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The purpose of the current study is to test different email messages to determine the most effect way of promoting enrollment in Geisinger's patient portal, called myGeisinger.
Online patient portals are convenient tools that improve patient access to healthcare services while often reducing burden to both patients and providers. However, fewer than half of patients have enrolled in Geisinger's patient portal, myGeisinger.
The purpose of the current study is to assess what kind of messaging improves the effectiveness of an email campaign targeted at enrolling patients into Geisinger's online patient portal, called myGeisinger. Currently, Geisinger sends an email every month to patients who have started but not completed the enrollment process (they have had an activation code generated but have not yet used that code to enroll). This study will A/B test 5 email messages to assess if they perform better than the current standard email message.
Performance will be assessed based on whether patients open the email, click on the myGeisinger enrollment link, and enroll in myGeisinger. Statistical analyses will employ generalized linear models with a binary distribution and log-link function.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Control | A standard marketing message encouraging activation and describing the benefits of myGeisinger |
| |
| Focused on provider communication | A simple message focused on one benefit of myGeisinger: communicating easily with providers |
| |
| Focused on scheduling | A simple message focused on one benefit of myGeisinger: scheduling and managing appointments online |
| |
| Focused on medical information access | A simple message focused on one benefit of myGeisinger: accessing medical information, like test results |
| |
| Social proof | A message similar to control, but including information about how many other patients are using myGeisinger |
| |
| Endowment / decision staging | A message similar to control, but framing myGeisinger as something that patients already have, and just need to take one more step to activate. Endowment: Give patients the impression they already have the account, so they value it more. Decision staging: Break down the process into multiple stages - "having" an account and "activating" that account- and giving the impression that they are almost there because the first stage is complete |
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Less-is-better | Behavioral |
|
| Measure | Description | Time Frame |
|---|---|---|
| Email Opened: Control vs. Less-is-better vs. Social Proof vs. Endowment | Whether email was opened (yes / no) | 8-10 days post-intervention |
| Link Clicked: Control vs. Less-is-better vs. Social Proof vs. Endowment | Whether the link / button to start the activation process was clicked (yes / no) | 8-10 days post-intervention |
| Enrollment: Control vs. Less-is-better vs. Social Proof vs. Endowment | Whether the patient enrolled in myGeisinger (yes / no) | 8-10 days post-intervention |
| Measure | Description | Time Frame |
|---|---|---|
| Email Opened: Control vs. Less-is-better vs. Social Proof vs. Endowment | Whether email was opened (yes / no) | 32-35 days post-intervention |
| Link Clicked: Control vs. Less-is-better vs. Social Proof vs. Endowment |
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Inclusion Criteria:
Exclusion Criteria:
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The population consists of Geisinger patients whose myGeisinger status is "Pending" and who have an email address on file.
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| Name | Affiliation | Role |
|---|---|---|
| Amir Goren, PhD | Geisinger Clinic | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Geisinger | Danville | Pennsylvania | 17822 | United States |
Data with no personally identifiable information will be made available to other researchers on the Open Science Framework for transparency. This will include the essential data and code needed to replicate the analysis that yielded reported findings.
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.
The data on the Open Science Framework will be open to anyone requesting that information.
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| ID | Title | Description |
|---|---|---|
| FG000 | Control | A standard marketing message encouraging activation and describing the benefits of myGeisinger Standard email: Email |
| FG001 | Focused on Provider Communication | A simple message focused on one benefit of myGeisinger: communicating easily with providers Less-is-better: Email |
| FG002 | Focused on Scheduling | A simple message focused on one benefit of myGeisinger: scheduling and managing appointments online Less-is-better: Email |
| FG003 | Focused on Medical Information Access | A simple message focused on one benefit of myGeisinger: accessing medical information, like test results Less-is-better: Email |
| FG004 | Social Proof | A message similar to control, but including information about how many other patients are using myGeisinger Social proof: Email |
| FG005 | Endowment / Decision Staging | A message similar to control, but framing myGeisinger as something that patients already have, and just need to take one more step to activate. Endowment: Give patients the impression they already have the account, so they value it more. Decision staging: Break down the process into multiple stages - "having" an account and "activating" that account- and giving the impression that they are almost there because the first stage is complete Endowment / decision staging: Email |
| Title | Milestones | Reasons Not Completed | |||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| ~1 Week After Study Launch |
| ||||||||||||||||
| ~1 Month After Study Launch |
|
Investigators did not have access to baseline demographic information for study participants.
