Opportunity

Preventive screenings and routine laboratory tests can identify health problems earlier, but, for a variety of reasons, patients may miss completing them according to recommended guidelines. To ensure that patients complete screenings, care teams must currently identify these gaps, discuss them during busy appointments, place the appropriate orders, and help patients follow through afterward.

In collaboration with Penn Medicine Primary Care, the Population Health Lab developed a solution to make this process more consistent while reducing the work required of primary care teams. 

Intervention

PROACTIVE—short for Preventive Reminder Ordering Assistance via Texting for Improved Visit Encounters—uses timely patient messages and electronic health record tools to help close overdue preventive care gaps. The program timing is anchored to primary care visits.

Before an appointment, eligible patients receive an automated text message encouraging them to discuss overdue care with their clinician at their upcoming visit. During the visit, the clinician receives an electronic alert that the patient was contacted, along with automatically prepared orders for eligible screenings or tests. The clinician can review, sign, or cancel each order. Patients whose orders are signed receive follow-up messages with reminders and scheduling information.

Earlier Population Health Lab projects—such as BE IMMUNE and I-SCREEN—designed to close a singular preventive care gap showed that multilevel nudges targeted to both the clinician and patient improve completion rates. PROACTIVE applies this approach to address multiple health needs with one program.

The initial program supports eight care gaps: mammography, bone-density screening, colorectal cancer screening, hepatitis C screening, cholesterol testing, A1C testing, a basic metabolic panel, and urine microalbumin testing. The intervention is being tested in a stepped-wedge rollout across 26 practices, allowing the team to evaluate the program as it enters routine care. 

Impact

PROACTIVE’s impact is still being evaluated. The primary outcome is completion of the selected preventive care gaps within three months of the office visit, with additional follow-up planned at six months.