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| ID | Type | Description | Link |
|---|---|---|---|
| P30AG034532 | U.S. NIH Grant/Contract | View source |
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| Name | Class |
|---|---|
| Geisinger Clinic | OTHER |
| Massachusetts Institute of Technology | OTHER |
| National Institute on Aging (NIA) | NIH |
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In the current study, the study team will explore whether small incentives are effective at promoting flu vaccine uptake. The study is designed to compare the relative efficacy of incentives of equal perceived expected value (EV) or equal implementation costs, to assess whether people are more likely to get vaccinated in response to lotteries with very high payoffs than to small certain cash payout or slightly higher-probability, more moderate payoffs. In particular, given the potential appeal of official state lottery tickets, one study arm will receive a Pennsylvania scratch-off lottery ticket for getting a flu vaccine. A primary hypothesis is that lotteries will outperform simple reminders (encouraging respondents to get the flu shot at their upcoming appointment) and the standard of care, representing the ambient healthcare system and public health campaigns to increase vaccination.
During the 2021-22 flu season, the study team will contact Geisinger patients who have a primary care or specialist appointment scheduled during flu season and encourage them to get a flu shot.
Patients will be randomized into 4 to 9 study arms, depending on a sample size projection completed in August 2021. Arms will test the relative efficacy of a variety of small monetary incentives on flu shot uptake. Incentives may include (a) a $1 Pennsylvania scratch-off lottery ticket (with top prize of $5,000), (b) $1 in cash, (c) entry into a raffle for $5,000 absent upfront odds, (d) entry into a raffle for $5,000, with 1-in-5,000 odds of winning, (d) entry into a raffle for $50, with 1-in-50 odds of winning, and (e) entry into a raffle for $500, with 1-in-500 odds of winning. There will be one no-contact control arm and at least 1 reminder control arm (with additional control arms added given sufficient sample size and additional message versions to be tested).
Included in the study will be current Geisinger patients 18+ years of age with no contraindications for flu vaccine who have an appointment scheduled during the study period with a provider who can administer the vaccine. The primary study outcomes will be the rates of flu vaccination and flu diagnosis during the 2021-22 season by targeted patients.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Pennsylvania (PA) Lottery Scratch-Off Financial Incentive | Experimental | Participants in this arm will receive a message stating that they will receive a PA lottery $1 scratch-off ticket if they get a flu shot at an upcoming appointment. The message will mention that they could win $5,000 (the top prize for the scratch-off game). Note: $1 scratch-off products vary over time; at study implementation, an active game with top prize of $5,000 (or the next-highest top prize) will be selected and will define the prize in the raffle absent upfront odds |
|
| Certain Cash Payout Financial Incentive | Experimental | Participants in this arm will receive a message stating that they will receive $1 in cash if they get a flu shot at an upcoming appointment. |
|
| Reminder / Active Control (No Financial Incentive) | Experimental | Participants in this arm will receive a message stating that they can get a flu shot at an upcoming appointment. These participants will not be offered a financial incentive for getting a flu shot. |
|
| No Treatment Control | No Intervention | No additional contact beyond standard Geisinger flu shot communications |
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Reminder | Behavioral | Letter, short message service (SMS) text, phone, and/or email |
|
| Measure | Description | Time Frame |
|---|---|---|
| Flu Vaccination at Appointment | Received flu vaccination at relevant PCP or specialty appointment. | 3 days after patient is randomized |
| Measure | Description | Time Frame |
|---|---|---|
| Flu Vaccination Within 7 Days | Received flu vaccination | Within 7 days of when patient is randomized |
| Flu Diagnosis | Received a "high confidence flu" diagnosis (with positive polymerase chain reaction [PCR]/antigen/molecular test) and/or "likely flu" diagnosis (as assessed via International Classification of Disease [ICD] codes or Tamiflu administration or positive PCR/antigen/molecular test) Note that "likely flu" is a superset of the "high confidence flu" diagnoses. |
| Measure | Description | Time Frame |
|---|---|---|
| Flu Vaccination (Among Subject Cohabitants) Within 28 Days | Cohabitant of study subject received flu vaccination | Within 28 days of when the study subject is randomized |
| Flu Vaccination at Appointment by Gender |
Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Michelle N Meyer, PhD JD | Geisinger Clinic | Principal Investigator |
| Christopher F Chabris, PhD | Geisinger Clinic | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Geisinger Clinic | 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.
