Death from colorectal cancer can be prevented with early detection. Controlling high blood pressure would extend the lives of the nearly half a million Americans who die from the disease each year. Vaccination prevents tetanus, which can be fatal.
It’s clear that preventive medicine can make a big difference to your health.
Yet most people don’t understand it preventive medicine It may save their lives. In fact, in 2015, only 8% of U.S. adults over the age of 35 received all recommended immunizations, cancer screenings, and other high-priority services.
Researchers looking to change this situation are renting pages from Facebook, Google and other tech companies. By quickly comparing small differences in how they communicate with their patients (a process known in the tech industry as A/B testing), healthcare professionals can quickly learn what works and what doesn’t. I can. This approach has already yielded some practical improvements, but not everyone is convinced of its value.
Tech-oriented companies use A/B testing to determine marketing slogans, web page colors, and many other options. Randomization is key. This means that people are randomly assigned to view different versions to test. Does a large “subscribe” button on a website generate more clicks than a smaller one, and does his one headline in an article attract more readers than the others?
Leora Horwitz, a physician and health services researcher at New York University Langone Health, and her colleagues are using this technique, which they call rapid randomized controlled trials, to learn how to improve the delivery of health services. ) was adopted. Randomized controlled trials (RCTs) are widely used in medicine, usually to test new drugs or treatments for other diseases. For example, patients are randomly assigned to receive a new drug or the current standard of care and then followed for months or years to assess whether the new drug works better. But these trials are time-consuming and expensive, partly because researchers have to recruit people willing to participate in medical experiments.
In contrast, rapid RCTs are not used to study new treatments and therefore do not need to recruit participants. Rather, Horwitz’s goal is to improve healthcare delivery through rapid trials that allow researchers to iterate and fine-tune changes to healthcare delivery based on what they learned from each test.
“we Randomize what we do so that it can be evaluated quickly and accurately I wonder if what we’re doing is working,” said Horwitz, who wrote about the 2023 approach. Public Health Annual Review.
For example, Horwitz and colleagues wanted to find a way to get patients to book care gaps, or overdue preventative service appointments. Due to the sheer volume of patients, the clinic is unable to reach everyone by phone or through the online patient portal that NYU Langone uses to communicate with patients. So the healthcare system needed to understand what kinds of reminders worked best.
In the A/B test, we divided patients with care gaps into two sets. Patients who have signed up for an online portal account and those who have not. Patients in each set were then classified into different groups based on their health care history. Based on past behavior, patients who were less likely to initiate an appointment on their own were classified as a high-risk group. Those who ended up booking themselves in the past were assigned to the lower risk group.
In some of the tests, thousands of patients without portal accounts were randomly assigned, some receiving phone reminders and others not. Of those who received the call, 6.2 percent made an appointment to close the care gap, compared to only 0.05 percent who did not.
In another part of the test, some patients with patient portal accounts received reminder messages through that channel, while others did not. Of those who received the message, 13 percent of them booked the service they needed, compared to 1.1 percent of those who didn’t hear back.
Importantly, this study revealed that for the subgroup of patients who were at high risk and least likely to receive preventive services without nudging, telephone reminders were the most effective way to reach them. about it.Shortly after the test results became available, New York University Langone Prioritize all patients at highest risk Received phone reminders and greatly expanded use of remaining patient portal messages.
“When we learn something, we immediately apply it to all our messages,” Horwitz says. This allows what they learn to quickly spread to tens of thousands of people. “It makes me happy,” she says.
Thousands of female patients at New York University of Langon are now being tested, thanks to the University of Langon A/B test. short A message prompting you to book a mammogram appointment. Researchers used a rapid RCT to test reminder text sent through an online portal. Do short messages give better results? Nearly twice as many patients scheduled for mammography After receiving a 76-word reminder, just like those who received the old 155-word message.
In another study, to find ways to increase vaccination rates among young children, Horwitz and her team compared one-text and two-text reminders to parents to parents who received no text reminders at all. We turned to rapid randomized tests that Only two text reminders (one sent at 6pm and hers another two days after hers at noon) made all the difference. Triple the number of scheduled bookings. Most of the appointments were made after the second text message, suggesting that this boosting reminder prompted parents to take action.
Although still new in medicine, the idea of rapid RCTs is gaining popularity. A team of researchers — an economist, a doctor, and a public policy expert — none of whom belonged to Horwitz’s group — learned how to use this technique to increase their income. Use of preventive care services by black menwith the lowest life expectancy of any US demographic group.
They recruited more than 1,300 black men from barbershops and flea markets in the Oakland area, asked them to complete health questionnaires, and gave them coupons for free health checks. A pop-up clinic staffed by 14 black and non-black male physicians was set up to offer testing, and participating men were randomly assigned to black or non-black physicians. The result: Black men randomly assigned to black doctors were much more likely to be infected. diabetes testflu shots and other preventative services are distinct from those assigned to non-Black physicians.
Some experts doubt that rapid A/B testing will become commonplace in healthcare. Physician Darren DeWalt, director of the University of North Carolina’s Institute for Healthcare Quality Improvement, likes the concept, but people often don’t support randomization, even for ethical reasons. would avoid this concept. Harmless things like appointment reminders. “People in this country don’t like the idea of being randomly assigned to something, even something as simple as that,” says DeWalt. “There are many doubts about researchers in the medical field.”
Some people criticize A/B testing for playing around with its limits. Pierre Barker, chief scientific officer at Boston’s nonprofit Institute for Better Health Care, says significant improvements in health care delivery require a detailed analysis of the problem to be solved, which requires a system that has many resources. We believe that changes may be necessary. In contrast, rapid randomized controlled trials are not broad efforts to understand why patients are not receiving preventive services and what can be done to change them, but rather single, discrete changes, such as Focuses on words used in phone scripts.
“It’s more about how fast you can move than how big the impact is,” he says. From rapid randomized controlled trials, “I’m not yet convinced that we can get much more than small incremental changes.”
According to Professor Horwitz, while it’s true that most of the care gaps at NYU Langone weren’t closed by the new reminder, the test provided information that could potentially lead to the implementation of thousands of life-saving services. It says. This is what persuades her that the medical industry should adopt rapid randomized trials.
“If you work for a web company or an airline or any other industry, you would naturally randomize, and that’s standard practice,” she says. “But it is still foreign in medicine, and it shouldn’t be.”
written by
Laura Butcher I write about healthcare business and policy from home in Portugal.
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