Encouraging Overdue Healthcare Appointment Scheduling Among Patients With Chronic Diseases

The goal of this study is to determine the most effective messages for encouraging patients with chronic conditions, who have not seen their doctor in at least one year, to return to the clinic. Study participants will receive postcards or letters encouraging them to make an appointment. Researchers will assess whether messages increase appointment scheduling (and attendance).

About 18,500 Geisinger patients, Geisinger Health Plan members, and Medicaid patients with chronic illness have not been seen in a clinic for at least one year, which is concerning because regular appointments are necessary for chronic disease management. Geisinger is therefore working to encourage those with chronic illness and overdue appointments to return to the clinic. In the present study, patients will either receive a mailer (with a message encouraging them to schedule an appointment with their physician), or no mailer. The purpose of the study is to compare three different mailers to assess which is most effective at encouraging patients to schedule and attend an appointment. The three mailers include (1) a standard outreach postcard (emphasizing that we are "checking in" with the patient), and, informed by behavioral science research, (2) a postcard with a cartoon and humorous messages and (3) a letter signed by a physician. The study will compare the effectiveness of the three experimental mailer arms to each other and to a no-contact control arm.

Participants will not be informed specifically of their assignment to different arms throughout the study. Providers who conduct appointments will not be randomized to study arms or informed of patient assignment.

This group receives a postcard with a stock image on the front and a message encouraging regular visits to manage health on the back.

This group receives a postcard with with a cartoon image and a visit-related joke on the front and a humorous message on the back, with additional information about why visits are important, and what to expect at the appointment.

This group receives a personalized letter signed by a physician with information about why visits are important, and what to expect at the appointment.

Proportion of Geisinger patients who schedule an appointment, comparing relative efficacy of the mailers

Proportion of appointments (from the primary outcome) that were attended. This outcome focuses on attendance at appointments that were scheduled within 30 days of the mailer drop date. It is possible to schedule an appointment months in advance, so the Time Frame needs to be long to capture attendance at any appointment scheduled within 30 days of the mailer. 180 days should be sufficient to capture all scheduled appointments.

Proportion of Geisinger patients who schedule an appointment, comparing relative efficacy of the interventions. Note: this analysis will inform internal operations but will not be reported in publication.

Inclusion Criteria: Geisinger patient, Geisinger Health Plan member or Medicaid patient Chronic illness No appointment for > 1 year

Data with no personally identifiable information will be made available to other researchers on the Open Science Framework for transparency.

The data will become available after publication of study results in a scientific journal and will be available as long as the Open Science Framework hosts the data.