By the paper's online publication date or within 12 months of the primary completion date (whichever comes first). Data will remain available for as long as the Open Science Framework hosts it.
The data on the Open Science Framework will be open to anyone requesting that information.
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| ID | Title | Description |
|---|---|---|
| FG000 | Pennsylvania (PA) Lottery Scratch-Off Financial Incentive | Participants in this arm will receive a message stating that they will receive a PA lottery $1 scratch-off ticket if they get a flu shot at an upcoming appointment. The message will mention that they could win $5,000 (the top prize for the scratch-off game). Note: $1 scratch-off products vary over time; at study implementation, an active game with top prize of $5,000 (or the next-highest top prize) will be selected and will define the prize in the raffle absent upfront odds Reminder: Letter, short message service (SMS) text, phone, and/or email Financial incentive: Letter, SMS, phone, and/or email Lottery: Letter, SMS, phone, and/or email |
| FG001 | Certain Cash Payout Financial Incentive | Participants in this arm will receive a message stating that they will receive $1 in cash if they get a flu shot at an upcoming appointment. Reminder: Letter, short message service (SMS) text, phone, and/or email Financial incentive: Letter, SMS, phone, and/or email |
| FG002 | Reminder / Active Control (No Financial Incentive) | Participants in this arm will receive a message stating that they can get a flu shot at an upcoming appointment. These participants will not be offered a financial incentive for getting a flu shot. Reminder: Letter, short message service (SMS) text, phone, and/or email |
| FG003 | No Treatment Control | No additional contact beyond standard Geisinger flu shot communications |
| Title | Milestones | Reasons Not Completed | ||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Overall Study |
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| ID | Title | Description |
|---|---|---|
| BG000 | Pennsylvania (PA) Lottery Scratch-Off Financial Incentive | Participants in this arm will receive a message stating that they will receive a PA lottery $1 scratch-off ticket if they get a flu shot at an upcoming appointment. The message will mention that they could win $5,000 (the top prize for the scratch-off game). Note: $1 scratch-off products vary over time; at study implementation, an active game with top prize of $5,000 (or the next-highest top prize) will be selected and will define the prize in the raffle absent upfront odds Reminder: Letter, short message service (SMS) text, phone, and/or email Financial incentive: Letter, SMS, phone, and/or email Lottery: Letter, SMS, phone, and/or email |
| Units | Counts |
|---|---|
| Participants |
|
| Title | Description | Population Description | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Denominator Units Selected | Denominators | Classes |
|---|---|---|---|---|---|---|---|---|---|
| Age, Customized | 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 | Flu Vaccination at Appointment | Received flu vaccination at relevant PCP or specialty appointment. | All enrolled patients were included in analyses, except the two patients who were inadvertently enrolled at age 17. | Posted | Count of Participants | Participants | 3 days after patient is randomized |
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This is a minimal risk study, and has received expedited IRB review in keeping with 45 CFR §46.110. EHR and claims data will report inputs (i.e., the subject's assigned arm) and outcomes (i.e., flu vaccination, flu diagnosis, flu-like symptoms). We therefore did not monitor the data for AE/SAEs.
