Recruitment of trial participants through electronic medical record patient portal messaging: A pilot study

Abstract

Background/aim: Cost-efficient methods are essential for successful participant recruitment in clinical trials. Patient portal messages are an emerging means of recruiting potentially eligible patients into trials. We assessed the response rate and complaint rate from direct-to-patient, targeted recruitment through patient portals of an electronic medical record for a clinical trial, and compared response rates by differences in message content. Methods: The Study to Understand Fall Reduction and Vitamin D in You (STURDY) trial is a National Institutes of Health–sponsored, community-based study of vitamin D supplementation for fall prevention in older adults conducted at Johns Hopkins. Potential participants were identified using the Epic electronic medical record at the Johns Hopkins Health System based on age (≥70 years), ZIP code (30-mile radius of study site), and prior activation of a patient portal account. We prepared a shorter message and a longer message. Both had basic information about study participation, but the longer message also contained information about the significance of the study and a personal invitation from the STURDY principal investigator. The Hopkins Institutional Review Board did not require prior consent from the patient or their providers. We calculated the response rate and tracked the number of complaints and requests for removal from future messages. We also determined response rate according to message content. Results: Of the 5.5 million individuals receiving care at the Johns Hopkins Health System, a sample of 6896 met our inclusion criteria and were sent one patient portal recruitment message between 6 April 2017 and 3 August 2017. Assessment of enrollment by this method ended on 1 December 2017. There were 116 patients who expressed interest in the study (response rate: 1.7%). Twelve (0.2%) recipients were randomized. There were two complaints (0.03%) and one request to unsubscribe from future recruitment messages (0.01%). Response rate was higher with the longer message than the shorter message (2.1% vs 1.2%; p = 0.005). Conclusion: Patient portal messages inviting seniors to participate in a randomized controlled trial resulted in a response rate similar to commercial email marketing and resulted in very few complaints or opt-out requests. Furthermore, a longer message with more content enhanced response rate. Recruitment through patient portals might be an effective strategy to enroll trial participants.

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

“…8 The downstream effects of the under-representation of minority groups has been noted in two studies that used patient portal messaging, where 92% and 91% of the enrolled participants were White. 9,13 In contrast, our study demonstrated that the EMR-based methods recruited a diverse sample of participants. However, this is likely because we deployed a variety of EMR-based methods.…”

“…In addition to the cost reduction associated with the EMR, utilizing the EMR for participant recruitment can offer a significant time advantage. A study using MyChart patient portal messaging to recruit a sample of older adults into a community-based study of vitamin D supplementation for fall prevention showed that half of the recruitment inquiries/responses were received within 2 days of the patient portal message being sent, 13 a turnaround time that is likely much briefer than individuals being recruited through traditional methods, such as postal mailing. On the contrary, utilizing a vendor-acquired community mailing list does offer advantages that the EMR-based methods cannot, such as enrolling adults outside the Johns Hopkins Health System patients in clinical research, which may be important for generalizability.…”

“…Selection of recruitment strategies were based on our prior recruitment experience with community mailings, social media, and the EMR. 11,13 Given our observation that EMR electronic portal users were predominantly White, we included a novel, hybrid approach in this study that involved mailing our study brochure to adults identified to have gout in the EMR. Methods were adjusted throughout the study based on real-time yields to optimize recruitment goals (see Supplementary Table ST1 for additional details).…”

“…11,12 These novel strategies have the potential to reach more targeted populations faster than traditional media, such as periodicals and physically mailed advertisements. 11,13,14 However, previous literature has indicated that the use of primarily digital methods for recruitment may result in homogeneous trial samples and under-representation of minority racial groups. 8,11,15 Further exploration is warranted to understand if these electronic tools are cost-effective or can be used to recruit a diverse, generalizable study population relative to traditional recruitment methods.…”

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

“…In our study, we utilized the EHR for several purposes: to generate lists of potentially eligible patients using a computable phenotype, to obtain postal mailing addresses and email addresses, and to send recruitment invitations using the secure patient portal at 2 sites. Some academic research centers have designed patient portal recruitment services to enable, but also limit, recruitment using the portal for certain approved studies [ 1 , 21 , 27 , 28 ]. In a 2019 single-institution study that included 13 separate EHR-based recruitment strategies using the patient portal recruitment service, the average response rate for patient portal messages was 2.9%, which was the same as our enrollment rate for both email and patient portal recruitment [ 21 ].…”