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| ID | Title | Description |
|---|---|---|
| BG000 | Control | A standard marketing message encouraging activation and describing the benefits of myGeisinger Standard email: Email |
| BG001 | Focused on Provider Communication | A simple message focused on one benefit of myGeisinger: communicating easily with providers Less-is-better: Email |
| Units | Counts |
|---|---|
| Participants |
|
| Title | Description | Population Description | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Denominator Units Selected | Denominators | Classes |
|---|---|---|---|---|---|---|---|---|---|
| Age, Categorical | Count of Participants |
| Type | Title | Description | Population Description | Reporting Status | Anticipated Posting Date | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Time Frame | Units Analyzed | Denominator Units Selected | Arm/Group Information | Denominators | Classes | Analyses | |||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Primary | Email Opened: Control vs. Less-is-better vs. Social Proof vs. Endowment | Whether email was opened (yes / no) | Patients who were delivered an email (i.e. email did not bounce back) and for whom there was a record in the EHR 10 days post-intervention. | Posted | Count of Participants | Participants | 8-10 days post-intervention |
|
No adverse events were evaluated.
We only received information about email engagement and portal enrollment. We did not collect or receive any information regarding adverse events.
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| ID | Title | Description | Deaths (Affected) | Deaths (At Risk) | Serious Events (Affected) | Serious Events (At Risk) | Other Events (Affected) | Other Events (At Risk) |
|---|---|---|---|---|---|---|---|---|
| EG000 | Control | A standard marketing message encouraging activation and describing the benefits of myGeisinger Standard email: Email |
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For this study, we only received data about engagement with the email and enrollment in the patient portal. Demographic information such as age, sex, or gender were not collected. Note that for some patients, enrollment data could not be extracted from Geisinger's electronic health records; these patients were excluded from analyses. Also note that "1 week" and "1 month" outcome data were extracted within a time range that was a few days longer than 7 and 30 days post-intervention, respectively.
| Title | Organization | Phone | Extension | |
|---|---|---|---|---|
| Amir Goren, PhD | Geisinger Clinic | 5702144395 | agoren@geisinger.edu |
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| Type | Includes Protocol | Includes SAP | Includes ICF | Document Label | Document Date | Document Uploaded Date | Document File Name |
|---|---|---|---|---|---|---|---|
| Prot_SAP | Yes | Yes | No | Study Protocol and Statistical Analysis Plan | Apr 5, 2021 | Apr 6, 2021 | Prot_SAP_000.pdf |
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| ID | Term |
|---|---|
| D015438 | Health Behavior |
| ID | Term |
|---|---|
| D001519 | Behavior |
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| ID | Term |
|---|---|
| D005376 | Financial Management |
| ID | Term |
|---|---|
| D004467 | Economics |
| D004472 | Health Care Economics and Organizations |
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|
| Social proof | Behavioral |
|
| Endowment / decision staging | Behavioral |
|
| Standard email | Behavioral |
|
Whether the link / button to start the activation process was clicked (yes / no)
| 32-35 days post-intervention |
| Enrollment: Control vs. Less-is-better vs. Social Proof vs. Endowment | Whether the patient enrolled in myGeisinger (yes / no) | 32-35 days post-intervention |
| Email Opened: Within Less-is-better (Provider Communication vs. Managing Appointments vs. Medical Information Access) | Whether email was opened (yes / no) | 8-10 days post-intervention |
| Link Clicked: Within Less-is-better (Provider Communication vs. Managing Appointments vs. Medical Information Access) | Whether the link / button to start the activation process was clicked (yes / no) | 8-10 days post-intervention |
| Enrollment: Within Less-is-better (Provider Communication vs. Managing Appointments vs. Medical Information Access) | Whether the patient enrolled in myGeisinger (yes / no) | 8-10 days post-intervention |
| Email Opened: Within Less-is-better (Provider Communication vs. Managing Appointments vs. Medical Information Access) | Whether email was opened (yes / no) | 32-35 days post-intervention |
