Timely Nudge About Lab Results to Increase myGeisinger Uptake

• Sponsor: Geisinger Clinic (Other)
• Overall Status: Completed
• CT.gov ID: NCT04333199
• Collaborator: (none)
• Enrollment: 5,012
• Location: 1
• Arms: 3
• Actual Duration (Months): 1.4
• Patients Per Site Per Month: 3467.1

Study Details

Study Description

Brief Summary

The purpose of the current study is to test whether sending email communications in a timely manner - when patients have laboratory results available to view on the myGeisinger patient portal - increases enrollment in the portal.

Condition or Disease	Intervention/Treatment	Phase
Telehealth; Health Behavior	Behavioral: Timely; Behavioral: Transparency; Behavioral: Foot-in-the-door	N/A

Detailed Description

Online patient portals are convenient tools that improve patient access to healthcare services while often reducing burden to both patients and providers. However, many patients have not enrolled in such portals, including Geisinger's patient portal, known as myGeisinger.

The purpose of the current study is to test whether sending myGeisinger enrollment information in a timely manner - when the benefits of enrolling are most readily available - increases enrollment. Specifically, messages will be timely in terms of lab test results having just been made available online, with the added benefit that patients can view their results prior to receiving them via mail. Unenrolled patients who recently had a laboratory procedure ordered and whose results are now ready for sharing will be informed via email that their lab results are available. At the same time, these patients will be reminded that these results can be viewed online through myGeisinger.

The primary outcome measure of interest, myGeisinger enrollment rates, will be compared between the emailed population and a control group that similarly has lab results available but will not be contacted. In addition, two different versions of the email communication will be tested. One will highlight that the patient will have to go through a sign-up process before viewing test results (in the service of transparency). The other will provide a presumed direct link to view those results, via a button that potentially serves as a pre-commitment step to undergo the registration process ("foot in the door" effect). Secondary analyses will assess differences in enrollment rates as well as unsubscribe rates between the email versions. Exploratory analyses will further examine differences in the rates at which patients opened and clicked on enrollment links within the two emails. Statistical analyses will employ generalized linear models with a binary distribution and log-link function.

Study Design

• Study Type: Interventional
• Actual Enrollment: 5012 participants
• Allocation: Randomized
• Intervention Model: Parallel Assignment
• Intervention Model Description: Every day within the designated study period, an email will be sent to patients who 1) fulfill inclusion criteria, 2) have been randomized to one of the email conditions (rather than the control group), and 3) have not already been randomized to a study condition on a previous day (i.e. no patient will be emailed for this study twice).Every day within the designated study period, an email will be sent to patients who 1) fulfill inclusion criteria, 2) have been randomized to one of the email conditions (rather than the control group), and 3) have not already been randomized to a study condition on a previous day (i.e. no patient will be emailed for this study twice).
• Masking: Single (Participant)
• Masking Description: Participants (i.e., patients) will not be informed specifically of their assignment to different arms throughout the study.
• Primary Purpose: Health Services Research
• Official Title: Nudging myGeisinger Enrollment Using Timely Email Messaging Reminding Patients of Lab Results Available
• Actual Study Start Date: May 18, 2020
• Actual Primary Completion Date: Jun 8, 2020
• Actual Study Completion Date: Jul 1, 2020

Arms and Interventions

Arm	Intervention/Treatment
No Intervention: Control Patients do not receive an email
Experimental: Timely nudge - view results Patients are emailed about myGeisinger when they have a lab result ready to view. The email includes a "View My Lab Results" button, which encourages them to click as a pre-commitment step that then brings them to the myGeisinger sign-up page.	Behavioral: Timely; Email; Behavioral: Foot-in-the-door; Email
Experimental: Timely nudge - get started Patients are emailed about myGeisinger when they have a lab result ready to view. The email includes a "Get Started With myGeisinger" button that is transparent about the next step in the process, before the patient can view test results.	Behavioral: Timely; Email; Behavioral: Transparency; Email

Outcome Measures

Primary Outcome Measures

1. Enrollment - Timely Email (Combined Email Arms) vs. no Intervention [1 week post-intervention]

   Patient enrolled in myGeisinger (yes / no)

Secondary Outcome Measures

1. Enrollment - Email Including a "Get Started" Button vs. a "View Results" Button [1 week post-intervention]

   Patient enrolled in myGeisinger (yes / no)

2. Email Opened - Email Including a "Get Started" Button vs. a "View Results" Button [1 week post-intervention]

   Email was opened (yes / no)

3. Link Clicked - Email Including a "Get Started" Button vs. a "View Results" Button [1 week post-intervention]

   Link / button to start the enrollment process was clicked (yes / no)

