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

• Sponsor: Geisinger Clinic (Other)
• Overall Status: Not yet recruiting
• CT.gov ID: NCT05787548
• Collaborator: (none)
• Enrollment: 850,000
• Location: 1
• Arms: 4
• Anticipated Duration (Months): 5
• Patients Per Site Per Month: 169097.2

Study Details

Study Description

Brief Summary

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.

Condition or Disease	Intervention/Treatment	Phase
Behavior, Health	Behavioral: Contact information; Behavioral: Urgent care map; Behavioral: Self-triage chart	N/A

Study Design

• Study Type: Interventional
• Anticipated Enrollment: 850000 participants
• Allocation: Randomized
• Intervention Model: Parallel Assignment
• Masking: None (Open Label)
• Primary Purpose: Prevention
• Official Title: Reducing Emergency Department Utilization With an After Visit Summary Nudge Toward Alternative Care Options
• Anticipated Study Start Date: Apr 1, 2023
• Anticipated Primary Completion Date: Sep 1, 2023
• Anticipated Study Completion Date: Sep 1, 2023

Arms and Interventions

Arm	Intervention/Treatment
No Intervention: Standard practice Patients in this arm will receive the current standard practice AVS.
Experimental: Contact us first Patients in this arm will receive the standard AVS, plus information on how to contact Geisinger if they need medical attention.	Behavioral: Contact information; Information on how to contact Geisinger if the patient needs care
Experimental: Contact us first + urgent care map 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; Information on how to contact Geisinger if the patient needs care; Behavioral: Urgent care map; A map of the patient's nearest Geisinger urgent care location, with information about urgent care
Experimental: Contact us first + urgent care map + self-triage 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; Information on how to contact Geisinger if the patient needs care; Behavioral: Urgent care map; A map of the patient's nearest Geisinger urgent care location, with information about urgent care; Behavioral: Self-triage chart; A chart demonstrating what to do in response to several common conditions where the patient might be compelled to visit the ED

Outcome Measures

Primary Outcome Measures

1. Inappropriate ED visits [In the 30 days following the appointment]

   Visited the ED inappropriately (y/n) We will apply the NYU algorithm (Ballard et al., 2010) to determine whether an ED visit is inappropriate.

Other Outcome Measures

1. Urgent care visits [In the 30 days following the appointment]

   Visited urgent care (y/n)

2. Calls [In the 30 days following the appointment]

   Called Geisinger (y/n)

3. Patient portal messages [In the 30 days following the appointment]

   Sent a patient portal message (y/n)

Eligibility Criteria

Criteria

• Ages Eligible for Study: 18 Years and Older
• Sexes Eligible for Study: All
• Accepts Healthy Volunteers: No

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

Contacts and Locations

Locations

	Site	City	State	Country	Postal Code
1	Geisinger Clinic	Danville	Pennsylvania	United States	17822

Sponsors and Collaborators

• Geisinger Clinic

Investigators

• Principal Investigator: Amir Goren, PhD, Geisinger Clinic

Study Documents (Full-Text)

• Study Protocol and Statistical Analysis Plan - Mar 29, 2023

More Information

Publications

None provided.

• Responsible Party: Amir Goren, Program Director, Behavioral Insights Team, Geisinger Clinic
• ClinicalTrials.gov Identifier: NCT05787548
• Other Study ID Numbers: 2022-0340
• First Posted: Mar 28, 2023
• Last Update Posted: Mar 31, 2023
• Last Verified: Mar 1, 2023

• Individual Participant Data (IPD) Sharing Statement: Yes
• Plan to Share IPD: Yes
• Studies a U.S. FDA-regulated Drug Product: No
• Studies a U.S. FDA-regulated Device Product: No
• Keywords provided by Amir Goren, Program Director, Behavioral Insights Team, Geisinger Clinic: Emergency Department Use; Urgent Care Use
• Additional relevant MeSH terms: Emergencies

Study Results

No Results Posted as of Mar 31, 2023