Nudging High Emergency Department Utilizers to Consider Non-emergent Healthcare Resources

NCT06818825 | Completed

• 1 other identifier: 2024-0686
• Study Type: interventional
• Target: 1,126
• Locations: 1 country
• Sites: 1

Brief Summary

The goal of this campaign is to reduce unnecessary ED visits by providing patients who are high ED utilizers (with a visit of any acuity) with alternative resources to manage their health outside of the ED. In this campaign, patients will be randomized to receive one of two types of outreach following discharge aligned with the goal. Outreach may occur via (1) a phone call from a Geisinger Community Health Worker (CHW) or Community Medical Assistant (CMA); current standard practice or (2) an interactive chatbot message providing similar information and questions to those provided by the CHW/CMA. The study team will measure whether ED use differs across patients in different outreach conditions. The study team will also examine whether patients followed through on the message-specific calls to action in the messages differently across conditions.

Conditions

Emergency Service, Hospital

Outcome Measures

Primary Outcomes (1)

• Return to ED (Y/N)

  Patient had a new Geisinger ED encounter after being discharged

  Within 120 calendar days following day of discharge

Other Outcomes (6)

• Successful Patient Contact (Y/N) - 3 days

  Within 3 business days following day of discharge

• Successful Patient Contact (Y/N) - 5 days

  Within 5 business days following day of discharge

• Time to Contact

  Within 30 calendar days following day of discharge

Study Arms (2)

Community Health Worker/Community Medical Assistant Outreach

ACTIVE COMPARATOR

Patients will receive outreach from a community health worker or a community medical assistant, as is current standard practice, including guidance about ED-alternative resources to encourage care outside of the ED when appropriate.

Behavioral: Live outreach

SMS Chatbot Messages

EXPERIMENTAL

Patients will be sent interactive SMS chatbot messages, including guidance about ED-alternative resources to encourage care outside of the ED when appropriate; patients will not receive outreach from a community health worker or community medical assistant.

Behavioral: Automated interactive messages

Interventions

Automated interactive messages BEHAVIORAL

High ED utilizers will be sent SMS text messages guiding them through ED-alternative resources, with different guidance (including a follow-up phone call from a healthcare worker) depending on patient responses.

Also known as: Text

SMS Chatbot Messages

Live outreach BEHAVIORAL

High ED utilizers will be called (and possibly visited) by a CHW/CMA guiding them through ED-alternative resources.

Also known as: Call

Community Health Worker/Community Medical Assistant Outreach

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Geisinger Health Plan insurance or KACO membership
• Any PCP or no PCP
• Visit of any acuity
• or more ED visits in the past 6 months

You may not qualify if:

• Institutionalized
• Cannot be contacted via the communication modality being used in the study (i.e., SMS), due to insufficient/missing contact information in the electronic health record or because the patient opted out
• Admitted to hospital
• Eloped from ED
• Left ED without being seen
• Deceased prior to messaging
• Qualifies for more intensive care management due to higher-level category of complexity

Sponsors & Collaborators

• Geisinger Clinic: lead

Study Sites (1)

Geisinger Health System

Danville, Pennsylvania, 17822, United States

Location

MeSH Terms

Conditions

Emergencies

Interventions

Communication Devices for People with Disabilities; CD56 Antigen

Condition Hierarchy (Ancestors)

Disease Attributes; Pathologic Processes; Pathological Conditions, Signs and Symptoms

Intervention Hierarchy (Ancestors)

Self-Help Devices; Equipment and Supplies; Neural Cell Adhesion Molecules; Cell Adhesion Molecules, Neuronal; Cell Adhesion Molecules; Membrane Glycoproteins; Glycoproteins; Glycoconjugates; Carbohydrates; Proteins; Amino Acids, Peptides, and Proteins; Membrane Proteins; Antigens, Differentiation, T-Lymphocyte; Antigens, Differentiation; Antigens, Surface; Antigens; Biological Factors; Biomarkers

Study Officials

• Amir Goren, PhD

  Geisinger Clinic

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: NONE
• Masking Details: Patients will be aware of their own messages but will not be aware of other messages.
• Purpose: HEALTH SERVICES RESEARCH
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Program Director, Behavioral Insights Team

Study Record Dates

• First Submitted: January 29, 2025
• First Posted: February 11, 2025
• Study Start: February 3, 2025
• Primary Completion: September 20, 2025
• Study Completion: September 20, 2025
• Last Updated: March 13, 2026

Record last verified: 2026-03

Data Sharing

• IPD Sharing: Will not share

Locations

US (1)