Trial Title:
UCLA Health Patient Health Maintenance Outreach Text Message
NCT ID:
NCT05793788
Condition:
Health Maintenance
Diabetes
Cancer
Conditions: Keywords:
primary care
digital outreach
Study type:
Interventional
Study phase:
N/A
Overall status:
Active, not recruiting
Study design:
Allocation:
Randomized
Intervention model:
Parallel Assignment
Intervention model description:
Parallel-arm randomized control trial
Primary purpose:
Health Services Research
Masking:
Double (Participant, Care Provider)
Intervention:
Intervention type:
Behavioral
Intervention name:
Outreach Text Messages
Description:
The investigators will send randomized participants an SMS message encouraging them to
click provided link and close their outstanding, overdue preventive care measures.
The provided link will take them to their MyChart login page; after logging in, they
would see their personalized My Action Plan Letter detailing their personalized, overdue
preventive care measures. Message content will vary based on randomization arm as noted
below.
Arm group label:
Arm 1: Specific
Arm group label:
Arm 2: General
Arm group label:
Arm 3: Intention-oriented; General
Arm group label:
Arm 4: Action-oriented; General
Intervention type:
Behavioral
Intervention name:
Specific
Description:
The message will inform patients that the care team has identified tests/screenings that
they are due for.
Arm group label:
Arm 1: Specific
Intervention type:
Behavioral
Intervention name:
General
Description:
The message will inform patients that the care team has identified a care gap in their
record.
Arm group label:
Arm 2: General
Arm group label:
Arm 3: Intention-oriented; General
Arm group label:
Arm 4: Action-oriented; General
Intervention type:
Behavioral
Intervention name:
Elevating Intentions
Description:
The message will point out that even if patients feel healthy, their doctor recommends
them to take care of their health gaps.
Arm group label:
Arm 3: Intention-oriented; General
Intervention type:
Behavioral
Intervention name:
Prompting Action
Description:
The message will prompt patients to take care of their health gaps right away before they
forget.
Arm group label:
Arm 4: Action-oriented; General
Summary:
This is a prospective randomized clinical trial evaluating how behaviorally-informed
outreach text messages impact patient engagement with primary care. This prospective
randomized control trial is being implemented in conjunction with UCLA Health's larger
quality improvement initiative (the My Action Plan Quality Improvement Initiative) in
order to improve primary care preventive measure completion rates.
Detailed description:
Health maintenance measures have been shown to be critical in early detection, secondary
prevention, and early management of numerous medical conditions--from diabetes to various
cancers. The standardization of these health maintenance measures have resulted in major
improvements in population health. Despite the importance of these primary care tests and
screenings, many patients are overdue for these tests.
Given this healthcare gap, it is critical to investigate more effective strategies to
facilitate health maintenance measure completion. This study aims to evaluate the
effectiveness of a variety of behaviorally-informed outreach text messages. The
investigators intend to launch the study as a part of UCLA Health's My Action Plan
initiative, a UCLA Health primary care outreach quality improvement initiative aimed at
encouraging patients to complete their overdue health maintenance measures.
Specifically, the My Action Plan initiative is an outreach effort targeting primary care
patients at UCLA who have an outstanding, clinically indicated primary care preventative
care gap (e.g., overdue colorectal cancer screening, outstanding diabetes tests). At the
beginning of each month, identified UCLA Health primary care patients will be randomized
in a 1:1:1:1 ratio to receive one of four text messages informing them that they have an
overdue health maintenance measures and urging them to taking action to complete these
measures. These text messages will contain a link to their MyChart patient portal
account, specifically linking them to a My Action Plan electronic letter that will
contain a personalized list of outstanding preventive care items and actionable steps to
complete the items.
Within each text-message arm, patients will also be randomized to one of three time slots
for getting the message.
The My Action Plan quality improvement initiative is expected to start at the beginning
of the 2023 calendar year and continue for a span of at least 12 months. Each month, the
initiative targets patients whose birthday falls into that month. The investigators plan
to run this randomized clinical trial during four months of the larger QI initiative.
By studying how patients interact with these outreach messages and whether it then
translates to them completing their indicated health maintenance measures, the proposed
study would provide insightful information on how health systems could optimize
electronic patient outreach, narrow the gap in health maintenance measures in primary
care, and ultimately improve health on a population level.
