Harnessing A/B Testing for Health: Revolutionizing Preventive Care Delivery

Preventing Colorectal Cancer Deaths through Regular Screenings: A Call to Action

The potential to save lives through preventive medicine is evident. Consider colorectal cancer, which claims the lives of nearly 500,000 Americans annually. However, this grim statistic can be significantly reduced through regular screenings. Similarly, managing high blood pressure could extend the lives of those affected by this disease. Vaccinations, too, play a pivotal role in preventing lethal illnesses like tetanus. Clearly, preventive measures wield substantial power in promoting good health.

Despite the life-saving potential, a glaring disparity exists: most individuals fail to receive the preventive care that could safeguard their well-being. Astonishingly, a mere 8 percent of U.S. adults aged 35 and above had undergone all recommended immunizations, cancer screenings, and other vital services by 2015.

To bridge this gap, innovators in healthcare are taking a leaf out of the tech giants' playbook—Facebook, Google, and others. This approach involves rapid comparison of small communication tweaks with patients, a process known as A/B testing. Health-care practitioners can expediently discern effective strategies using this technique. While it has yielded several actionable insights, skepticism lingers around its value.

A/B testing is commonplace in tech circles, guiding decisions on marketing slogans, webpage designs, and various other choices. The linchpin here is randomization, wherein individuals are randomly exposed to different versions of the tested element. Does a larger "Subscribe" button prompt more clicks than a smaller one? Which headline garners greater reader engagement?

Leora Horwitz, a health-services researcher at NYU Langone Health, and her team have embraced this methodology, dubbing it rapid randomized controlled trials (RCTs), to enhance healthcare delivery. Contrasting conventional RCTs that assess new treatments, rapid RCTs focus on refining service delivery through swift trials that iteratively improve based on insights gained.

Horwitz's team delved into addressing care gaps—overdue preventive services appointments—for patients with varying health-care histories. The challenge was to identify the most effective reminder types for patients with care gaps, given the impracticality of contacting each patient via telephone or online portals.

The A/B test segregated care gap patients into two categories: those with and without online portal accounts. Within each category, patients were further grouped based on their likelihood to initiate appointments. Telephone-call reminders were administered to certain patients, yielding significant results—a 6.2 percent appointment booking rate for those contacted versus a mere 0.5 percent for those not.

Furthermore, using the online portal, reminder messages were sent to patients with portal accounts. A staggering 13 percent scheduled services, in contrast to 1.1 percent without reminders. Crucially, the trials uncovered that high-risk patients, unlikely to seek preventive services independently, responded best to phone-call reminders. This insight promptly prompted NYU Langone to prioritize telephone reminders for high-risk patients, amplifying their patient portal messaging capabilities.

This innovative approach also impacted women's health, with shorter reminder messages proving more effective in encouraging mammogram appointments. Additionally, the technique has transformed vaccination rates among young children. Two-text reminders, strategically timed, tripled appointment bookings, indicating the power of well-timed booster reminders.

While rapid RCTs are gaining traction, some experts remain skeptical about their integration into healthcare. Concerns include ethical qualms around randomization and the limited scope of impact. Nevertheless, Horwitz asserts that rapid RCTs have led to hundreds of life-saving services and believes healthcare should wholeheartedly embrace this approach.

In an age where industries like tech adopt randomized practices as routine, the medical field can harness the power of A/B testing to revolutionize healthcare delivery, saving lives and enhancing well-being.