A Digital Care Plan Nudge to Improve Primary Care Outcomes

Preventive care is underutilized in the United States. A digital care plan nudge delivered prior to primary care visits may prime patients to address these care gaps during the visit. A two-group, cluster randomized trial of 76 primary care practices in four U.S. states compared usual care with a digital care plan nudge, which sent text messages to patients before a primary care visit informing them of up to three of six possible care gaps to address at the visit. Outcomes were care gaps addressed the day of the visit (primary) and completed by 90 days after the visit (secondary). We also explored appointment engagement and patient experience. The sample included 204 clinicians with 29,334 patient encounters. The mean (standard deviation) patient age was 56.9 (16.5) years, 61.0% were female, and 15.2% and 11.1% were Black and non-Hispanic or Hispanic, respectively. The primary outcome of care gaps addressed at the visit occurred in 23.5% of cases in the intervention group, compared with 20.3% of cases in the usual care group (adjusted difference 3.8 percentage points; 95% confidence interval (CI), -0.4 to 8.1; P=0.08). The intervention was associated with greater care gaps completed by 90 days (5.4 percentage points; 95% CI, 0.7 to 10.1). In post hoc analyses, the intervention was also associated with greater appointment engagement with an increase in completion (difference of 2.8 percentage points; 95% CI, 1.8 to 3.8), a decrease in no-shows (-1.2 percentage points; 95% CI, -1.7 to -0.6) and a decrease in cancellations (-1.5 percentage points; 95% CI, -2.2 to -0.8). This trial of a digital care plan nudge did not meet the primary outcome of addressing care gaps during the visit. Observed associations in secondary outcomes, including care gap closure within 90 days and appointment engagement, warrant further evaluation. (Funded by Ascension; ClinicalTrials.gov number, NCT05799976.).