Patient Recruitment Into a Multicenter Clinical Cohort Linking Electronic Health Records From 5 Health Systems: Cross-sectional Analysis

Abstract

Background There is growing interest in identifying and recruiting research participants from health systems using electronic health records (EHRs). However, few studies have described the practical aspects of the recruitment process or compared electronic recruitment methods to in-person recruitment, particularly across health systems. Objective The objective of this study was to describe the steps and efficiency of the recruitment process and participant characteristics by recruitment strategy. Methods EHR-based eligibility criteria included being an adult patient engaged in outpatient primary or bariatric surgery care at one of 5 health systems in the PaTH Clinical Research Network and having ≥2 weight measurements and 1 height measurement recorded in their EHR within the last 5 years. Recruitment strategies varied by site and included one or more of the following methods: (1) in-person recruitment by study staff from clinical sites, (2) US postal mail recruitment letters, (3) secure email, and (4) direct EHR recruitment through secure patient web portals. We used descriptive statistics to evaluate participant characteristics and proportion of patients recruited (ie, efficiency) by modality. Results The total number of eligible patients from the 5 health systems was 5,051,187. Of these, 40,048 (0.8%) were invited to enter an EHR-based cohort study and 1085 were enrolled. Recruitment efficiency was highest for in-person recruitment (33.5%), followed by electronic messaging (2.9%), including email (2.9%) and EHR patient portal messages (2.9%). Overall, 779 (65.7%) patients were enrolled through electronic messaging, which also showed greater rates of recruitment of Black patients compared with the other strategies. Conclusions We recruited a total of 1085 patients from primary care and bariatric surgery settings using 4 recruitment strategies. The recruitment efficiency was 2.9% for email and EHR patient portals, with the majority of participants recruited electronically. This study can inform the design of future research studies using EHR-based recruitment.

Electronic Health Record–Based Recruitment and Retention and Mobile Health App Usage: Multisite Cohort Study

“…Each of these health systems have made significant investments into building and maintaining their EHRs and infrastructure to enable these recruitment methods for research purposes. In addition, for this study, we leveraged existing health information technology infrastructure from the PaTH network [ 30 ], which enabled efficiency from both a time and resource perspective. However, for this methodology to be used more broadly in a variety of settings, greater institutional and community partnerships and resources are needed.…”

“…The era of COVID-19, in particular, has additionally highlighted the importance of remote research procedures. Electronic health record (EHR)–based recruitment strategies provide potentially efficient (ie, low touch and low participant burden) methods for identifying and recruiting high volumes of patients meeting predetermined medical criteria for population-based research studies [ 28 - 30 ].…”

Using a Patient Portal to Increase Enrollment in a Newborn Screening Research Study: Observational Study

“…Studies using patient portal research invitations for recruitment report a wide range of study enrollment rates, with 1.8% to 24.7% of those who received an invitation consenting to participate [ 20 - 27 ]. A summary of 14 studies that sent research recruitment invitations through the patient portal at a single medical center found that condition-specific studies had higher response and enrollment rates compared to general health studies [ 23 ].…”

“…Although in-person recruitment had the highest enrollment rates of all the modes, patient portal, and email outreach yielded the most overall study enrollment because they allowed the study team to approach many more potential participants than did the other modes [ 24 ]. A recent study comparing in-person, email, and patient portal recruitment of adults from primary care and bariatric clinics also found that electronic forms of outreach resulted in the most overall study participants in spite of lower recruitment efficiency compared to in-person recruitment [ 27 ].…”

Describing current use, barriers, and facilitators of patient portal messaging for research recruitment: Perspectives from study teams and patients at one institution

“…Given patient portal integration with the EHR and robust use among the US population, patient portals have started being leveraged for participant recruitment for clinical research studies [8][9][10][11]. Briefly, discrete data values in the EHR, such as diagnostic codes, lab values, and medication lists, are used to identify a target population.…”