1. The Capture of Social and Behavioral Determinants of Health in
Selecting EHR-driven Recruitment Strategies: An Evidence-Based Approach
Daniel R. Hood, MPH1, William K. Barnett, Ph.D.1,2; Peter J. Embi, MD, MS, FACP, FACMI1,2
Regenstrief Institute, Indianapolis, IN; 2Indiana University School of Medicine, Indianapolis, IN;
Introduction
Low rates of participant recruitment for clinical research continue to be a major barrier to advancing science and discovery. The Trial Innovation Network (trialinnovationnetwork.org), and specifically the Recruitment Innovation Center (RIC), funded by the CTSA program, is developing and disseminating innovative methods to improve trials recruitment. EHR-based recruitment approaches are increasingly being used, however, there is little to guide use of one strategy over another. The use of an inappropriate strategy can lead to poor enrollment rates and/or wasted resources. We undertook and effort to develop an evidence-based approach to the selection and use of EHRs for participant recruitment.
Expanding Landscape of EHR
Recruitment Strategies
More strategies do not necessarily result in better recruitment. The appropriate strategy can be guided by these factors:
Study factors:
Complexity, Disease-characteristics, Study type/design
Setting factors:
Ambulatory, Emergency, Hospital, ICU, etc.
Population factors:
Specialty, Disease severity, etc.
Resource factors:
IT resources, data network participation, EHR maturity ?
The Capture of Social and Behavioral Determinants of Health in
Electronic Health Records
Methods: Development of a Recruitment Toolbox
Based upon a review of the literature related to EHR-driven recruitment and collection of firsthand feedback using methodologies from our team’s content experts, we developed and categorized a list of EHR-driven recruitment methodologies. We documented literature-derived considerations for the use of certain approaches. We then conducted a series of open-ended group discussions with content experts to elicit their experiences and internal heuristics for the selection and use of specific EHR-driven approaches to recruitment. Field notes were used to create a list of key questions to inform the use of one approach over others. From this, we developed a decision matrix and presented back to the content experts to refine the decision approach.
Results: Recruitment Strategy Workflow Framework
Conclusion and Next Steps
EHR-driven approaches to participant recruitment have the potential to improve recruitment rates, but all approaches are not appropriate to all studies or settings. This is the first attempt we are aware of to create a guide to the selection and use of EHR-based recruitment approaches based upon best evidence (i.e. literature and expert opinion). More research is needed to inform the underlying assumptions of this approach to and to validate this approach as applied to real-world studies. We are actively evaluating this approach via studies utilizing CTSA RIC services.
Acknowledgements
Thanks to our colleagues in the NCATS supported RIC for their input and contributions to this effort. Support provided by: NIH/NCATS: 1U24TR