4. Unsubscribed - Email Including a "Get Started" Button vs. a "View Results" Button [1 month post-intervention]

   Patient unsubscribed from these email communications (yes / no)

5. Enrollment - Timely Email (Combined Email Arms) vs. no Intervention [1 month post-intervention]

   Patient enrolled in myGeisinger (yes / no)

Eligibility Criteria

Criteria

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

Inclusion Criteria:

• Geisinger patient for whom a lab was ordered within 30 days prior to email date

• Patient's lab test result released day before email date

Exclusion Criteria:

• Patient already enrolled in myGeisinger

• Patient has already declined myGeisinger

Contacts and Locations

Locations

	Site	City	State	Country	Postal Code
1	Geisinger	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 - Apr 7, 2021

More Information

Publications

None provided.

• Responsible Party: Amir Goren, Program Director, Behavioral Insights Team, Geisinger Clinic
• ClinicalTrials.gov Identifier: NCT04333199
• Other Study ID Numbers: 2020-0316
• First Posted: Apr 3, 2020
• Last Update Posted: Jun 11, 2021
• Last Verified: May 1, 2021

• 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: Behavioral Economics; Patient Portal

Study Results

Participant Flow

Arm/Group Title	Control	Timely Nudge - View Results	Timely Nudge - Get Started
Arm/Group Description	Patients do not receive an email	Patients are emailed about myGeisinger when they have a lab result ready to view. The email includes a "View My Lab Results" button, which encourages them to click as a pre-commitment step that then brings them to the myGeisinger sign-up page. Timely: Email Foot-in-the-door: Email	Patients are emailed about myGeisinger when they have a lab result ready to view. The email includes a "Get Started With myGeisinger" button that is transparent about the next step in the process, before the patient can view test results. Timely: Email Transparency: Email
Period Title: Evaluated Patients
STARTED	1669	1672	1671
COMPLETED	1669	1671	1669
NOT COMPLETED	0	1	2
Period Title: Evaluated Patients
STARTED	0	1671	1669
Valid Email Address	0	1495	1441
COMPLETED	0	1399	1351
NOT COMPLETED	0	272	318

Baseline Characteristics

Arm/Group Title	Control	Timely Nudge - View Results	Timely Nudge - Get Started	Total
Arm/Group Description	Patients do not receive an email	Patients are emailed about myGeisinger when they have a lab result ready to view. The email includes a "View My Lab Results" button, which encourages them to click as a pre-commitment step that then brings them to the myGeisinger sign-up page. Timely: Email Foot-in-the-door: Email	Patients are emailed about myGeisinger when they have a lab result ready to view. The email includes a "Get Started With myGeisinger" button that is transparent about the next step in the process, before the patient can view test results. Timely: Email Transparency: Email	Total of all reporting groups
Overall Participants	1669	1671	1669	5009
Age (Count of Participants)
<=18 years	NA NaN	NA NaN	NA NaN	NA NaN
Between 18 and 65 years	NA NaN	NA NaN	NA NaN	NA NaN
>=65 years	NA NaN	NA NaN	NA NaN	NA NaN
Sex: Female, Male (Count of Participants)
Female	NA NaN	NA NaN	NA NaN	NA NaN
Male	NA NaN	NA NaN	NA NaN	NA NaN
Race and Ethnicity Not Collected (Count of Participants)
Count of Participants [Participants]	0 0%

Outcome Measures

1. Primary Outcome

Title	Enrollment - Timely Email (Combined Email Arms) vs. no Intervention
Description	Patient enrolled in myGeisinger (yes / no)
Time Frame	1 week post-intervention

Outcome Measure Data

Analysis Population Description

Patients who were randomized and for whom there was a record in the EHR.

Arm/Group Title	Control	Timely Nudge
Arm/Group Description	Patients do not receive an email	Patients are emailed about myGeisinger when they have a lab result ready to view. Timely: Email
Measure Participants	1669	3340
Count of Participants [Participants]	65 3.9%	361 21.6%

Statistical Analysis 1

Statistical Analysis Overview	Comparison Group Selection	Control, Timely Nudge
	Comments
	Type of Statistical Test	Superiority
	Comments
Statistical Test of Hypothesis	p-Value	<0.001
	Comments	We used an a priori threshold of p < .05.
	Method	Regression, Logistic
	Comments
Method of Estimation	Estimation Parameter	Odds Ratio (OR)
	Estimated Value	2.9903891
	Confidence Interval	(2-Sided) 95%; 2.2805876 to 3.9211066
	Parameter Dispersion	Type: Value:
	Estimation Comments

2. Secondary Outcome

Title	Enrollment - Email Including a "Get Started" Button vs. a "View Results" Button
Description	Patient enrolled in myGeisinger (yes / no)
Time Frame	1 week post-intervention

Outcome Measure Data

Analysis Population Description

Patients who were delivered an email (i.e. email did not bounce back) and for whom there was a record in the EHR.

