| Field | Before | After |
|---|---|---|
| Field Last Published | Before March 26, 2025 08:17 AM | After March 28, 2025 02:58 AM |
| Field Intervention (Public) | Before The Wellbeing Services County of Ostrobothnia, a mid-sized administrative region in Western Finland, will launch its digital clinic platform, a website and app for its digital services, on April 15, 2025. Over time, the digital clinic platform will include several different chat channels for various services. The main channel, the digital clinic, will be a chat channel to contact primary care professionals. The initial contact will be with a nurse, after which the nurse has the opportunity to consult with a physician. Primary care patients with new health issues who choose to contact the digital clinic are expected to log in with strong identification for a care needs assessment and treatment. At the time of writing, the plan is to keep the digital clinic open from 8 AM to 3 PM Monday through Thursday and from 8 AM to 2 PM on Fridays. Other chat channels that Ostrobothnia plans to launch using the platform, such as a chat for social services, a chat for rehabilitation, and a chat for customer service, do not require strong identification, and are not intended to serve as a substitute for the digital clinic. Our intervention is to randomize access to the digital clinic for a nine-month period, starting on April 15. The randomization assigns households to two groups that either have access (the treatment group) or do not have access (the control group) to the newly launched digital clinic. Individuals in the treatment group will have access to the digital clinic immediately after its opening. The entire population residing in the region will have access to the digital clinic after the nine-month trial period. The trial does not affect access to other available alternatives for contacting primary care, such as traditional PPC, occupational healthcare, or private clinics. The intervention (access to the digital clinic) is accompanied by an information campaign targeting all households in the treatment group. The primary communication channel with the treatment group is through mailed letters. These letters will inform recipients about their option to use the digital clinic during the trial period and provide instructions on what the digital clinic is, and how to use it, as well as the rationale for granting access initially only to a randomly-selected subgroup of the population. We will send these information letters to all households belonging to the treatment group. We will send one letter per household and randomize the recipient within the household so that all household members over the age of eighteen have the same probability of receiving the letter. In a small sample of households consisting only of minors, all individuals aged 15 to 18 have an equal probability of receiving the letter. There will be no information letters addressed to individuals under the age of fifteen. The letters will be mailed shortly before the launch of the digital clinic. For more information on the intervention, see Section 3 of our Analysis Plan (PAP). | After The Wellbeing Services County of Ostrobothnia, a mid-sized administrative region in Western Finland, will launch its digital clinic platform, a website and app for its digital services, on April 15, 2025. Over time, the digital clinic platform will include several different chat channels for various services. The main channel, the digital clinic, will be a chat channel to contact primary care professionals. The initial contact will be with a nurse, after which the nurse has the opportunity to consult with a physician. Primary care patients with new health issues who choose to contact the digital clinic are expected to log in with strong identification for a care needs assessment and treatment. At the time of writing, the plan is to keep the digital clinic open from 8 AM to 3 PM Monday through Thursday and from 8 AM to 2 PM on Fridays. Other chat channels that Ostrobothnia plans to launch using the platform, such as a chat for social services, a chat for rehabilitation, and a chat for customer service, do not require strong identification, and are not intended to serve as a substitute for the digital clinic. Our intervention is to randomize access to the digital clinic for a nine-month period, starting on April 15. The randomization assigns households to two groups that either have access (the treatment group) or do not have access (the control group) to the newly launched digital clinic. Individuals in the treatment group will have access to the digital clinic immediately after its opening. The entire population residing in the region will have access to the digital clinic after the nine-month trial period. The trial does not affect access to other available alternatives for contacting primary care, such as traditional public primary care, occupational healthcare, or private clinics. The intervention (access to the digital clinic) is accompanied by an information campaign targeting all households in the treatment group. The primary communication channel with the treatment group is through mailed letters. These letters will inform recipients about their option to use the digital clinic during the trial period and provide instructions on what the digital clinic is, and how to use it, as well as the rationale for granting access initially only to a randomly-selected subgroup of the population. We will send these information letters to all households belonging to the treatment group. We will send one letter per household and randomize the recipient within the household so that all household members over the age of eighteen have the same probability of receiving the letter. In a small sample of households consisting only of minors, all individuals aged 15 to 18 have an equal probability of receiving the letter. There will be no information letters addressed to individuals under the age of fifteen. The letters will be mailed shortly before the launch of the digital clinic. For more information on the intervention, see Section 3 of our Analysis Plan (PAP). |
