Abstract WMP88 Comparing Behavioral Principles in Mailed Messages to Activate Patients at High Risk for Stroke

Williams LS, Clark DO, Myers L, Daggy J, Baye F, Martin H, Blackwell L, Snow K, Teal E, Damush TM. Abstract WMP88 Comparing Behavioral Principles in Mailed Messages to Activate Patients at High Risk for Stroke. [Abstract]. Stroke. 2018 Jan 22; 49(Suppl 1):AWMP88.

Objectives: To compare the effect of behaviorally-tailored mailed messages on patient activation to reduce stroke risk. Methods: We used EHR data to construct Framingham Stroke Risk Scores (FSRS) in primary care patients in one VA and one non-VA urban healthcare system. Patients in the highest risk quintile were eligible. We recruited 15 subjects to develop four stroke risk messages: standard, incentive ($5 gift card), salience, and incentive plus salience. Patients were randomly assigned to receive one of the messages. All letters asked the patient to call a stroke prevention coordinator. Response to the messages (calling the prevention coordinator) was modeled separately in the two healthcare system cohorts using logistic regression. Results: From 6,695 eligibles, 1,759 Veterans (mean age 75.6, 99% male, 61% White, mean FSRS 18.6) and 2,084 non-Veterans (mean age 65.6, 36% male, 68% Black, mean FSRS 13.1) received a letter. Overall call response rate was 23% among Veterans and 13% among non-Veterans. Both cohorts were significantly more likely to respond to the incentive and to the incentive plus salience message compared to the standard message (Table). Older age (for Veterans) and Black race (for non-Veterans) were also significantly associated with response, but FSRS and medical comorbidity were not. Among 631 subjects calling the stroke prevention coordinator, 26% (100/390) of Veterans and 30% (73/241) of non-Veterans were unaware of their risk factors. Conclusions: A mailed letter including a small monetary incentive may be more effective than standard or salience-related messages in engaging high-risk patients with their health care system. Many patients are unaware of their stroke risk. Future analyses will examine the relationship between messages and primary care follow-up.