Arm/Group Title	Timely Nudge - View Results	Timely Nudge - Get Started
Arm/Group Description	Patients are emailed about myGeisinger when they have a lab result ready to view. The email includes a "View My Lab Results" button, which encourages them to click as a pre-commitment step that then brings them to the myGeisinger sign-up page. Timely: Email Foot-in-the-door: Email	Patients are emailed about myGeisinger when they have a lab result ready to view. The email includes a "Get Started With myGeisinger" button that is transparent about the next step in the process, before the patient can view test results. Timely: Email Transparency: Email
Measure Participants	1399	1351
Count of Participants [Participants]	190 11.4%	159 9.5%

Statistical Analysis 1

Statistical Analysis Overview	Comparison Group Selection	Control, Timely Nudge
	Comments
	Type of Statistical Test	Superiority
	Comments
Statistical Test of Hypothesis	p-Value	0.154
	Comments	We used an a priori threshold of p < .05.
	Method	Regression, Logistic
	Comments
Method of Estimation	Estimation Parameter	Odds Ratio (OR)
	Estimated Value	1.1781659
	Confidence Interval	(2-Sided) 95%; 0.9404654 to 1.4759445
	Parameter Dispersion	Type: Value:
	Estimation Comments

3. Secondary Outcome

Title	Email Opened - Email Including a "Get Started" Button vs. a "View Results" Button
Description	Email was opened (yes / no)
Time Frame	1 week post-intervention

Outcome Measure Data

Analysis Population Description

Patients who were delivered an email (i.e. email did not bounce back) and for whom there was a record in the EHR.

Arm/Group Title	Timely Nudge - View Results	Timely Nudge - Get Started
Arm/Group Description	Patients are emailed about myGeisinger when they have a lab result ready to view. The email includes a "View My Lab Results" button, which encourages them to click as a pre-commitment step that then brings them to the myGeisinger sign-up page. Timely: Email Foot-in-the-door: Email	Patients are emailed about myGeisinger when they have a lab result ready to view. The email includes a "Get Started With myGeisinger" button that is transparent about the next step in the process, before the patient can view test results. Timely: Email Transparency: Email
Measure Participants	1399	1351
Count of Participants [Participants]	654 39.2%	617 36.9%

Statistical Analysis 1

Statistical Analysis Overview	Comparison Group Selection	Control, Timely Nudge
	Comments
	Type of Statistical Test	Superiority
	Comments
Statistical Test of Hypothesis	p-Value	0.571
	Comments	We used an a priori threshold of p < .05.
	Method	Regression, Logistic
	Comments
Method of Estimation	Estimation Parameter	Odds Ratio (OR)
	Estimated Value	0.9575636
	Confidence Interval	(2-Sided) 95%; 0.8242111 to 1.1124918
	Parameter Dispersion	Type: Value:
	Estimation Comments

4. Secondary Outcome

Title	Link Clicked - Email Including a "Get Started" Button vs. a "View Results" Button
Description	Link / button to start the enrollment process was clicked (yes / no)
Time Frame	1 week post-intervention

Outcome Measure Data

Analysis Population Description

Patients who were delivered an email (i.e. email did not bounce back) and for whom there was a record in the EHR.

Arm/Group Title	Timely Nudge - View Results	Timely Nudge - Get Started
Arm/Group Description	Patients are emailed about myGeisinger when they have a lab result ready to view. The email includes a "View My Lab Results" button, which encourages them to click as a pre-commitment step that then brings them to the myGeisinger sign-up page. Timely: Email Foot-in-the-door: Email	Patients are emailed about myGeisinger when they have a lab result ready to view. The email includes a "Get Started With myGeisinger" button that is transparent about the next step in the process, before the patient can view test results. Timely: Email Transparency: Email
Measure Participants	1399	1351
Count of Participants [Participants]	494 29.6%	307 18.4%

Statistical Analysis 1

Statistical Analysis Overview	Comparison Group Selection	Control, Timely Nudge
	Comments
	Type of Statistical Test	Superiority
	Comments
Statistical Test of Hypothesis	p-Value	<0.001
	Comments	We used an a priori threshold of p < .05.
	Method	Regression, Logistic
	Comments
Method of Estimation	Estimation Parameter	Odds Ratio (OR)
	Estimated Value	1.8562672
	Confidence Interval	(2-Sided) 95%; 1.5692523 to 2.1957769
	Parameter Dispersion	Type: Value:
	Estimation Comments

5. Secondary Outcome

Title	Unsubscribed - Email Including a "Get Started" Button vs. a "View Results" Button
Description	Patient unsubscribed from these email communications (yes / no)
Time Frame	1 month post-intervention

Outcome Measure Data

Analysis Population Description

Patients who were delivered an email (i.e. email did not bounce back) and for whom there was a record in the EHR.