| Link Clicked: Within Less-is-better (Provider Communication vs. Managing Appointments vs. Medical Information Access) | Whether the link / button to start the activation process was clicked (yes / no) | 32-35 days post-intervention |
| Enrollment: Within Less-is-better (Provider Communication vs. Managing Appointments vs. Medical Information Access) | Whether the patient enrolled in myGeisinger (yes / no) | 32-35 days post-intervention |
| COMPLETED | Record was found in EHR ~1 month after intervention AND email was delivered (did not bounce back) |
|
| NOT COMPLETED |
|
| BG002 | Focused on Scheduling | A simple message focused on one benefit of myGeisinger: scheduling and managing appointments online Less-is-better: Email |
| BG003 | Focused on Medical Information Access | A simple message focused on one benefit of myGeisinger: accessing medical information, like test results Less-is-better: Email |
| BG004 | Social Proof | A message similar to control, but including information about how many other patients are using myGeisinger Social proof: Email |
| BG005 | Endowment / Decision Staging | A message similar to control, but framing myGeisinger as something that patients already have, and just need to take one more step to activate. Endowment: Give patients the impression they already have the account, so they value it more. Decision staging: Break down the process into multiple stages - "having" an account and "activating" that account- and giving the impression that they are almost there because the first stage is complete Endowment / decision staging: Email |
| BG006 | Total | Total of all reporting groups |
| Participants |
|
| Sex: Female, Male | Count of Participants | Participants |
|
| Race and Ethnicity Not Collected | Race and Ethnicity were not collected from any participant. | Count of Participants | Participants |
|
| Region of Enrollment | Number | participants |
|
| Social Proof |
A message similar to control, but including information about how many other patients are using myGeisinger |
| OG003 | Endowment / Decision Staging | A message similar to control, but framing myGeisinger as something that patients already have, and just need to take one more step to activate. Endowment: Give patients the impression they already have the account, so they value it more. Decision staging: Break down the process into multiple stages - "having" an account and "activating" that account- and giving the impression that they are almost there because the first stage is complete |
|
|
|
| Primary | Link Clicked: Control vs. Less-is-better vs. Social Proof vs. Endowment | Whether the link / button to start the activation process was clicked (yes / no) | Patients who opened the intervention email and for whom there was a record in the EHR 10 days post-intervention. | Posted | Count of Participants | Participants | 8-10 days post-intervention |
|
|
|
|
| Primary | Enrollment: Control vs. Less-is-better vs. Social Proof vs. Endowment | Whether the patient enrolled in myGeisinger (yes / no) | Patients who opened the intervention email and for whom there was a record in the EHR 10 days post-intervention. | Posted | Count of Participants | Participants | 8-10 days post-intervention |
|
|
|
|
| Secondary | Email Opened: Control vs. Less-is-better vs. Social Proof vs. Endowment | Whether email was opened (yes / no) | Patients who were delivered an email (i.e. email did not bounce back) and for whom there was a record in the EHR 32 days post-intervention. | Posted | Count of Participants | Participants | 32-35 days post-intervention |
|
|
|
|
| Secondary | Link Clicked: Control vs. Less-is-better vs. Social Proof vs. Endowment | Whether the link / button to start the activation process was clicked (yes / no) | Patients who opened the intervention email and for whom there was a record in the EHR 32 days post-intervention. | Posted | Count of Participants | Participants | 32-35 days post-intervention |
|
|
|
|
| Secondary | Enrollment: Control vs. Less-is-better vs. Social Proof vs. Endowment | Whether the patient enrolled in myGeisinger (yes / no) | Patients who opened the intervention email and for whom there was a record in the EHR 32 days post-intervention. | Posted | Count of Participants | Participants | 32-35 days post-intervention |
|
|
|
|
| Secondary | Email Opened: Within Less-is-better (Provider Communication vs. Managing Appointments vs. Medical Information Access) | Whether email was opened (yes / no) | Patients who were delivered an email (i.e. email did not bounce back) and for whom there was a record in the EHR 10 days post-intervention. | Posted | Count of Participants | Participants | 8-10 days post-intervention |