Analysis Plan:
- The investigators will utilize patient-level ordinary least squares (OLS)
estimation, with statistical inferences based on model-robust standard errors. The
primary model term will be indicator variables for arm assignment.
- The analysis will adjust for sex, age, race/ethnicity, indicators for
screenings/tests that patients are due for, and whether patients have upcoming
primary care appointments. Missing covariate values will be handled by including
'unknown' indicators, along with mean imputation for quantitative covariates.
- The investigators will use this dataset to address two separate research questions.
- Research question 1: The investigators will compare Arm 1 with Arm 2 to test whether
more specific or general text message is more likely to improve the outcome measures
- Research question 2: The investigators will compare Arm 3, Arm 4, with Arm 2 to test
whether the general intention-oriented message and general action-oriented message
can outperform the general text message as well as which of these two messages is
better.
- For research question 2, exploratory analyses will investigate heterogeneous
treatment effects by patients' baseline motivation (i.e., the extent to which
patients seem to have some intentions to get the screenings/tests) in two ways.
First, the investigators will use each patient's history of screenings/tests to
construct a proxy for their baseline motivation to obtain the due screenings/tests.
Specifically, the investigator will calculate, among all the screenings/tests that
are included in the My Action Plan Initiative and that a patient was due for in the
past few years (exact time window TBD based on data availability), what percentage
was completed by the patient (as far as UCLA Health could tell). A higher percentage
indicates a higher baseline motivation to get the screenings/tests patients are due
for during the study period. Second, the investigators will obtain demographics and
medical information that UCLA Health is willing to provide (e.g., gender, age,
race/ethnicity, history of cancer and other pre-existing conditions, family cancer
history, past adherence to screenings/tests that are included in the My Action Plan
Initiative, past receipt of influenza vaccination, frequency of doctor visits; time
window of these variables is TBD depending on data availability). With such
information, the investigators will train an algorithm to predict patients' baseline
motivation level using patients in Arm 2 as the ground truth. Specifically, the
investigators will take the aforementioned information about patients in Arm 2 as
input, and use whether they complete any of the screenings/visits recommended in the
My Action Plan letter within 6 months as the outcome measure. Then the investigators
will apply the algorithm to all patients to predict their baseline motivation level.
For both approaches, the proxy for baseline motivation (Approach 1) and the
predicted baseline motivation level (Approach 2) will be used to analyze the
heterogeneous treatment effects of Arms 3 and 4 (vs. Arm 2).
- Additionally the investigators will investigate proxies for whether patients face
structural barriers to get screenings/tests as moderators, including socioeconomic
factors at the zipcode level, insurance type, proxies for accessibility to
healthcare resources such as distance from UCLA Health clinics.
- The investigators will also explore how the effect of text messages varies across
the three times of the day when the reminders will be sent.
Criteria for eligibility:
Criteria:
Inclusion Criteria:
1. Empaneled to UCLA Health DOM Primary Care
2. Has at least one overdue health maintenance measure that the My Action Plan
initiative focuses on
3. Has an active MyChart status
4. Can accept SMS messages from UCLA Health
5. Has a March, April, May or June Birthday
Exclusion Criteria:
1. Under the age of 18
2. Deceased patients
3. Hospice patients
4. Has opted out electronic communication (bulk messages, email, and/or text)
5. For the final analysis, we will further exclude patients who have scheduled
appointments for all screening/tests or completed all screenings/tests prior to the
date when they are supposed to receive the text message
Gender:
All
Minimum age:
18 Years
Maximum age:
N/A
Healthy volunteers:
No
Locations:
Facility:
Name:
UCLA Health Department of Medicine, Quality Office
Address:
City:
Los Angeles
Zip:
90095
Country:
United States
Start date:
March 9, 2023
Completion date:
June 30, 2024
Lead sponsor:
Agency:
University of California, Los Angeles
Agency class:
Other
Collaborator:
Agency:
UCLA Health Department of Medicine
Agency class:
Other
Source:
University of California, Los Angeles
Record processing date:
ClinicalTrials.gov processed this data on November 12, 2024
Source: ClinicalTrials.gov page:
https://clinicaltrials.gov/ct2/show/NCT05793788
