Literature Collection

BACKGROUND: As health care delivery shifts toward value-based care, proactive strategies to close preventive care gaps are essential. However, patient engagement remains suboptimal due to logistical, behavioral, and socioeconomic barriers. Traditional outreach methods, such as phone calls, emails, and postal mail, have long been used, but emerging digital approaches, such as chatbot-based messaging, offer potential advantages in scalability and personalization. Their comparative effectiveness, however, remains underexplored. OBJECTIVE: This study aimed to evaluate the effectiveness of chatbot outreach compared with traditional communication methods (phone, email, mail, and multichannel) in promoting compliance with preventive screenings and wellness visits defined by the Healthcare Effectiveness Data and Information Set and the Centers for Medicare & Medicaid Services guidelines. METHODS: This retrospective study evaluated patient outreach campaigns conducted from 2021 to 2023 across an integrated health system in New York. The final analytic sample included 50,145 care gaps from 41,959 eligible participants, predominantly female (29,989/50,145, 60%), White (31,857/50,145, 64%), with mean age ranging from 49.36 to 72.81 years over the study period. All participants were residents of New York state, and 81% (40,553/50,145) maintained an active relationship with a primary care provider during the participation year. Outreach modalities included automated chatbot SMS text messages, nonautomated phone calls, and organization-led email or mail campaigns. Participant data were enriched with social vulnerability scores to account for community-level disadvantages. Exposure was defined as the outreach method (chatbot, phone, email, mail, or multichannel), with assignment based on engagement history and operational protocols. The primary outcome was care-gap closure or compliance with identified measure gaps annually. Logistic regression and chi-square analyses examined associations between outreach method, patient demographics, primary care physician relationship, social vulnerability index (SVI), and compliance. RESULTS: Phone outreach consistently achieved higher compliance than chatbot or multichannel outreach across most groups and years. Chatbot messages outperformed phone calls only in diabetes care in 2023 (odds ratio [OR] 1.81, 95% CI 1.48-2.21; P<.001). Primary care physician continuity remained a strong predictor of gap closure, especially in primary care (ORs ranged 1.36-2.61; P<.001). Higher SVI quartiles were associated with lower compliance in blood pressure, cancer care, and diabetes care groups; however, primary care outcomes showed higher odds of compliance in the third quartile of SVI, contradicting the typical linear-deprivation narrative. Women, Hispanic or Latino individuals, and Asian patients demonstrated higher odds of compliance in some groups and years. CONCLUSIONS: Outreach modality is an important, modifiable factor in preventive care adherence. While phone-based outreach remains the most effective overall approach, chatbot-based strategies may have targeted applications in digitally engaged populations such as the diabetic group. Segmented, equity-informed outreach strategies that integrate technology, patient preferences, and primary care continuity are essential to achieving high-impact, scalable outcomes in value-based care settings.

INTRODUCTION: Borderline personality disorder (BPD) is a burdensome and diagnostically challenging condition. There is a need to identify its risk factors, yet prior studies are scarce and small-scale. We aimed to describe the prevalence of psychiatric comorbidities and the level of mental health resource utilization during adolescence in patients with BPD. METHODS: We conducted a retrospective descriptive study of 938 participants (aged 18-26 years) with BPD at a large, multi-site, integrated health maintenance organization (HMO) system in Southern California. Data were collected from January 2010 to September 2020. Comorbidities of interest were other psychiatric conditions diagnosed before age 18. Healthcare utilization data included age of first psychiatry encounter, age at first psychiatric hospitalization, number of psychiatric hospitalizations per year, number of sessions of intensive outpatient group therapy and partial hospitalization, number of visits with a psychiatrist, number of crisis calls, and number of psychotherapy sessions. RESULTS: The analytic cohort included 816 (87.0%) female patients with a mean age of 22 years. BPD prevalence in the overall population was 0.1% (n=2,287). Comorbidities with the highest prevalence included depressive and anxiety disorders at 83.5% (n=783) and 69.6% (n=653), respectively. Suicidal ideation and suicide attempts were prevalent at 38.6% (n=362) and 0.5% (n=5). Before the age of 18 years, 70.7% (n=663) had a psychiatric visit, 86.7% (n=813) had psychotherapy, and 34.8% (n=326) had a psychiatric hospitalization. CONCLUSION: The findings of this study suggest high psychiatric comorbidity and healthcare utilization in patients with BPD. Given lower rates of adolescent suicidality, early intervention may decrease BPD-associated mortality. Psychiatric comorbidities may predict the risk of developing BPD. Future comparative analyses should validate the statistical significance of these predictors and whether screening improves BPD outcomes.