Patient Messaging for Health Behaviors

(PROACTIVE Trial)

This trial aims to increase the completion of overdue health screenings by sending reminders to both patients and their doctors. It tests whether text message nudges and automatic order setups, known as "Default pended order" and "EHR communication," can encourage people to complete important screenings like mammograms, diabetes tests, and cholesterol checks. The study focuses on individuals overdue for these tests who have a non-urgent primary care visit scheduled. Participants must have missed at least one health screening and not had a primary care visit in the last three months. As an unphased trial, this study provides a unique opportunity to enhance healthcare practices and ensure timely screenings for everyone.

Research has shown that patient messaging systems, like the one used in this trial, are generally safe and easy to use. One study found that secure messaging improved communication and workflow in primary care clinics, benefiting both patients and healthcare providers. Another study discovered that secure text reminders reduced missed appointments by 25% to 40% without causing safety issues. This indicates that the messaging system keeps patients engaged without introducing new risks. Additionally, combining text messages with electronic health records (EHRs) has improved communication between patients and healthcare providers, further demonstrating its safety and usefulness in healthcare. Overall, these findings suggest that the patient messaging system in this trial is expected to be safe.¹²³⁴⁵

Researchers are excited about this trial because it explores innovative ways to enhance patient engagement and improve healthcare delivery. Unlike standard care, which often relies on in-person reminders or follow-ups, this approach uses pre- and post-visit text message nudges to remind patients about overdue health screenings or treatments. Additionally, it introduces clinician nudges through default pended orders and EHR communication to streamline care processes and ensure timely interventions. By integrating technology into patient and clinician interactions, the trial aims to close care gaps more effectively and encourage proactive health management.

Research has shown that digital reminders, such as messages before and after doctor visits, help patients stay engaged and address gaps in their care. In this trial, participants in the active intervention arm will receive pre- and post-visit text message reminders about overdue care gaps. Studies have found that these reminders lead to small improvements in preventive care by keeping patients informed and more likely to complete necessary screenings. Additionally, evidence suggests that prompts in electronic health records (EHRs) enhance healthcare quality by aiding doctors with documentation and decision-making. In this trial, the active intervention arm will also include EHR prompts, such as default pended orders and communication banners, to assist in better tracking and coordination of patient care. Overall, reminders for both patients and doctors can effectively increase the number of completed screenings and improve health outcomes.⁶⁷⁸⁹¹⁰