Addressing Statistical Power and Increasing Diversity in Hospice Research: Electronic Medical Record Participant Identification Compared to Nurse Referral Approaches to Recruitment.

CONTEXT

Recruitment of targeted samples into hospice clinical trials is often challenging. While electronic medical records (EMR) are commonly used in hospital-based research, it is uncommon in hospice research. The community setting and the variability in hospices and their medical record creates unique challenges.

OBJECTIVES

This paper compares recruitment in two hospice randomized controlled trials, each of which had a group recruited by using the EMR identification and a group recruited by nurse referral. We sought to answer three questions: 1) What is the impact of using the EMR to identify hospice participants for clinical research? 2) How do the referral count and consent rate (referrals that ultimately result in verbal informed consent to participate in research) differ between hospice agencies using an EMR participant identification approach compared to those using a nurse referral approach? and 3) What are the challenges associated with using the EMR to identify potential research participants?

METHOD

Recruitment data from two hospice clinical trials was combined into a new database. Data from hospice nurse referral agencies was compared with data from those agencies who participated in EMR-identified referrals.

RESULTS

The EMR identification process was feasible and efficient, resulting in more referrals and more consented participants than the nurse referral method. Of particular interest is that 8% more black caregivers were recruited using the EMR identification process than the nurse referral.

CONCLUSIONS

The EMR-identified recruitment process is the recommended method in hospice research.