Regular screenings have the potential to prevent deaths from colorectal cancer. Similarly, controlling high blood pressure could extend the lives of the roughly 500,000 Americans who succumb to the disease annually. Vaccinations against tetanus can also save lives. The impact of preventive medicine on health outcomes is clear. However, despite the evidence, most individuals do not receive the preventive care they need to stay healthy. In fact, as of 2015, only 8 percent of U.S. adults aged 35 and older had received all recommended immunizations, cancer screenings, and other high-priority services.
In an effort to change this trend, researchers are borrowing techniques used by tech companies like Facebook and Google. By employing A/B testing, which involves comparing small differences in how they communicate with patients, healthcare workers can quickly identify effective strategies. This approach has already yielded valuable insights, although its value remains a subject of debate.
Tech-oriented companies utilize A/B testing to inform decisions about marketing slogans, web page designs, and other variables. Randomization is crucial in this process, as it ensures that participants are randomly assigned to different versions of whatever is being tested. For instance, does a larger “Subscribe” button on a website result in more clicks than a smaller one? Does one headline generate more readership than another?
Leora Horwitz, an internist and health services researcher at NYU Langone Health, and her team have adopted this methodology, which they call rapid randomized controlled trials, to improve the delivery of healthcare services. Traditional randomized controlled trials (RCTs) are commonly used in medicine to test new drugs or treatments. Participants are randomly assigned to receive either the new treatment or the existing standard of care, and their health is monitored over an extended period to evaluate efficacy. However, traditional RCTs are time-consuming and expensive, as it can be challenging to recruit participants.
In contrast, rapid RCTs are not focused on new treatments and therefore, do not require participant recruitment. Instead, the goal is to enhance healthcare delivery by continuously testing and refining changes based on insights obtained from each trial. Horwitz states, “We are randomizing what we’re doing so that we can quickly and accurately assess whether what we are doing is working.”
To provide an example, Horwitz and her colleagues aimed to determine effective strategies for prompting patients to schedule appointments to address care gaps. Due to the large volume of patients, healthcare providers cannot contact everyone via telephone or online portals. Hence, NYU Langone needed to identify the most effective reminders for this purpose.
In the A/B test, patients with care gaps were divided into two groups: those with online portal accounts and those without. Within each group, patients were further divided based on their healthcare history. Higher-risk patients, who were less likely to initiate appointments on their own, were placed in one group, while lower-risk patients who had previously scheduled appointments were placed in another.
In one part of the test, a random sample of patients without portal accounts received telephone-call reminders, while others did not. Those who received a phone call accounted for 6.2 percent of care gap appointments, compared to only 0.5 percent among those who were not called.
In another part of the test, some patients with portal accounts received reminder messages through the online platform, while others did not. Among those who received the message, 13 percent scheduled the necessary services, compared to 1.1 percent of those who were not contacted.
These experiments uncovered the effectiveness of phone call reminders, especially for high-risk patients who needed a nudge to seek preventive services. Upon receiving the test results, NYU Langone immediately prioritized its highest-risk patients to receive telephone reminders and expanded its capacity to send messages via the patient portal. Horwitz describes the process as gratifying, with tens of thousands of people benefiting from the rapid implementation of lessons learned.
As a result of A/B testing, many of NYU Langone’s female patients now receive concise reminders via short messages to schedule mammograms. The researchers tested various phrasings of reminders sent through the portal and discovered that shorter messages resulted in nearly double the number of booked mammograms compared to the longer, previously used messages.
To increase vaccination rates among young children, Horwitz and her team employed rapid randomized tests comparing one-text and two-text reminders to parents against no reminder at all. Only the two-text reminder, sent at specific times, led to a significant increase in scheduled appointments. This booster reminder was found to trigger parents to take action.
While rapid A/B testing is still a relatively new concept in healthcare, its adoption is growing. One research team, consisting of an economist, a physician, and a public policy expert, conducted a study using the technique to increase preventive care service utilization among Black men, a demographic group in the U.S. with low life expectancy. The study recruited over 1,300 Black men and implemented pop-up clinics staffed by Black and non-Black male doctors. The findings demonstrated that Black men assigned to Black doctors were more likely to undergo preventive screenings and vaccinations than those assigned to non-Black doctors.
Some experts express skepticism about the widespread adoption of rapid A/B testing in healthcare. Ethical concerns, particularly related to randomization, may discourage healthcare organizations. Despite their skepticism, the potential for rapid randomized controlled trials to drive incremental change motivates supporters. The ability to quickly gather substantial insights, even if they do not resolve all care gaps, can still lead to the delivery of hundreds of lifesaving services. This success indicates the importance of embracing rapid randomized trials in the healthcare industry to drive continuous improvement.
In summary, the utilization of rapid A/B testing holds great potential for improving preventive care practices in the healthcare sector. Drawing inspiration from the methods employed by tech companies, healthcare workers can quickly identify effective strategies to optimize patient engagement. While some remain skeptical, the demonstrated success of rapid randomized controlled trials encourages the broader adoption of this innovative approach.
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