Patient Portal Reminder/Recall for Influenza Vaccination in a Health System- UCLA Portal R/R Influenza RCT 3

University of California, Los Angeles (UCLA) logo

University of California, Los Angeles (UCLA)

Status

Completed

Conditions

Influenza
Respiratory Tract Infections

Treatments

Behavioral: Pre-Appointment flu vaccine reminders
Behavioral: Portal Reminders for Influenza Vaccination: No direct scheduling link
Behavioral: Pre-Commitment Prompt
Behavioral: Portal Reminders for Influenza Vaccination: Direct scheduling link

Study type

Interventional

Funder types

Other
NIH

Identifiers

NCT04533685
17-001889-AM-00012
R01AI135029

Details and patient eligibility

About

This trial is taking place in Los Angeles, CA among patients from primary care practices within the UCLA Health System. The study design is a 2x2x2 factorial design, nested in a parallel 2-arm trial. The parallel arms are control v. reminder letter (reminder messages sent via the patient portal, reminding participants of an overdue influenza vaccine) Nested within the reminder letter arm, we will have 3 additional components: A direct scheduling link within the reminder letter enabling the patient to schedule an influenza vaccine only visit (direct scheduling link vs. no direct scheduling link). A pre-commitment prompt (pre-commitment prompt vs. no prompt) asking about a patient's intention to get the influenza vaccination A pre-appointment reminder, encouraging patients to ask for their influenza vaccine at their upcoming appointment (pre-appointment reminder encouraging influenza vaccination vs. standard pre-appointment reminder not mentioning influenza vaccination)

Full description

This trial is taking place in Los Angeles, CA among patients from primary care practices within the UCLA Health System, using 2x2x2 factorial design, nested in a parallel 2-arm trial. Sub-optimal vaccination rates are a significant problem in the U.S., despite their effectiveness in preventing morbidity and mortality from vaccine-preventable illness. For influenza specifically, annual epidemics of influenza cause substantial morbidity in the U.S. with up to 40,00-80,000 deaths/year and many hospitalizations, emergency and outpatient visits, and significant costs. Reminder/recall (R/R) messages, sent by phone, mail or other modality, can improve child and adult influenza vaccination rates. However, the majority of pediatric or adult primary care practices to not conduct R/R. Barriers are lack of finances, personnel, and algorithms to identify eligible patients. A technological breakthrough that might overcome these barriers involves patient portals-- secure, web-based communication systems, embedded within electronic health records (EHRs), for patients and providers to communicate with each other via email and the internet. Portals are used by about half of Americans and half of UCLA patients. This randomized controlled trial will assess the effectiveness of reminders messages, encouraging influenza vaccination, sent to patient portal users on increasing influenza vaccination rates within a health system by randomizing patients to two groups: 1) two-thirds of patients will receive reminder letters, 2) one-third will not receive reminders. Patients in the reminder arm will be further randomized (separately) for three additional components: 1) direct appointment scheduling, 2) pre-commitment prompts and 3) pre-appointment reminders. Direct scheduling: The convenience of scheduling an appointment for influenza vaccination may increase the likelihood that patients receive an influenza vaccination. Patients receiving reminders will be randomized to receive one of two types of reminder letters: 1) one half will receive flu vaccine reminder letters with a link to the MyChart direct appointment scheduling page and 2) one half will receive flu vaccine reminder message without the direct appointment scheduling link. Pre-commitment: Another potential influence on the decision to vaccinate is pre-commitment. Previous studies suggest that, upon being prompted, indicating an intention to do something increases the likelihood of following through. Patients will be randomized to one of two groups: 1) one half will receive pre-commitment prompt at the beginning of influenza vaccination season and 2) one half will not receive a pre-commitment prompt. The pre-commitment prompt asks whether the patient intends to receive influenza vaccine, and where and when they plan to get the vaccine. Pre-appointment flu reminders: Finally, a missed opportunities for vaccination occurs when patients are eligible for vaccination but are not offered a vaccine at their medical appointment. Pre-appointment reminders, sent in advance of an upcoming appointment, encouraging the patient talk to their doctor about influenza vaccination, may increase the likelihood of that patient receiving a vaccine. Patients will be randomized to one of two groups: 1) one half will receive modified pre-appointment reminders that mention influenza vaccination and 2) one half will receive the standard pre-appointment reminders for an upcoming appointment (no mention of influenza vaccination).

