete Hepatitis C screening within 3 months after the first eligible primary care visit.
Time frame
Within 3 months after first eligible primary care visit.3
Lipids Screening Completion (3 months)
The primary outcome is the proportion of patients overdue who complete lipids screening within 3 months after the first eligible primary care visit.
Time frame
Within 3 months after first eligible primary care visit.Secondary outcomes
1
DEXA Screening Completion (3 months)
The secondary outcome is the proportion of patients overdue who complete DEXA screening within 3 months after the first eligible primary care visit.
Time frame
Within 3 months after the first eligible primary care visit.2
Hemoglobin A1C Screening Completion (3 months)
The secondary outcome is the proportion of patients overdue who complete Hemoglobin A1C screening within 3 months after the first eligible primary care visit.
Time frame
Within 3 months after the first eligible primary care visit.3
Basic Metabolic Panel Screening Completion (3 months)
The secondary outcome is the proportion of patients overdue who complete Basic Metabolic Panel screening within 3 months after the first eligible primary care visit.
Time frame
Within 3 months after the first eligible primary care visit.4
Urine Microalbumin Screening Completion (3 months)
The secondary outcome is the proportion of patients overdue who complete Urine Microalbumin screening within 3 months after the first eligible primary care visit.
Time frame
Within 3 months after the first eligible primary care visit.Sponsors and contacts
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Source ClinicalTrials.gov
This trial is not recruiting at the moment. You can still explore other options: