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If you build it, will they come? Comparing patient recruitment strategies for new care models  

Authors:

  • Adam Wolfberg, MD, MPH, CMO, Current Health 
  • Juliana Pugmire, DrPH, MPH, Current Health 
  • Constantinos Michaelidis, MD, MBA, MS, UMass Medical Center 

In the decentralization of healthcare delivery, many organizations are building technology-enabled home-based healthcare models. Health leaders may invest hundreds if not thousands of hours of precious time into standing up a program that seeks to deliver a better patient experience and control costs. Yet, often overlooked is the challenge of recruiting patients into these innovative care delivery programs, and it can be frustrating to watch a brand-new program go unused.  

Leaders looking to tip the scale in favor of success must consider their plans to support patient enrollment for new program. Step one: create a strategic patient recruitment plan and invest appropriately. We have successfully recruited thousands of patients into novel programs, and we have learned the hard way what works and what doesn’t. One framework for thinking about patient recruitment based on peer-reviewed evidence is the active vs. passive patient recruitment structure. 

Active vs. Passive Recruitment 

The active vs. passive recruitment construct is a helpful way to think about how patient recruitment initiatives are structured across all healthcare programs regardless of acuity—from chronic disease management to acute hospital care at home. A strategically designed and resourced recruitment plan is a critically important component of any new healthcare program, because without successful patient recruitment, a program may fail, or flounder, wasting precious resources, generating institutional frustration, and losing the opportunity to impact patients’ lives. As it turns out, active and passive patient recruitment produce very different results when it comes to novel healthcare programs. 

“Passive” recruitment is typically less resource intensive. Program leadership solicits input from the organization’s marketing team to develop and broadly disseminate materials such as advertisements, brochures, or commercials. These materials provide program details and invite individuals to seek out further information via a telephone number or a website.  

“Active” recruitment is typically more resource intensive. A program team member identifies and approaches individuals that meet inclusion criteria into a study or program and invites them to participate. They might approach a patient in clinic or call them on the phone. They might speak directly to a patient’s healthcare provider and ask if the provider will refer his or her patient into the program. 

Published research suggests that active recruitment methods lead to higher numbers of enrolled participants than passive recruitment strategies for the same recruitment effort. In a study1 focused on recruitment methods for a hereditary cancer registry, active recruitment resulted in a fourfold increase in enrollment compared to passive recruitment, highlighting the benefits of allocating staff specifically for recruitment and face-to-face contact with potential participants. Interestingly, actively recruited patients may be less engaged in the health program, at least for the low acuity programs where existing research exists. Researchers hypothesize that this is because they simply said “yes,” to program participation, and did not personally take the initiative to sign up for the program. 

Conversely, passive recruitment tends to yield fewer patients who sign up for the program but may lead to better retention. In a 2015 study2 focused on recruitment for a trial targeting childhood obesity, passive recruitment methods resulted in nearly 73% of families that inquired about the trial ultimately being recruited into the program, versus just 50% of families targeted by active recruitment methods. Again, researchers hypothesize that passively recruited patients are more motivated to engage with health behaviours (they did after all, see an ad and take the initiative to act on it), leading to better program adherence parameters. 

We believe active recruitment for new programs is more effective and leads to faster enrollment of more patients. That said, most of the literature supports a multi-pronged marketing effort that includes both passive and active approaches if resources allow. 

Growing One of the Largest Hospital at Home Programs with UMass Memorial Health  

Since its launch in August 2021, the UMass Memorial Medical Center home hospital program has employed both passive and active patient recruitment approaches in parallel. Passive patient recruitment approaches included website development, dissemination of marketing material in the emergency department and hospital wards, and incorporation of patient stories into broad marketing outreach to patients and providers. Active patient recruitment approaches have included use of electronic medical record screening tools to identify eligible patients in the emergency department and hospital wards and communication with individual providers and case managers regarding their patient’s eligibility for the home hospital program.  

The combined effect of these tactics has been to grow the program’s daily patient census from 2 to 14 in the first year. The volume of referrals from passive channels has increased steadily, with higher yield of passive referrals (40% admit yield) than active acquisition from HAH (20% admit yield). While it is difficult to unwind the effects of the passive tactics from those of the active ones, the balance of referral channels suggests that over time, they both have a cumulative effect.  

The Right Information to the Right Person at the Right Time 

What we’re seeing at multiple health systems launching innovative virtual care programs in the U.S. and in the U.K. is that a major issue around growth is sharing key information with appropriate stakeholders — patients and family caregivers as well as clinicians —at the right moment in the patient’s journey.  

There is a reasonable dialogue regarding the appropriate balance of investment in more active or passive style recruitment strategies and how this investment should evolve from early to later days in program maturity. In alignment with the published literature referenced in this article,3,4 our experience suggests that active recruitment has greater potential for impact earlier in program development when program evolution is rapid, and program awareness and understanding may be more limited. Hospital at Home is an example of a new healthcare program that may feel unfamiliar to clinicians and patients alike, albeit one with huge clinical and strategic potential. Until we reach a point where enrollment in hospital-at-home programs becomes the default admitting pathway, passive recruitment will be less effective than active recruitment.  

References:

  1. TM. Friebel, RA Beutler, SM Lee, BA Bernhardt, KJ Helzlsouer, CA Griffin. Active recruitment increased enrollment in a hereditary cancer registry,Journal of Clinical Epidemiology,Volume 57, Issue 11, 2004,Pages 1172-1176,ISSN 0895-4356, https://doi.org/10.1016/j.jclinepi.2004.04.007
  2. Fleming, J., Kamal, A., Harrison, E. et al. Evaluation of recruitment methods for a trial targeting childhood obesity: Families for Health randomised controlled trial. Trials 16, 535 (2015). https://doi.org/10.1186/s13063-015-1062-x 
  3. Raynor HA, Osterholt KM, Hart CN, Jelalian E, Vivier P, Wing RR. Evaluation of active and passive recruitment methods used in randomized controlled trials targeting pediatric obesity. Int J Pediatr Obes. 2009;4(4):224-32. doi: 10.3109/17477160802596189. PMID: 19922036; PMCID: PMC4828141. 
  4. Lee RE, McGinnis KA, Sallis JF, Castro CM, Chen AH, Hickmann SA. Active vs. passive methods of recruiting ethnic minority women to a health promotion program. Ann Behav Med. 1997, 19:378-384. 
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