Reducing Emergency Department Utilization With an After Visit Summary Nudge Toward Alternative Care Options

Study Overview
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Brief Summary
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Decreasing utilization of the Emergency Department (ED) is a priority for the system. Often, ED visits can be avoided if patients contact Geisinger first to get appropriate direction for their concern or are otherwise better informed about reasons to visit the ED vs. urgent care or primary care facilities. The study team is working to reduce ED utilization by including additional information in adult outpatient After Visit Summaries (AVSs). The study will involve will involve A/B testing different AVS versions, including 1) a version that encourages patients to contact Geisinger via different contact methods, 2) a version that includes a map to the patient's closest ConvenientCare location and accompanying information about ConvenientCare, and 3) a version that includes a self-triage guide. A control group will receive the current standard AVS. Analysis results will be assessed to determine which version is most effective at reducing ED use.

Official Title
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Reducing Emergency Department Utilization With an After Visit Summary Nudge Toward Alternative Care Options

Conditions
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Behavior, Health

Intervention / Treatment
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* Behavioral: Contact information
* Behavioral: Urgent care map
* Behavioral: Self-triage chart


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Age 18+ Has a Geisinger Primary Care Physician assigned Completes an outpatient office visit or telemedicine appointment at Geisinger Exclusion Criteria: The AVS was not printed according to the EHR, and the patient does not have an active MyGeisinger patient portal account, so they do not have a way to view the AVS

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: Prevention
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| No Intervention: Standard practice<br>Patients in this arm will receive the current standard practice AVS. | |
| Experimental: Contact us first<br>Patients in this arm will receive the standard AVS, plus information on how to contact Geisinger if they need medical attention. | Behavioral: Contact information<br>* Information on how to contact Geisinger if the patient needs care<br>|
| Experimental: Contact us first + urgent care map<br>Patients in this arm will receive the standard AVS, plus information on how to contact Geisinger if they need medical attention, plus a map to their nearest Geisinger urgent care location and additional information about urgent care. | Behavioral: Contact information<br>* Information on how to contact Geisinger if the patient needs care<br>Behavioral: Urgent care map<br>* A map of the patient's nearest Geisinger urgent care location, with information about urgent care<br>|
| Experimental: Contact us first + urgent care map + self-triage<br>Patients in this arm will receive the standard AVS, plus information on how to contact Geisinger if they need medical attention, plus a map to their nearest Geisinger urgent care location and additional information about urgent care. This arm will also receive a self-triage chart, with common reasons patients go to the ED and situations where seeking alternative care might be appropriate. | Behavioral: Contact information<br>* Information on how to contact Geisinger if the patient needs care<br>Behavioral: Urgent care map<br>* A map of the patient's nearest Geisinger urgent care location, with information about urgent care<br>Behavioral: Self-triage chart<br>* A chart demonstrating what to do in response to several common conditions where the patient might be compelled to visit the ED<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Inappropriate ED visits | Visited the ED inappropriately (y/n) We will apply the NYU algorithm (Ballard et al., 2010) to determine whether an ED visit is inappropriate. | In the 30 days following the appointment | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Emergency Department Use, Urgent Care Use