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

Geisinger Health

Status: Active, not recruiting

Conditions: Emergency Service, Hospital

Treatments: Behavioral: Live outreach; Behavioral: Automated interactive messages

Study type: Interventional

Funder types: Other

Identifiers

NCT06818825

2024-0686

Details and patient eligibility

About

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.

Enrollment: 1,553 patients

Sex: All

Ages: 18+ years old

Volunteers: No Healthy Volunteers

Inclusion criteria

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

Exclusion criteria

• 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

Trial design

Primary purpose: Health Services Research

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: None (Open label)

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1,553 participants in 2 patient groups

Community Health Worker/Community Medical Assistant Outreach

Active Comparator group

Description:

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.

Treatment:

Behavioral: Live outreach

SMS Chatbot Messages

Experimental group

Description:

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.

Treatment:

Behavioral: Automated interactive messages