Encouraging Overdue Healthcare Appointment Scheduling Among Patients With Chronic Diseases

Study Overview
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Brief Summary
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The goal of this study is to determine the most effective messages for encouraging patients with chronic conditions, who have not seen their doctor in at least one year, to return to the clinic. Study participants will receive postcards or letters encouraging them to make an appointment. Researchers will assess whether messages increase appointment scheduling (and attendance).

Detailed Description
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About 18,500 Geisinger patients, Geisinger Health Plan members, and Medicaid patients with chronic illness have not been seen in a clinic for at least one year, which is concerning because regular appointments are necessary for chronic disease management. Geisinger is therefore working to encourage those with chronic illness and overdue appointments to return to the clinic. In the present study, patients will either receive a mailer (with a message encouraging them to schedule an appointment with their physician), or no mailer. The purpose of the study is to compare three different mailers to assess which is most effective at encouraging patients to schedule and attend an appointment. The three mailers include (1) a standard outreach postcard (emphasizing that we are checking in with the patient), and, informed by behavioral science research, (2) a postcard with a cartoon and humorous messages and (3) a letter signed by a physician. The study will compare the effectiveness of the three experimental mailer arms to each other and to a no-contact control arm.

Official Title
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Encouraging Overdue Healthcare Appointment Scheduling Among Patients With Chronic Diseases

Conditions
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Health Promotion, Prevention, Risk Reduction Behavior

Intervention / Treatment
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* Behavioral: Outreach mailer
* Behavioral: Humor/Salience
* Behavioral: Doctor's authority
* Behavioral: Information


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Geisinger patient, Geisinger Health Plan member or Medicaid patient Chronic illness No appointment for > 1 year

Ages Eligible for Study
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Minimum Age: 18 Years

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
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Outreach Postcard<br>This group receives a postcard with a stock image on the front and a message encouraging regular visits to manage health on the back. | Behavioral: Outreach mailer<br>* Postcard or letter<br>|
| Experimental: Humorous Postcard<br>This group receives a postcard with with a cartoon image and a visit-related joke on the front and a humorous message on the back, with additional information about why visits are important, and what to expect at the appointment. | Behavioral: Outreach mailer<br>* Postcard or letter<br>Behavioral: Humor/Salience<br>* Funny cartoon<br>Behavioral: Information<br>* Information about benefits of the appointment<br>|
| Experimental: Physician Letter<br>This group receives a personalized letter signed by a physician with information about why visits are important, and what to expect at the appointment. | Behavioral: Outreach mailer<br>* Postcard or letter<br>Behavioral: Doctor's authority<br>* Letter from a doctor<br>Behavioral: Information<br>* Information about benefits of the appointment<br>|
| No Intervention: No-contact Control<br>This group will not receive a study mailer during the trial. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Patients - Appointment scheduling | Proportion of Geisinger patients who schedule an appointment | 30 days | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Patients - Appointment scheduling - Comparing mailers | Proportion of Geisinger patients who schedule an appointment, comparing relative efficacy of the mailers | 30 days | 
| Patients - Attendance at scheduled appointments within 180 days of mailer | Proportion of appointments (from the primary outcome) that were attended. This outcome focuses on attendance at appointments that were scheduled within 30 days of the mailer drop date. It is possible to schedule an appointment months in advance, so the Time Frame needs to be long to capture attendance at any appointment scheduled within 30 days of the mailer. 180 days should be sufficient to capture all scheduled appointments. | 180 days | 
| Patients, Members & Medicaid - Attendance at any appointment | Attendance at any appointment within 30 days of drop date | 30 days | 
| Patients, Members & Medicaid - Attendance at any appointment | Attendance at any appointment within 90 days of drop date | 90 days | 
| Patients, Members & Medicaid - Attendance at any appointment | Attendance at any appointment within 180 days of drop date | 180 days | 
| Patients, Members & Medicaid - Timing of appointment | Number of days between the drop date and any appointment captured in Secondary Outcome 3 | 30 days | 
| Patients, Members & Medicaid - Timing of appointment | Number of days between the drop date and any appointment captured in Secondary Outcome 4 | 90 days | 
| Patients, Members & Medicaid - Timing of appointment | Number of days between the drop date and any appointment captured in Secondary Outcome 5 | 180 days |