Text Message-Based Nudges Prior to Primary Care Visits to Increase Care Gap Closure

NCT05799976 | Completed

• 1 other identifier: RIN20230039
• Study Type: interventional
• Target: 29,334
• Locations: 1 country
• Sites: 1

Brief Summary

Primary care visits are a key aspect of clinical care focused on helping patients to close care gaps related to preventive care such as vaccination, diabetes testing, statin therapy and cancer screening. However, less than 50% of care gaps are closed during these visits and new approaches are needed to prime patients for a discussion during these visits. In this study, the study team will evaluate a health system initiative that uses text messaging to patients in days preceding a primary care visit to prime patients to be amenable to ordering of vaccination, diabetes testing, cancer screening, and statin prescribing.

Conditions

Pneumonia, Pneumococcal; Diabetes Mellitus; Breast Cancer; Colorectal Cancer

Outcome Measures

Primary Outcomes (1)

• Care gap order rate

  The proportion of open care gaps that have a test or treatment ordered to address them

  By the end of the day of the primary care visit

Other Outcomes (1)

• Care gap completion rate

  Within 3 months of the primary care visit

Study Arms (2)

Usual Care

NO INTERVENTION

This is a group will serve as usual care and have no intervention during the study period

Text Message Group

EXPERIMENTAL

This group of primary care practices will be randomized to have the text message intervention

Behavioral: Text message nudge

Interventions

Text message nudge BEHAVIORAL

The text message nudge will be sent to patients 3 days and 1 day prior to a visit with the primary care practices and notify them of up to 3 care gaps based on electronic health record data. Care gaps will be selected based on availability and ranked in this order: influenza vaccination, pneumococcal vaccination, breast cancer screening, colorectal cancer screening, hemoglobin A1 testing, or statin therapy.

Text Message Group

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: Yes
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Age 18 or older
• Have documented consent to communicate electronically
• Have a visit scheduled with a primary care practice
• Have at least one open care gap among those in the intervention

You may not qualify if:

• No phone number on file to send text messages

Sponsors & Collaborators

• Mitesh Patel: lead

Study Sites (1)

Ascension

St Louis, Missouri, 63134, United States

Location

Related Publications (2)

• Milkman KL, Patel MS, Gandhi L, Graci HN, Gromet DM, Ho H, Kay JS, Lee TW, Akinola M, Beshears J, Bogard JE, Buttenheim A, Chabris CF, Chapman GB, Choi JJ, Dai H, Fox CR, Goren A, Hilchey MD, Hmurovic J, John LK, Karlan D, Kim M, Laibson D, Lamberton C, Madrian BC, Meyer MN, Modanu M, Nam J, Rogers T, Rondina R, Saccardo S, Shermohammed M, Soman D, Sparks J, Warren C, Weber M, Berman R, Evans CN, Snider CK, Tsukayama E, Van den Bulte C, Volpp KG, Duckworth AL. A megastudy of text-based nudges encouraging patients to get vaccinated at an upcoming doctor's appointment. Proc Natl Acad Sci U S A. 2021 May 18;118(20):e2101165118. doi: 10.1073/pnas.2101165118.

  PMID: 33926993 BACKGROUND

• Patel MS, Aloia TA, Shoemaker AG, Fakih MG, Masoudi FA, Smith L, Rosenzweig E, Chaiyachati KH, Conrad BN, Bandreddi J, Fogel RI. A Digital Care Plan Nudge to Improve Primary Care Outcomes. NEJM Evid. 2025 Jun;4(6):EVIDoa2400419. doi: 10.1056/EVIDoa2400419. Epub 2025 May 27.

  PMID: 40423396 DERIVED

MeSH Terms

Conditions

Pneumonia, Pneumococcal; Diabetes Mellitus; Breast Neoplasms; Colorectal Neoplasms

Condition Hierarchy (Ancestors)

Pneumococcal Infections; Streptococcal Infections; Gram-Positive Bacterial Infections; Bacterial Infections; Bacterial Infections and Mycoses; Infections; Pneumonia, Bacterial; Pneumonia; Respiratory Tract Infections; Lung Diseases; Respiratory Tract Diseases; Glucose Metabolism Disorders; Metabolic Diseases; Nutritional and Metabolic Diseases; Endocrine System Diseases; Neoplasms by Site; Neoplasms; Breast Diseases; Skin Diseases; Skin and Connective Tissue Diseases; Intestinal Neoplasms; Gastrointestinal Neoplasms; Digestive System Neoplasms; Digestive System Diseases; Gastrointestinal Diseases; Colonic Diseases; Intestinal Diseases; Rectal Diseases

Study Officials

• Mitesh Patel, MD

  Principal Investigator

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: DOUBLE
• Who Masked: INVESTIGATOR, OUTCOMES ASSESSOR
• Purpose: HEALTH SERVICES RESEARCH
• Intervention Model: PARALLEL
• Sponsor Type: INDUSTRY
• Responsible Party: SPONSOR INVESTIGATOR
• PI Title: VP, Ascension

Model Details: This study will use a randomized clinical trial to evaluate a health system initiative to improve care gap closure. We will randomly assign primary care practices that use AthenaClinicals electronic health record at the following locations at Ascension's health system: Alabama-Birmingham, Kansas-Wichita, Tennessee-Nashville, Texas-Austin, and Texas-Waco. These practices will have the opportunity to opt-out from the program before randomization occurs.

Study Record Dates

• First Submitted: March 22, 2023
• First Posted: April 5, 2023
• Study Start: September 5, 2023
• Primary Completion: November 9, 2023
• Study Completion: February 9, 2024
• Last Updated: April 25, 2024

Record last verified: 2024-04

Data Sharing

• IPD Sharing: Will not share

Locations

US (1)