Decreasing ED Utilization by Nudging Patients to Call Their Providers

Study Overview
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Brief Summary
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In the present study, patients will be sent a message shortly after completing a medical procedure that informs or reminds them that they can reach out to Geisinger, and how to do it, if they have any medical issues or concerns. Researchers will assess if such messages make patients more likely to contact Geisinger with post-procedure medical concerns and decrease emergency department utilization.

Detailed Description
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Decreasing emergency department (ED) over-utilization is a priority for healthcare systems across the country. Patients uncertain about a medical issue routinely end up in the ED when less costly and time-consuming alternatives could have addressed their concern. If patients reach out to healthcare facilities rather than heading directly to the ED, they can often be directed toward resources better suited to their concerns than the ED. Geisinger is thus working to encourage patients to contact healthcare providers if any concerns arise and patients are uncertain about where to go for care. Patients who have recently had a medical procedure may be particularly valuable to encourage, as they routinely have concerns related to the procedure and discharge can serve as a useful touch-point to remind the patient where they can go for questions or concerns. In the present study, patients will be sent a patient portal message shortly after completing any Women's Health medical procedure. The message will inform or remind patients how they can reach Geisinger if they have any medical issues or concerns. The purpose of this study is to assess if such messages make patients more likely to contact Geisinger with medical concerns and, in turn, decrease unnecessary ED utilization. This study will A/B test 2 messages, encouraging patients to either call their recent provider directly or to call a tele-nurse hotline, and will assess if these messages perform better than a control group that will not be sent any such message. Generalized linear models will examine the primary study outcomes as a function of the study arms (between-subjects).

Official Title
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Decreasing ED Utilization by Nudging Patients to Call Their Provider or Triage Nurse After Women's Health Procedures

Conditions
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Emergency Treatment, Telephone Hotlines

Intervention / Treatment
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* Behavioral: message
* Behavioral: provider
* Behavioral: tele-nurse


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patient had a procedure in Women's Health within the study period (including both surgical and in-office procedures as well as baby delivery) Patient is enrolled in myGeisinger, Geisinger's patient portal Exclusion Criteria: If procedure was labor that resulted in fetal demise or stillborn.
Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Health Services Research
Allocation: Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: Throughout the study, patients will be randomized equally across all three arms.
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| No Intervention: Control<br>No intervention control group | |
| Experimental: Nudge: call provider<br>This group will receive a patient portal message the morning after completing their procedure. The message will encourage patients to call their recent Women's Health provider (with appropriate phone number listed) if any questions or concerns arise about their healthcare. | Behavioral: message<br>* patient portal message<br>Behavioral: provider<br>* nudging calling the patient's provider<br>|
| Experimental: Nudge: call tele-nurse<br>This group will receive a patient portal message the morning after completing their procedure. The message will encourage patients to call Geisinger's nurse triage hotline (with appropriate phone number listed) if any questions or concerns arise about their healthcare. | Behavioral: message<br>* patient portal message<br>Behavioral: tele-nurse<br>* nudging calling the tele-nurse<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Phone calls | Proportion of patients who call the tele-nurse or their provider within 30 days of their appointment | 18 months or as long as it takes to reach N=17,300, whichever occurs first | 
| ED utilization | Proportion of patients who visit the ED within 30 days of their appointment | 18 months or as long as it takes to reach N=17,300, whichever occurs first | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Phone calls | Proportion of patients who call the tele-nurse or their provider within 30 days of their appointment | 12 months | 
| ED utilization | Proportion of patients who visit the ED within 30 days of their appointment | 12 months | 
| Phone calls - surgical patients only | Proportion of patients who call the tele-nurse or their provider within 30 days of their appointment | 18 months or as long as it takes to reach N=17,300, whichever occurs first | 
| ED utilization - surgical patients only | Proportion of patients who visit the ED within 30 days of their appointment | 18 months or as long as it takes to reach N=17,300, whichever occurs first | 
| Phone calls - surgical patients only | Proportion of patients who call the tele-nurse or their provider within 30 days of their appointment | 12 months | 
| ED utilization - surgical patients only | Proportion of patients who visit the ED within 30 days of their appointment | 12 months | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Behavioral Economics, Patient Portal