N/A
N=26,248
Behavioral Economics to Improve Flu Vaccination Using EHR Nudges Replication
Behavior, Health · Flu · Flu Vaccination
Bottom Line
View on ClinicalTrials.gov: NCT06626321 ↗Enrolled (actual)
26,248
Serious AEs
0.0%
Results posted
Mar 2026
Primary outcome: Primary: Proportion of Patients Who Receive the Flu Vaccine at the Visit — 689; 2217; 645; 628 Participants
Study Design & Population
- Study type
- Interventional
- Phase
- N/A
- Interventions
- Pre-visit patient text messaging (Behavioral); Default pended order (Behavioral); Monthly peer comparison feedback (Behavioral); High risk bidirectional pre-visit text messaging (Behavioral)
- Age
- Adult, Older Adult · 50+ yrs
- Sex
- All
- Sponsor
- University of Pennsylvania
- Primary completion
- Feb 2025
Outcome Measures
| Outcome | Result | p-value |
|---|---|---|
| PRIMARY Proportion of Patients Who Receive the Flu Vaccine at the Visit |
689; 2217; 645; 628 | — |
| SECONDARY Proportion of Patients Who Receive the Flu Vaccine Within 3 Months After the Visit |
947; 2630; 765; 762 | — |
Summary
This study will be a 6-month, cluster randomized, pragmatic replication trial to evaluate the effectiveness of personalized nudges to clinicians and patients, relative to a control, to increase flu vaccination rates among older adults in accordance with CDC guidelines. This will include clinician and patient level nudge interventions, with additional, intensified nudge interventions for patients identified as high risk for not receiving a flu vaccine. Among the intervention clinics, patients will receive pre-visit text message reminders about the flu vaccine, and clinicians will receive a default pended order in the visit encounter in the EHR, along with monthly peer comparison feedback about their flu vaccine completion rate. Patients identified as high risk for noncompletion will be individually randomized to receive an additional bidirectional text message nudge or the standard text messaging
Eligibility Criteria
Inclusion Criteria
All patients must meet the following criteria to be eligible:
- Age ≥ 50 years
- A scheduled new or return (non-urgent/sick) primary care appointment at one of the study practices at Lancaster General Health
- Have not received their annual flu vaccine during the active intervention period (September- February)
- Eligible to receive the flu vaccine
For the patient intensification nudge, at least one of the following criteria must be met to be considered high risk and randomized to receive the intensification nudge:
- Age ≥ 70 years
- Living in a lower income community (lowest quartile, zip-code based)
- Did not receive a flu vaccine in the previous calendar year
- Self-identifies as Non-Hispanic Black
Clinicians must meet the following criteria to be eligible to receive peer comparison feedback:
- Practicing physician (MD, DO) or advanced practice provider (NP, PA) with the exception of residents and fellows
- Have a minimum patient panel of at least 50 patients, and
- Practicing at a clinical site randomized to receive the clinic-level nudge interventions.
Exclusion Criteria
Patients will be excluded from the study if they:
- Have a documented allergy to flu vaccine
- Have a flu vaccine exclusion modifier in Health Maintenance
- Have opted out of research according to individual site guidelines and policies
- Have no phone number (home or mobile) listed in their chart
Data sourced from ClinicalTrials.gov (NCT06626321). Outcome figures and adverse-event rates are extracted automatically from the registry's posted results and are provided for clinician reference, not as a substitute for the primary publication.