Recruiting for a pragmatic trial using the electronic health record and patient portal: successes and lessons learned

Abstract

Objective Querying electronic health records (EHRs) to find patients meeting study criteria is an efficient method of identifying potential study participants. We aimed to measure the effectiveness of EHR-driven recruitment in the context of ADAPTABLE (Aspirin Dosing: A Patient-centric Trial Assessing Benefits and Long-Term Effectiveness)—a pragmatic trial aiming to recruit 15 000 patients. Materials and Methods We compared the participant yield of 4 recruitment methods: in-clinic recruitment by a research coordinator, letters, direct email, and patient portal messages. Taken together, the latter 2 methods comprised our EHR-driven electronic recruitment workflow. Results The electronic recruitment workflow sent electronic messages to 12 254 recipients; 13.5% of these recipients visited the study website, and 4.2% enrolled in the study. Letters were sent to 427 recipients; 5.6% visited the study website, and 3.3% enrolled in the study. Coordinators recruited 339 participants in clinic; 23.6% visited the study website, and 16.8% enrolled in the study. Five-hundred-nine of the 580 UNC enrollees (87.8%) were recruited using an electronic method. Discussion Electronic recruitment reached a wide net of patients, recruited many participants to the study, and resulted in a workflow that can be reused for future studies. In-clinic recruitment saw the highest yield, suggesting that a combination of recruitment methods may be the best approach. Future work should account for demographic skew that may result by recruiting from a pool of patient portal users. Conclusion The success of electronic recruitment for ADAPTABLE makes this workflow well worth incorporating into an overall recruitment strategy, particularly for a pragmatic trial.

Use of electronic recruitment methods in a clinical trial of adults with gout

“…Use of the EMR for cohort identification and participant recruitment has increased in recent years. 10,20,21 Our study contributes to the existing and growing body of evidence that EMR-based methods are a promising tool for research recruitment and can reduce the cost and time associated with traditional recruitment methods. 8,22,23 Among enrolled participants of this trial, 56% were recruited by an EMR-based method.…”

“…With the advent of electronic medical records (EMRs) and social media, investigators have multiple new available tools for meeting enrollment targets, such as EMR patient portal messaging 8–10 and targeted Facebook advertisements. 11,12 These novel strategies have the potential to reach more targeted populations faster than traditional media, such as periodicals and physically mailed advertisements.…”

Testing a Model of Patient Portal Use in Adult Patients

“…There may be a potential recall bias due to self‐reported data collection. The survey response rate was 7.5%, which was similarly low as in previous studies that used portal messages for recruitment (Gleason et al, 2018; Pfaff et al, 2019). Despite the limitations, strengths such as analyzing survey data collected from a large sample of adult patients using a robust model testing approach have made this study theoretically and methodologically solid.…”

Exploring the potential for collaborative use of an app-based platform for n-of-1 trials among healthcare professionals that treat patients with insomnia

“…Of course, there are plenty of challenges of working with such data (e.g., bias and missingness) but the EHR also offers countless opportunities for research and a promising resource for patient engagement [61]. For instance, study recruitment via EHRs and patient portals are an emerging trend for pragmatic trials [62]. In our EHR analysis, we found a significant comorbidity enrichment between sleep disturbances, specifically insomnia, and AD or dementia.…”