Study design
fibrosis, liver cirrhosis
FIBROSIS, LIVER CIRRHOSIS
This was a 3-arm randomized controlled trial applying behavioral economic approaches to encourage patients with liver cirrhosis or advanced fibrosis to complete routine surveillance ultrasounds. Eligible patients were randomized in a 1:2:2 ratio into 3 arms: (1) Usual care, (2) Letter + Order, or (3) Letter + Order + Incentive. They were identified in a series of 3 batches each 3 months apart, and randomization was stratified by batch. Patients in the Usual care arm received standard of care and were not mailed any outreach as part of this study. Patients in the Letter + Order arm were sent a letter invoking opt-out framing with an order slip for the ultrasound. Patients in the Letter + Order + Incentive arm were also sent a letter and order slip in addition to a $20 unconditional incentive.All research was conducted in accordance with both the Declarations of Helsinki and Istanbul. The study was approved by the Institutional Review Board at the University of Pennsylvania. A waiver of informed consent was obtained because the study was minimal risk to patients and could not have been practicably carried out without the waiver.