To reduce atherosclerotic cardiovascular disease (ASCVD) risk, the American College of Cardiology/American Heart Association recommends routinely assessing traditional cardiovascular risk factors and calculation of 10-year ASCVD risk for adults 40-75 years of age and traditional ASCVD risk factors for adults 20-39 years of age at least every 4-6 years. For many patients, the ASCVD risk can’t be calculated due to a missing comprehensive lipid panel. In our health system, 23% of adult patients had not had labs within the past 5 years. We aim to evaluate the effect of behavioral economic interventions on lipid screening uptake. We hypothesize that reducing effort for patients and clinicians through default bulk ordering and salient communication through outreach letters with PCP endorsement, time-limited components and physical lab orders will result in greater completion of lipid screening compared to usual care (H1), and that increased salience through additional complementary communication (text message reminders and scheduling assistance) will result in higher response rates compared to usual care, and bulk order and outreach alone (H2). Results from a mini-pilot on 100 patients indicated that bulk ordering and text message concierge service increased response rate (21%) compared to conventional outreach (12%) or bulk-ordering only (9%). We are conducting a pragmatic randomized clinical trial among patients from two primary care practices at an academic health system. Eligible patients aged 20-75 years and overdue for a lipid panel are randomized to 3 intervention arms (N=1,000,1:2:2 ratio): usual care (1), outreach and bulk orders (2), outreach, bulk orders and text message reminders (3). The primary outcome is the completion of the lipid panel within 3 months. Secondary outcomes include completion of the lipid panel within 6 months, the number of patients with an elevated ASCVD risk score and the number of patients who receive statin prescription due to this information. Results from the pilot trial launching in June 2023 are forthcoming. They will provide data that can be used to design future interventions that test the use of various behavioral economic tools to increase completion of lab tests, a necessary input into calculation of patient risk.
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