|
|
|
|
| Secondary | Link Clicked: Within Less-is-better (Provider Communication vs. Managing Appointments vs. Medical Information Access) | Whether the link / button to start the activation process was clicked (yes / no) | Patients who opened the intervention email and for whom there was a record in the EHR 10 days post-intervention. | Posted | Count of Participants | Participants | 8-10 days post-intervention |
|
|
|
|
| Secondary | Enrollment: Within Less-is-better (Provider Communication vs. Managing Appointments vs. Medical Information Access) | Whether the patient enrolled in myGeisinger (yes / no) | Posted | Count of Participants | Participants | 8-10 days post-intervention |
|
|
|
|
| Secondary | Email Opened: Within Less-is-better (Provider Communication vs. Managing Appointments vs. Medical Information Access) | Whether email was opened (yes / no) | Patients who were delivered an email (i.e. email did not bounce back) and for whom there was a record in the EHR 32 days post-intervention. | Posted | Count of Participants | Participants | 32-35 days post-intervention |
|
|
|
|
| Secondary | Link Clicked: Within Less-is-better (Provider Communication vs. Managing Appointments vs. Medical Information Access) | Whether the link / button to start the activation process was clicked (yes / no) | Patients who opened the intervention email and for whom there was a record in the EHR 32 days post-intervention. | Posted | Count of Participants | Participants | 32-35 days post-intervention |
|
|
|
|
| Secondary | Enrollment: Within Less-is-better (Provider Communication vs. Managing Appointments vs. Medical Information Access) | Whether the patient enrolled in myGeisinger (yes / no) | Patients who opened the intervention email and for whom there was a record in the EHR 32 days post-intervention. | Posted | Count of Participants | Participants | 32-35 days post-intervention |
|
|
|
|
| 0 |
| 0 |
| 0 |
| 0 |
| 0 |
| 0 |
| EG001 | Focused on Provider Communication | A simple message focused on one benefit of myGeisinger: communicating easily with providers Less-is-better: Email | 0 | 0 | 0 | 0 | 0 | 0 |
| EG002 | Focused on Scheduling | A simple message focused on one benefit of myGeisinger: scheduling and managing appointments online Less-is-better: Email | 0 | 0 | 0 | 0 | 0 | 0 |
| EG003 | Focused on Medical Information Access | A simple message focused on one benefit of myGeisinger: accessing medical information, like test results Less-is-better: Email | 0 | 0 | 0 | 0 | 0 | 0 |
| EG004 | Social Proof | A message similar to control, but including information about how many other patients are using myGeisinger Social proof: Email | 0 | 0 | 0 | 0 | 0 | 0 |
| EG005 | Endowment / Decision Staging | A message similar to control, but framing myGeisinger as something that patients already have, and just need to take one more step to activate. Endowment: Give patients the impression they already have the account, so they value it more. Decision staging: Break down the process into multiple stages - "having" an account and "activating" that account- and giving the impression that they are almost there because the first stage is complete Endowment / decision staging: Email | 0 | 0 | 0 | 0 | 0 | 0 |
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| Between 18 and 65 years |
|
| >=65 years |
|
| Male |
|
| <0.0001 |
We used an a priori threshold of p < .05. All 3 comparisons run within same logistic regression model. |
| Odds Ratio (OR) |
| 0.2851440 |
| 2-Sided |
| 95 |
| 0.1881589 |
| 0.4321194 |
| Superiority |
| Regression, Logistic | 0.0003 | We used an a priori threshold of p < .05. All 3 comparisons run within same logistic regression model. | Odds Ratio (OR) | 0.5565905 | 2-Sided | 95 | 0.4059477 | 0.7631354 | Superiority |
| 0.120 |
We used an a priori threshold of p < .05. All 3 comparisons run within same logistic regression model. |
| Odds Ratio (OR) |
| 0.63578603 |
| 2-Sided |
| 95 |
| 0.35943749 |
| 1.1246013 |
| Superiority |
| Regression, Logistic | 0.789 | We used an a priori threshold of p < .05. All 3 comparisons run within same logistic regression model. | Odds Ratio (OR) | 1.06482385 | 2-Sided | 95 | 0.67282661 | 1.6852036 | Superiority |
| <0.0001 |
We used an a priori threshold of p < .05. All 3 comparisons run within same logistic regression model. |
| Odds Ratio (OR) |
| 0.6000149 |
| 2-Sided |
| 95 |
