Flu Shot Pre-visit Questionnaire

Study Overview
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Brief Summary
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The purpose of this study is to assess, prospectively, the effect on flu vaccination rates of a pre-visit questionnaire that asks patients to indicate their preferences for a flu shot. Responses to the questionnaire will also be shown to clinicians via additional text in an existing flu shot alert. The investigators hypothesize that the pre-visit questionnaire will lead to increased flu vaccination compared with standard practices.

Detailed Description
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The CDC (Centers for Disease Control and Prevention) recommends a flu vaccination to everyone aged 6+ months, with rare exception; almost anyone can benefit from the vaccine, which can reduce illnesses, missed work, hospitalizations, and death. One barrier to vaccination is a lack of cues to action, which could be overcome by asking patients for a pre-visit commitment to get a flu shot and additional reminders for the clinician to act on this commitment. Eligible patients will be randomized to either receive or not receive a one-item, pre-visit questionnaire about the flu shot (that will show responses to clinicians in an existing flu shot alert).

Official Title
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Pre-visit Questionnaire to Increase Influenza Vaccinations

Conditions
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Influenza

Intervention / Treatment
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* Behavioral: Precommitment Nudge
* Behavioral: Salience


Participation Criteria
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Eligibility Criteria
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Patient Inclusion Criteria: On a list of active Geisinger patients (all patients on this list attended at least one primary care appointment at Geisinger between 10/1/2008 and 4/13/2022, and either had a Geisinger primary care provider assigned as of April 2022, or were in the Electronic Health Record [EHR] since at least September 2021 and had at least one encounter in 2020-2022) Has an upcoming flu shot-eligible outpatient visit with a provider Has activated Geisinger's patient portal Has not yet received a flu vaccine at the time the questionnaire became available, according to the EHR Clinician Inclusion Criteria Any Geisinger clinician who sees patient-participants in our study for a flu shot-eligible outpatient visit

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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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Prevention
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| No Intervention: Passive Control<br>No change to the standard of care for flu vaccines | |
| Experimental: Pre-visit Questionnaire<br>One-item questionnaire in online patient portal and additional information in the flu shot alert | Behavioral: Precommitment Nudge<br>* Ask participants to commit to a decision about getting a flu shot<br>Behavioral: Salience<br>* Additional text and icon in the flu shot alert makes the pre-visit questionnaire response salient to the clinician, which could facilitate action or further discussion with the patient<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Count of patients with a flu vaccination | Patient received a flu vaccine (yes/no) between the day questionnaires became available for the patient's first scheduled flu-shot-eligible appointment and 7 days following the appointment. Questionnaires were available 14 days prior to the appointment date for appointments scheduled at least 14 days in advance. Questionnaires were available on the day the appointment was scheduled for appointments scheduled less than 14 days in advance. Note that control patients did not receive a flu shot questionnaire, but they may have received other questionnaires from the health system 14 days before their appointment. We will conduct subgroup analyses for people who had responded to MyGeisinger pre-visit messages in the previous year and those who did not. | Up to 21 days | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Vaccination, Health Promotion, Health Behavior, Reminder Systems, Economics, Behavioral