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

NCT ID: NCT04533685

Last Updated: 2022-10-25

Study Results

Results available

Outcome measurements, participant flow, baseline characteristics, and adverse events have been published for this study.

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Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

213773 participants

Study Classification

INTERVENTIONAL

Study Start Date

2020-09-01

Study Completion Date

2021-04-01

Brief Summary

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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)

Detailed Description

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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).

Conditions

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Influenza Respiratory Tract Infections

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

FACTORIAL

A 2x2x2 factorial design, nested within a parallel 2-arm trial.
Primary Study Purpose

HEALTH_SERVICES_RESEARCH

Blinding Strategy

SINGLE

Participants

Study Groups

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Direct scheduling + Pre-commitment + Pre-appt reminder

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

Group Type ACTIVE_COMPARATOR

Portal Reminders for Influenza Vaccination: Direct scheduling link

Intervention Type BEHAVIORAL

Patients receive reminder/recall messages via the patient portal to get an influenza vaccination that include a direct scheduling link, enabling the patient to directly schedule a flu vaccination only visit

Pre-Commitment Prompt

Intervention Type BEHAVIORAL

Patients receive a pre-commitment prompt asking about their intention to get an influenza vaccination

Pre-Appointment flu vaccine reminders

Intervention Type BEHAVIORAL

Patients receive modified pre-appointment reminders for upcoming scheduled appointments that include language encouraging patients to ask the provider for the flu vaccine

Direct scheduling + Pre-commitment

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

Group Type ACTIVE_COMPARATOR

Portal Reminders for Influenza Vaccination: Direct scheduling link

Intervention Type BEHAVIORAL

Patients receive reminder/recall messages via the patient portal to get an influenza vaccination that include a direct scheduling link, enabling the patient to directly schedule a flu vaccination only visit

Pre-Commitment Prompt

Intervention Type BEHAVIORAL

Patients receive a pre-commitment prompt asking about their intention to get an influenza vaccination

Direct scheduling + Pre-appt reminder

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

Group Type ACTIVE_COMPARATOR

Portal Reminders for Influenza Vaccination: Direct scheduling link

Intervention Type BEHAVIORAL

Patients receive reminder/recall messages via the patient portal to get an influenza vaccination that include a direct scheduling link, enabling the patient to directly schedule a flu vaccination only visit

Pre-Appointment flu vaccine reminders

Intervention Type BEHAVIORAL

Patients receive modified pre-appointment reminders for upcoming scheduled appointments that include language encouraging patients to ask the provider for the flu vaccine

Direct scheduling

Participants receive 1) reminder/recall messages regarding influenza vaccination via the patient portal with a link enabling direct scheduling

Group Type ACTIVE_COMPARATOR

Portal Reminders for Influenza Vaccination: Direct scheduling link

Intervention Type BEHAVIORAL

Patients receive reminder/recall messages via the patient portal to get an influenza vaccination that include a direct scheduling link, enabling the patient to directly schedule a flu vaccination only visit

No direct scheduling + Pre-commitment + Pre-Appt reminder

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

Group Type ACTIVE_COMPARATOR

Portal Reminders for Influenza Vaccination: No direct scheduling link

Intervention Type BEHAVIORAL

Patients receive reminder/recall messages via the patient portal to get an influenza vaccination (no direct scheduling link included)

Pre-Commitment Prompt

Intervention Type BEHAVIORAL

Patients receive a pre-commitment prompt asking about their intention to get an influenza vaccination

Pre-Appointment flu vaccine reminders

Intervention Type BEHAVIORAL

Patients receive modified pre-appointment reminders for upcoming scheduled appointments that include language encouraging patients to ask the provider for the flu vaccine

No direct scheduling + Pre-commitment

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

Group Type ACTIVE_COMPARATOR

Portal Reminders for Influenza Vaccination: No direct scheduling link

Intervention Type BEHAVIORAL

Patients receive reminder/recall messages via the patient portal to get an influenza vaccination (no direct scheduling link included)

Pre-Commitment Prompt

Intervention Type BEHAVIORAL

Patients receive a pre-commitment prompt asking about their intention to get an influenza vaccination

No direct scheduling + Pre-appt reminder

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

Group Type ACTIVE_COMPARATOR

Portal Reminders for Influenza Vaccination: No direct scheduling link

Intervention Type BEHAVIORAL

Patients receive reminder/recall messages via the patient portal to get an influenza vaccination (no direct scheduling link included)

Pre-Appointment flu vaccine reminders

Intervention Type BEHAVIORAL

Patients receive modified pre-appointment reminders for upcoming scheduled appointments that include language encouraging patients to ask the provider for the flu vaccine

No direct scheduling

Participants receive 1) reminder/recall messages regarding influenza vaccination via the patient portal without a link enabling direct scheduling for a flu vaccine appointment

Group Type ACTIVE_COMPARATOR

Portal Reminders for Influenza Vaccination: No direct scheduling link

Intervention Type BEHAVIORAL

Patients receive reminder/recall messages via the patient portal to get an influenza vaccination (no direct scheduling link included)

Control Arm

Participants will not receive any reminder/recall messages regarding influenza vaccination via the patient portal or other intervention components

Group Type NO_INTERVENTION

No interventions assigned to this group

Interventions

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Portal Reminders for Influenza Vaccination: Direct scheduling link

Patients receive reminder/recall messages via the patient portal to get an influenza vaccination that include a direct scheduling link, enabling the patient to directly schedule a flu vaccination only visit

Intervention Type BEHAVIORAL

Portal Reminders for Influenza Vaccination: No direct scheduling link

Patients receive reminder/recall messages via the patient portal to get an influenza vaccination (no direct scheduling link included)

Intervention Type BEHAVIORAL

Pre-Commitment Prompt

Patients receive a pre-commitment prompt asking about their intention to get an influenza vaccination

Intervention Type BEHAVIORAL

Pre-Appointment flu vaccine reminders

Patients receive modified pre-appointment reminders for upcoming scheduled appointments that include language encouraging patients to ask the provider for the flu vaccine

Intervention Type BEHAVIORAL

Eligibility Criteria

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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
Minimum Eligible Age

4 Months

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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National Institute of Allergy and Infectious Diseases (NIAID)

NIH

Sponsor Role collaborator

University of California, Los Angeles

OTHER

Sponsor Role lead

Responsible Party

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Peter G Szilagyi, MD MPH

Professor of Pediatrics

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Peter G Szilagyi, MD, MPH

Role: PRINCIPAL_INVESTIGATOR

Professor of Pediatrics

Locations

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University of California LA

Los Angeles, California, United States

Site Status

Countries

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United States

References

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Szilagyi PG, Casillas A, Duru OK, Ong MK, Vangala S, Tseng CH, Albertin C, Humiston SG, Ross MK, Friedman SR, Evans S, Sloyan M, Bogard JE, Fox CR, Lerner C. Evaluation of behavioral economic strategies to raise influenza vaccination rates across a health system: Results from a randomized clinical trial. Prev Med. 2023 May;170:107474. doi: 10.1016/j.ypmed.2023.107474. Epub 2023 Mar 2.

Reference Type DERIVED
PMID: 36870572 (View on PubMed)

Provided Documents

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Document Type: Study Protocol

View Document

Document Type: Statistical Analysis Plan

View Document

Other Identifiers

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R01AI135029

Identifier Type: NIH

Identifier Source: secondary_id

View Link

17-001889-AM-00012

Identifier Type: -

Identifier Source: org_study_id

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