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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 | Pennsylvania (PA) Lottery Scratch-Off Financial Incentive | Participants in this arm will receive a message stating that they will receive a PA lottery $1 scratch-off ticket if they get a flu shot at an upcoming appointment. The message will mention that they could win $5,000 (the top prize for the scratch-off game). Note: $1 scratch-off products vary over time; at study implementation, an active game with top prize of $5,000 (or the next-highest top prize) will be selected and will define the prize in the raffle absent upfront odds Reminder: Letter, short message service (SMS) text, phone, and/or email Financial incentive: Letter, SMS, phone, and/or email Lottery: Letter, SMS, phone, and/or email |
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| Title | Organization | Phone | Extension | |
|---|---|---|---|---|
| Gail Rosenbaum | Geisinger | 800-275-6401 | grosenbaum@geisinger.edu |
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| Type | Includes Protocol | Includes SAP | Includes ICF | Document Label | Document Date | Document Uploaded Date | Document File Name |
|---|---|---|---|---|---|---|---|
| Prot | Yes | No | No | Study Protocol | Jun 28, 2021 | Jan 18, 2023 | Prot_002.pdf |
| SAP | No | Yes | No | Statistical Analysis Plan | Feb 3, 2022 | Feb 4, 2022 | SAP_001.pdf |
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| ID | Term |
|---|---|
| D007251 | Influenza, Human |
| D015438 | Health Behavior |
| ID | Term |
|---|---|
| D012141 | Respiratory Tract Infections |
| D007239 | Infections |
| D009976 | Orthomyxoviridae Infections |
| D012327 | RNA Virus Infections |
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Eligible patients will be randomly assigned to one of four arms:
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Providers who prescribe vaccination and diagnose conditions will not be randomized to study arms or informed of patient assignment. Although patients will not be explicitly informed of which arm they were randomized to, they will be aware of the messages they receive.
| Financial incentive | Behavioral | Letter, SMS, phone, and/or email |
|
| Lottery | Behavioral | Letter, SMS, phone, and/or email |
|
| During the 2021-22 flu season (Up to 8 months, from the time the patient is randomized through April 30, 2022) |
| Flu Complications | Diagnosed with flu-related complications | During the 2021-22 flu season (Up to 11 months, from the time the patient is randomized through July 31, 2022) |
Received flu vaccination at relevant PCP or specialty appointment.
| 3 days after the patient is randomized. |
| Flu Vaccination at Appointment by Race | Received flu vaccination at relevant PCP or specialty appointment. | 3 days after the patient is randomized. |
| Flu Vaccination at Appointment by Ethnicity | Received flu vaccination at relevant PCP or specialty appointment. | 3 days after the patient is randomized. |
| BG001 | Certain Cash Payout Financial Incentive | Participants in this arm will receive a message stating that they will receive $1 in cash if they get a flu shot at an upcoming appointment. Reminder: Letter, short message service (SMS) text, phone, and/or email Financial incentive: Letter, SMS, phone, and/or email |
| BG002 | Reminder / Active Control (No Financial Incentive) | Participants in this arm will receive a message stating that they can get a flu shot at an upcoming appointment. These participants will not be offered a financial incentive for getting a flu shot. Reminder: Letter, short message service (SMS) text, phone, and/or email |
| BG003 | No Treatment Control | No additional contact beyond standard Geisinger flu shot communications |
| BG004 | Total | Total of all reporting groups |
| Participants |
|
| Sex: Female, Male | Count of Participants | Participants |
|
| Ethnicity (NIH/OMB) | Count of Participants | Participants |
|
| Race/Ethnicity, Customized | Count of Participants | Participants |
|
| OG001 | Certain Cash Payout Financial Incentive | Participants in this arm will receive a message stating that they will receive $1 in cash if they get a flu shot at an upcoming appointment. Reminder: Letter, short message service (SMS) text, phone, and/or email Financial incentive: Letter, SMS, phone, and/or email |
| OG002 | Reminder / Active Control (No Financial Incentive) | Participants in this arm will receive a message stating that they can get a flu shot at an upcoming appointment. These participants will not be offered a financial incentive for getting a flu shot. Reminder: Letter, short message service (SMS) text, phone, and/or email |
