CMSL Ambulatory Sensitive Condition Nudge Study 2

Geisinger Health

Status: Enrolling

Conditions: Emergency Department Visits; Nurse Care Coordination; Behavioral Intervention

Treatments: Behavioral: Nurse Nudge

Study type: Interventional

Funder types: Other

Identifiers

NCT07028398

2023-1716-2

Details and patient eligibility

About

The project aims to evaluate a nurse-led intervention to reduce inappropriate emergency department (ED) use among adult patients seen at Geisinger's Community Medicine Service Line (CMSL) clinics. The intervention occurs immediately following an appointment where a patient receives a diagnosis of an ambulatory sensitive condition (ASC; i.e., a condition considered to be a risk factor for near-term ED use). The evaluation will compare eligible patients with an ASC who were randomly assigned to receive follow-up outreach (patient portal message and/or call) from a nurse (who was automatically prompted via the Epic electronic health record system to initiate outreach) with those who were randomly assigned to receive standard care. Analyses will be intent-to-treat. The primary outcome is ED use in the week (i.e., 7 days) following the appointment.

We ran an earlier version of this intervention (NCT06798389). The current study is modified based on results and clinical guidance. Specifically, more conditions will be included as qualifying ASCs for enrollment. Patients under 30 will be excluded. And rather than calling all patients as in the original study, patient portal users may be contacted via the portal instead of or in addition to a phone call. Finally, in the first study, the intervention was differentially effective by age group (<45, 45-64, 65+). Our primary analysis will be conducted separately by age group, though we will also conduct an analysis combining across age groups.

We will run the study until we reach at least 4,330 patients in each of the following age groups: patients aged 30-45, patients aged 45-64, patients aged 65+. Therefore, our estimated sample size is at least 4,330x3 = 12,990.

We may be required to do an interim data pull and/or stop the study early at the direction of clinical or operational leaders.

Enrollment: 12,990 estimated patients

Sex: All

Ages: 30+ years old

Volunteers: No Healthy Volunteers

Inclusion and exclusion criteria

Inclusion Criteria:

• Age 30 years +
• Has a qualifying visit in CMSL with an ambulatory sensitive condition (ASC) encounter diagnosis

Trial design

Primary purpose: Health Services Research

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: None (Open label)

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12,990 participants in 2 patient groups

Nurse Nudge

Experimental group

Description:

Nurses in CMSL clinics will receive a notification to provide follow-up outreach (calls and/or patient portal messages) to patients after the patient receives an ambulatory sensitive diagnosis.

Treatment:

Behavioral: Nurse Nudge

Control

No Intervention group

Description:

Nurses in CMSL clinics will receive standard follow- up notifications, which may mean no notifications, after a patient has received an ambulatory sensitive diagnosis.