Enrollment

213,773 patients

Sex

All

Ages

4+ months old

Volunteers

No Healthy Volunteers

Inclusion criteria

A patient within the UCLA Health System identified as a primary care patient per an internal algorithm.

Exclusion criteria

A patient within the UCLA Health System not identified as a primary care patient per an internal algorithm

Trial design

Primary purpose

Health Services Research

Allocation

Randomized

Interventional model

Factorial Assignment

Masking

Single Blind

213,773 participants in 9 patient groups

Direct scheduling + Pre-commitment + Pre-appt reminder
Active Comparator group
Description:
Participants receive 1) reminder/recall messages regarding influenza vaccination via the patient portal with a link enabling direct scheduling, 2) a pre-commitment prompt and 3) pre-appointment reminders that mention asking the provider for a flu vaccine
Treatment:
Behavioral: Portal Reminders for Influenza Vaccination: Direct scheduling link
Behavioral: Pre-Commitment Prompt
Behavioral: Pre-Appointment flu vaccine reminders
Direct scheduling + Pre-commitment
Active Comparator group
Description:
Participants receive 1) reminder/recall messages regarding influenza vaccination via the patient portal with a link enabling direct scheduling and 2) a pre-commitment prompt
Treatment:
Behavioral: Portal Reminders for Influenza Vaccination: Direct scheduling link
Behavioral: Pre-Commitment Prompt
Direct scheduling + Pre-appt reminder
Active Comparator group
Description:
Participants receive 1) reminder/recall messages regarding influenza vaccination via the patient portal with a link enabling direct scheduling and 2) pre-appointment reminders that mention asking the provider for a flu vaccine
Treatment:
Behavioral: Portal Reminders for Influenza Vaccination: Direct scheduling link
Behavioral: Pre-Appointment flu vaccine reminders
Direct scheduling
Active Comparator group
Description:
Participants receive 1) reminder/recall messages regarding influenza vaccination via the patient portal with a link enabling direct scheduling
Treatment:
Behavioral: Portal Reminders for Influenza Vaccination: Direct scheduling link
No direct scheduling + Pre-commitment + Pre-Appt reminder
Active Comparator group
Description:
Participants receive 1) reminder/recall messages regarding influenza vaccination via the patient portal without a link enabling direct scheduling, 2) a pre-commitment prompt and 3) pre-appointment reminders that mention asking the provider for a flu vaccine
Treatment:
Behavioral: Pre-Commitment Prompt
Behavioral: Portal Reminders for Influenza Vaccination: No direct scheduling link
Behavioral: Pre-Appointment flu vaccine reminders
No direct scheduling + Pre-commitment
Active Comparator group
Description:
Participants receive 1) reminder/recall messages regarding influenza vaccination via the patient portal without a link enabling direct scheduling and 2) a pre-commitment prompt
Treatment:
Behavioral: Pre-Commitment Prompt
Behavioral: Portal Reminders for Influenza Vaccination: No direct scheduling link
No direct scheduling + Pre-appt reminder
Active Comparator group
Description:
Participants receive 1) reminder/recall messages regarding influenza vaccination via the patient portal without a link enabling direct scheduling and 2) pre-appointment reminders that mention asking the provider for a flu vaccine
Treatment:
Behavioral: Portal Reminders for Influenza Vaccination: No direct scheduling link
Behavioral: Pre-Appointment flu vaccine reminders
No direct scheduling
Active Comparator group
Description:
Participants receive 1) reminder/recall messages regarding influenza vaccination via the patient portal without a link enabling direct scheduling for a flu vaccine appointment
Treatment:
Behavioral: Portal Reminders for Influenza Vaccination: No direct scheduling link
Control Arm
No Intervention group
Description:
Participants will not receive any reminder/recall messages regarding influenza vaccination via the patient portal or other intervention components

Trial documents
2

Trial contacts and locations

1

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Data sourced from clinicaltrials.gov

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