| 0.5193168 |
| 0.6932528 |
| Superiority |
| Regression, Logistic | 0.0055 | Odds Ratio (OR) | 0.8225743 | 2-Sided | 95 | 0.7167043 | 0.9440832 | Superiority |
| <0.0001 |
We used an a priori threshold of p < .05. All 3 comparisons run within same logistic regression model. |
| Odds Ratio (OR) |
| 0.2790595 |
| 2-Sided |
| 95 |
| 0.1875017 |
| 0.4153254 |
| Superiority |
| Regression, Logistic | 0.0011 | We used an a priori threshold of p < .05. All 3 comparisons run within same logistic regression model. | Odds Ratio (OR) | 0.6097538 | 2-Sided | 95 | 0.4528751 | 0.8209762 | Superiority |
| 0.246 |
We used an a priori threshold of p < .05. All 3 comparisons run within same logistic regression model. |
| Odds Ratio (OR) |
| 0.7576895 |
| 2-Sided |
| 95 |
| 0.47412590 |
| 1.2108458 |
| Superiority |
| Regression, Logistic | 0.428 | We used an a priori threshold of p < .05. All 3 comparisons run within same logistic regression model. | Odds Ratio (OR) | 1.1728665 | 2-Sided | 95 | 0.79090107 | 1.7393021 | Superiority |
| Regression, Logistic |
| 0.276 |
We used an a priori threshold of p < .05. All 3 comparisons run within same logistic regression model, correcting for the 3 pairwise comparisons using Tukey's Contrasts. |
| Odds Ratio (OR) |
| 0.8953032 |
| 2-Sided |
| 95 |
| 0.7771682 |
| 1.031395 |
| Superiority |
| Regression, Logistic | 0.289 | We used an a priori threshold of p < .05. All 3 comparisons run within same logistic regression model, correcting for the 3 pairwise comparisons using Tukey's Contrasts. | Odds Ratio (OR) | 0.8970536 | 2-Sided | 95 | 0.7785981 | 1.033531 | Superiority |
| Regression, Logistic |
| 0.0041 |
We used an a priori threshold of p < .05. All 3 comparisons run within same logistic regression model, correcting for the 3 pairwise comparisons using Tukey's Contrasts. |
| Odds Ratio (OR) |
| 1.8998642 |
| 2-Sided |
| 95 |
| 1.2809137 |
| 2.817898 |
| Superiority |
| Regression, Logistic | 0.0015 | We used an a priori threshold of p < .05. All 3 comparisons run within same logistic regression model, correcting for the 3 pairwise comparisons using Tukey's Contrasts. | Odds Ratio (OR) | 2.0398184 | 2-Sided | 95 | 1.3648075 | 3.048678 | Superiority |
| Regression, Logistic |
| 0.404 |
We used an a priori threshold of p < .05. All 3 comparisons run within same logistic regression model, correcting for the 3 pairwise comparisons using Tukey's Contrasts. |
| Odds Ratio (OR) |
| 1.432003 |
| 2-Sided |
| 95 |
| 0.8279689 |
| 2.476702 |
| Superiority |
| Regression, Logistic | 0.753 | We used an a priori threshold of p < .05. All 3 comparisons run within same logistic regression model, correcting for the 3 pairwise comparisons using Tukey's Contrasts. | Odds Ratio (OR) | 1.212702 | 2-Sided | 95 | 0.7161724 | 2.053480 | Superiority |
| Regression, Logistic |
| 0.0612 |
We used an a priori threshold of p < .05. All 3 comparisons run within same logistic regression model, correcting for the 3 pairwise comparisons using Tukey's Contrasts. |
| Odds Ratio (OR) |
| 0.8518974 |
| 2-Sided |
| 95 |
| 0.7414610 |
| 0.9787827 |
| Superiority |
| Regression, Logistic | 0.1407 | We used an a priori threshold of p < .05. All 3 comparisons run within same logistic regression model, correcting for the 3 pairwise comparisons using Tukey's Contrasts. | Odds Ratio (OR) | 0.8739930 | 2-Sided | 95 | 0.7602296 | 1.0047804 | Superiority |
| Regression, Logistic |
| 0.0127 |
We used an a priori threshold of p < .05. All 3 comparisons run within same logistic regression model, correcting for the 3 pairwise comparisons using Tukey's Contrasts. |
| Odds Ratio (OR) |
| 1.6914929 |
| 2-Sided |
| 95 |
| 1.1762411 |
| 2.432450 |
| Superiority |
| Regression, Logistic | 0.0033 | We used an a priori threshold of p < .05. All 3 comparisons run within same logistic regression model, correcting for the 3 pairwise comparisons using Tukey's Contrasts. | Odds Ratio (OR) | 1.8608951 | 2-Sided | 95 | 1.2800275 | 2.705356 | Superiority |
| Regression, Logistic |
| 0.897 |
We used an a priori threshold of p < .05. All 3 comparisons run within same logistic regression model, correcting for the 3 pairwise comparisons using Tukey's Contrasts. |
| Odds Ratio (OR) |
| 1.0950508 |
| 2-Sided |
| 95 |
| 0.7331329 |
| 1.635633 |
| Superiority |
| Regression, Logistic | 0.498 | We used an a priori threshold of p < .05. All 3 comparisons run within same logistic regression model, correcting for the 3 pairwise comparisons using Tukey's Contrasts. | Odds Ratio (OR) | 1.2704886 | 2-Sided | 95 | 0.8377249 | 1.926816 | Superiority |