| OG003 | No Treatment Control | No additional contact beyond standard Geisinger flu shot communications |
|
|
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| Secondary | Flu Vaccination Within 7 Days | Received flu vaccination | Posted | Count of Participants | Participants | Within 7 days of when patient is randomized |
|
|
|
| Secondary | Flu Diagnosis | Received a "high confidence flu" diagnosis (with positive polymerase chain reaction [PCR]/antigen/molecular test) and/or "likely flu" diagnosis (as assessed via International Classification of Disease [ICD] codes or Tamiflu administration or positive PCR/antigen/molecular test) Note that "likely flu" is a superset of the "high confidence flu" diagnoses. | Posted | Count of Participants | Participants | During the 2021-22 flu season (Up to 8 months, from the time the patient is randomized through April 30, 2022) |
|
|
|
| Secondary | Flu Complications | Diagnosed with flu-related complications | Posted | Count of Participants | Participants | During the 2021-22 flu season (Up to 11 months, from the time the patient is randomized through July 31, 2022) |
|
|
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| Other Pre-specified | Flu Vaccination (Among Subject Cohabitants) Within 28 Days | Cohabitant of study subject received flu vaccination | Not Posted | Within 28 days of when the study subject is randomized | Participants |
| Other Pre-specified | Flu Vaccination at Appointment by Gender | Received flu vaccination at relevant PCP or specialty appointment. | All enrolled patients were included in analyses, except the two patients who were inadvertently enrolled at age 17. | Posted | Count of Participants | Participants | 3 days after the patient is randomized. |
|
|
|
| Other Pre-specified | Flu Vaccination at Appointment by Race | Received flu vaccination at relevant PCP or specialty appointment. | All enrolled patients were included in analyses, except the two patients who were inadvertently enrolled at age 17. | Posted | Count of Participants | Participants | 3 days after the patient is randomized. |
|
|
|
| Other Pre-specified | Flu Vaccination at Appointment by Ethnicity | Received flu vaccination at relevant PCP or specialty appointment. | All enrolled patients were included in analyses, except the two patients who were inadvertently enrolled at age 17. | Posted | Count of Participants | Participants | 3 days after the patient is randomized. |
|
|
|
| 0 |
| 0 |
| 0 |
| 0 |
| 0 |
| 0 |
| EG001 | Certain Cash Payout Financial Incentive | Participants in this arm will receive a message stating that they will receive $1 in cash if they get a flu shot at an upcoming appointment. Reminder: Letter, short message service (SMS) text, phone, and/or email Financial incentive: Letter, SMS, phone, and/or email | 0 | 0 | 0 | 0 | 0 | 0 |
| EG002 | Reminder / Active Control (No Financial Incentive) | Participants in this arm will receive a message stating that they can get a flu shot at an upcoming appointment. These participants will not be offered a financial incentive for getting a flu shot. Reminder: Letter, short message service (SMS) text, phone, and/or email | 0 | 0 | 0 | 0 | 0 | 0 |
| EG003 | No Treatment Control | No additional contact beyond standard Geisinger flu shot communications | 0 | 0 | 0 | 0 | 0 | 0 |
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| D014777 | Virus Diseases |
| D012140 | Respiratory Tract Diseases |
| D001519 | Behavior |
| Shot Within 7 Days |
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| Flu diagnosis |
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| Flu complications |
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| Male |
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| Asian |
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| Black or African American |
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| Native Hawaiian or Other Pacific Islander |
|
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| Unknown |
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| White |
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| Not Hispanic or Latino |
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| Unknown |
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| Shot at Appointment |
|
| Shot at Appointment |
|
| Shot at Appointment |
|
| Shot at Appointment |
|
| Shot at Appointment |
|
| Shot at Appointment |
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| Shot at Appointment |
|
| Shot at Appointment |
|