Study Recruitment Incorporated Into Check-In Process
Recruitment through patient portals has become more common. “It allows for broader-based recruitment at a lower cost than in-person efforts,” says Richard K. Leuchter, MD, clinical instructor of medicine at the David Geffen School of Medicine at UCLA.
However, Leuchter estimates only about 1% to 10% of patients contacted through these portals actually enrolled in a research study. “To make matters worse, the sociodemographic diversity of patients recruited in this way is not at all representative of health systems or our nation, which poses major issues in developing biomedical advances in effective and equitable ways,” Leuchter says.
It is not that patients contacted through patient portals are not diverse; it is the fact many historically less well-resourced groups tend not to engage with the patient portal compared to more well-resourced groups. “Well-intentioned efforts relying on patient portal utilization often don’t reach underserved patients,” Leuchter says.
Leuchter and colleagues were looking for a method to improve recruitment for research studies through patient portals.1 “We thought that if we could embed this recruitment process into a workflow patients were already completing, it could improve both the rates and diversity of enrollment,” Leuchter explains.
Roughly half of patients complete a pre-check-in process through the patient portal before physician appointments. The process entails confirming current medications, allergies, prior surgeries, family history, social history, and demographics. As part of this process, researchers added a study information sheet for patients and a HIPAA authorization form patients could voluntarily view and/or sign. “It didn’t require patients to log into the patient portal purely for the purposes of the study,” Leuchter notes.
Of 843 patients, 386 completed the pre-check-in; of those patients, 308 signed the HIPAA form and enrolled in the offered study. “We ended up having a 37% enrollment rate, which was seven to eight times higher than what we expected to see,” Leuchter reports. Additionally, the enrolled sample was sociodemographically representative of the health system. This suggests that pre-check-in recruitment may be an effective tool for improving equitable representation in biomedical research.
The study authors hope that researchers at other institutions will adopt pre-check-in recruitment so that it can be validated in other health systems and patient populations.
Patients stand to benefit because this method of recruitment is unintrusive, with no patient portal messages or contacts from study staff. Researchers benefit because pre-check-in recruitment is inexpensive and requires minimal resources.
“The entire research infrastructure stands to benefit from improved enrollment rates and representation of frequently marginalized groups,” Leuchter says.
1. Leuchter RK, Ma S, Bell DS, et al. Embedding research study recruitment within the patient portal precheck-in. J Am Med Inform Assoc 2023; Aug 18:ocad164.doi: 10.1093/jamia/ocad164. [Online ahead of print].
Recruitment through patient portals has become more common, but actual enrollment rates remain low. As part of patients' routine appointment check-ins, researchers included a study information sheet and a HIPAA authorization form. This led to a 37% enrollment rate, which was seven to eight times higher than what researchers expected.
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