Overview

The project aims to evaluate a nurse-led intervention to reduce inappropriate emergency department (ED) use among adult patients seen at Geisinger's Community Medicine Service Line (CMSL) clinics. The intervention occurs immediately following an appointment where a patient receives a diagnosis of an ambulatory sensitive condition (ASC; i.e., a condition considered to be a risk factor for near-term ED use). The evaluation will compare eligible patients with an ASC who were randomly assigned to receive follow-up outreach (patient portal message or call) from a nurse (who was automatically prompted via the Epic electronic health record system to initiate outreach) with those who were randomly assigned to receive standard care. Analyses will be intent-to-treat. The primary outcome is ED use in the week following the appointment.

We ran an earlier version of this intervention (NCT06798389). The current study is modified based on results and clinical guidance. Specifically, more conditions will be included as qualifying ASCs for enrollment. Patients under 30 will be excluded. And rather than calling all patients as in the original study, patient portal messages will be sent to patient portal users (i.e., those with a portal account and 1+ login in the 6 months prior to enrollment). Finally, in the first study, the intervention was differentially effective by age group (<45, 45-64, 65+). Our primary analysis will be conducted separately by age group, though we will conduct an analysis combining across age groups. We will also run an analysis separately by modality (call, portal message) to determine the effectiveness of each modality individually for eligible patients.

We will run the study until we reach at least 4,330 patients in each of the following groups: patients aged 30-45, patients aged 45-64, patients aged 65+, patients eligible for a call, patients eligible for a portal message. Our estimated sample size is at least 4,330x3 = 12,990, because by the time we reach our target in each of the three age groups, we expect we will already have reached 4,330 patients in each of the individual modalities (but if that is not the case, we will continue running the study until we reach 4,330 in each age group and modality).

We may be required to stop the study early at the direction of clinical or operational leaders. We will not analyze data before deciding to stop the study.

Eligibility

Inclusion Criteria:

• Age 30 years +
• Has a qualifying visit in CMSL with an ambulatory sensitive condition (ASC) encounter diagnosis