Efficacy of Communication Modalities for Promoting Flu Shots

Geisinger Health

Status: Completed

Conditions: Health Promotion; Influenza Vaccination; Risk Reduction; Health Behavior

Treatments: Behavioral: SMS; Behavioral: Letter; Behavioral: Patient portal

Study type: Interventional

Funder types: Other

Identifiers

NCT05509270

2022-0373

Details and patient eligibility

About

The purpose of this study is to test which modalities (mailed letter, short message service [SMS] text, or patient portal messages) are most effective for encouraging flu shots in high-risk patients.

Full description

The Centers for Disease Control (CDC) recommends a flu vaccination to everyone aged 6+ months, with rare exception; almost anyone can benefit from the vaccine, which can reduce illnesses, missed work, hospitalizations, and death. Flu shots are particularly important for patients at high risk of experiencing severe outcomes.

During the 2020-21 and 2021-22 flu seasons, the study team sent messages to Geisinger patients in the top 10% of risk for flu and complications according to an artificial intelligence algorithm. Messages that told patients they were at high risk significantly increased their likelihood of getting vaccinated.

The present study will extend previous work by testing which modality or modalities are most effective at boosting flu shot rates in patients at high risk. In previous campaigns, patients received messages via all communication modalities patients were eligible for (mailed letter, SMS text, and/or patient portal message). In this study, patients will be randomized to receive high-risk messages in one or more modalities.

Enrollment: 43,225 patients

Sex: All

Ages: 18+ years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Included on a list of active Geisinger patients (all patients on this list attended at least one primary care appointment at Geisinger between 10/1/2008 and 4/13/2022, and either had a Geisinger primary care provider assigned as of April 2022, or were in the Electronic Health Record [EHR] since at least September 2021 and had at least one encounter in 2020-2022)
• Aged 18 or older
• In the top 10% of risk for flu and flu complications, according to Medial's flu complications machine learning algorithm (which operates on coded EHR data)
• Has a Geisinger PCP assigned as of August 2022
• Has had an encounter in the last 2 years as of August 2022

Exclusion criteria

• Cannot be contacted via any of the communication modalities (e.g., letter, patient portal, SMS) being used in the study, either due to insufficient/missing contact information in the EHR or because they opted out of all modalities

Trial design

Primary purpose: Prevention

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Single Blind

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43,225 participants in 6 patient groups

Control

No Intervention group

Description:

No additional pro-vaccination intervention - some patients are currently targeted for flu vaccination messages due to a non-machine learning-based assessment that they are at high risk for complications, but are not told that they are at high risk or that they have been targeted

Letter only

Experimental group

Description:

This group will receive a letter telling them they are at high risk for flu and complications

Treatment:

Behavioral: Letter

Patient portal only

Experimental group

Description:

This group will receive a patient portal message telling them they are at high risk for flu and complications

Treatment:

Behavioral: Patient portal

SMS only

Experimental group

Description:

This group will receive an SMS telling them they are at high risk for flu and complications

Treatment:

Behavioral: SMS

Patient portal + SMS

Experimental group

Description:

This group will receive a patient portal message and an SMS telling them they are at high risk for flu and complications

Treatment:

Behavioral: Patient portal

Behavioral: SMS

Letter + Patient portal + SMS

Experimental group

Description:

This group will receive a letter, a patient portal message, and an SMS telling them they are at high risk for flu and complications

Treatment:

Behavioral: Letter

Behavioral: Patient portal

Behavioral: SMS