Arm/Group Title	Timely Nudge - View Results	Timely Nudge - Get Started
Arm/Group Description	Patients are emailed about myGeisinger when they have a lab result ready to view. The email includes a "View My Lab Results" button, which encourages them to click as a pre-commitment step that then brings them to the myGeisinger sign-up page. Timely: Email Foot-in-the-door: Email	Patients are emailed about myGeisinger when they have a lab result ready to view. The email includes a "Get Started With myGeisinger" button that is transparent about the next step in the process, before the patient can view test results. Timely: Email Transparency: Email
Measure Participants	1399	1351
Count of Participants [Participants]	2 0.1%	2 0.1%

6. Secondary Outcome

Title	Enrollment - Timely Email (Combined Email Arms) vs. no Intervention
Description	Patient enrolled in myGeisinger (yes / no)
Time Frame	1 month post-intervention

Outcome Measure Data

Analysis Population Description

Patients who were randomized and for whom there was a record in the EHR.

Arm/Group Title	Control	Timely Nudge
Arm/Group Description	Patients do not receive an email	Patients are emailed about myGeisinger when they have a lab result ready to view. Timely: Email
Measure Participants	1669	3340
Count of Participants [Participants]	141 8.4%	488 29.2%

Statistical Analysis 1

Statistical Analysis Overview	Comparison Group Selection	Control, Timely Nudge
	Comments
	Type of Statistical Test	Superiority
	Comments
Statistical Test of Hypothesis	p-Value	<0.001
	Comments	We used an a priori threshold of p < .05.
	Method	Regression, Logistic
	Comments
Method of Estimation	Estimation Parameter	Odds Ratio (OR)
	Estimated Value	1.8542767
	Confidence Interval	(2-Sided) 95%; 1.5220654 to 2.2589975
	Parameter Dispersion	Type: Value:
	Estimation Comments

Adverse Events

Time Frame	No adverse events were evaluated.
Adverse Event Reporting Description	We only received information about email engagement and portal enrollment. We did not collect or receive any information regarding adverse events.
Arm/Group Title	Control		Timely Nudge - View Results		Timely Nudge - Get Started
Arm/Group Description	Patients do not receive an email		Patients are emailed about myGeisinger when they have a lab result ready to view. The email includes a "View My Lab Results" button, which encourages them to click as a pre-commitment step that then brings them to the myGeisinger sign-up page. Timely: Email Foot-in-the-door: Email		Patients are emailed about myGeisinger when they have a lab result ready to view. The email includes a "Get Started With myGeisinger" button that is transparent about the next step in the process, before the patient can view test results. Timely: Email Transparency: Email
All Cause Mortality
	Control		Timely Nudge - View Results		Timely Nudge - Get Started
	Affected / at Risk (%)	# Events	Affected / at Risk (%)	# Events	Affected / at Risk (%)	# Events
Total	0/0 (NaN)		0/0 (NaN)		0/0 (NaN)
Serious Adverse Events
	Control		Timely Nudge - View Results		Timely Nudge - Get Started
	Affected / at Risk (%)	# Events	Affected / at Risk (%)	# Events	Affected / at Risk (%)	# Events
Total	0/0 (NaN)		0/0 (NaN)		0/0 (NaN)
Other (Not Including Serious) Adverse Events
	Control		Timely Nudge - View Results		Timely Nudge - Get Started
	Affected / at Risk (%)	# Events	Affected / at Risk (%)	# Events	Affected / at Risk (%)	# Events
Total	0/0 (NaN)		0/0 (NaN)		0/0 (NaN)

Limitations/Caveats

For this study, we only received data about engagement with the email and enrollment in the patient portal. Demographic information such as age, sex, or gender were not collected. Note that for some patients, enrollment data could not be extracted from Geisinger's electronic health records; these patients were excluded from analyses.

More Information

Certain Agreements

All Principal Investigators ARE employed by the organization sponsoring the study.

There is NOT an agreement between Principal Investigators and the Sponsor (or its agents) that restricts the PI's rights to discuss or publish trial results after the trial is completed.