| Field Primary Outcomes (End Points) | Before In-person visits in PPC (Y1.1). The number of public digital clinic contacts (D.1). | After The number of in-person visits in public primary care (Y1.1). The number of public digital clinic contacts (D.1). |
| Field Primary Outcomes (Explanation) | Before Y1.1: Our main research question is whether the use of digital clinics can reduce contacts with traditional PPC, including in-person visits and phone contacts. Of these contacts, we chose in-person visits as our primary outcome (Y1.1). In-person visits are more expensive to provide than phone contacts and require face-to-face interaction. At the same time, we expect that other contacts with traditional PPC, involving telemedicine (mainly phone calls) and professional-to-professional interactions, are a closer substitute for digital clinic contacts than in person visits. D.1: Outcome D.1 is required for estimating the impact of using the public digital clinic on the utilization of traditional PPC. | After Y1.1: This outcome includes in-person visits to nurses and physicians in traditional public primary care clinics. D.1: This outcome includes care needs assessments, remote appointments to nurses and physicians (via chat and video), and professional-to-professional interactions between nurses and physicians in digital public primary care clinics. |
| Field Experimental Design (Public) | Before Our intervention is to randomize access to the digital clinic for a nine-month period, starting on April 15. The randomization assigns households to two groups that either have access (the treatment group) or do not have access (the control group) to the newly launched digital clinic. Individuals in the treatment group will have access to the digital clinic immediately after its opening. The entire population residing in the region will have access to the digital clinic after the nine-month trial period. The trial does not affect access to other available alternatives for contacting primary care, such as traditional PPC, occupational healthcare, or private clinics. We randomized treatment at the household level based on permanent addresses, ensuring that all members of a household were assigned to the same treatment group. Households were stratified by size to maintain balance across different household compositions. Within each stratum, we randomly assigned 50% of the households to the treatment group (a 1:1 ratio). Specifically, for each household ID cluster, we generated a random floating-point number and sorted the clusters by this value within each household size group. Households in the top 50% of these sorted values were assigned to the treatment group. Moreover, we randomized one recipient of the information letter (see Section 3.2 of the pre-analysis plan) per treated household as follows: All household members over the age of eighteen had the same probability of receiving the letter. In a small sample of households consisting only of minors, all individuals aged 15 to 18 had an equal probability of receiving the letter. The randomization code, like all other code written for this PAP, is available in the Github repository of this project. | After Our intervention is to randomize access to the digital clinic for a nine-month period, starting on April 15. The randomization assigns households to two groups that either have access (the treatment group) or do not have access (the control group) to the newly launched digital clinic. Individuals in the treatment group will have access to the digital clinic immediately after its opening. The entire population residing in the region will have access to the digital clinic after the nine-month trial period. The trial does not affect access to other available alternatives for contacting primary care, such as traditional public primary care, occupational healthcare, or private clinics. We randomized treatment at the household level based on permanent addresses, ensuring that all members of a household were assigned to the same treatment group. Households were stratified by size to maintain balance across different household compositions. Within each stratum, we randomly assigned 50% of the households to the treatment group (a 1:1 ratio). Specifically, for each household ID cluster, we generated a random floating-point number and sorted the clusters by this value within each household size group. Households in the top 50% of these sorted values were assigned to the treatment group. Moreover, we randomized one recipient of the information letter (see Section 3.2 of the pre-analysis plan) per treated household as follows: All household members over the age of eighteen had the same probability of receiving the letter. In a small sample of households consisting only of minors, all individuals aged 15 to 18 had an equal probability of receiving the letter. The randomization code, like all other code written for this PAP, is available in the Github repository of this project. |
| Field Secondary Outcomes (End Points) | Before Secondary: Other contacts with traditional PPC (Y1.2). Tertiary: The total number of PPC contacts (Y1.3) An indicator for having any public digital clinic contact during the follow-up (D.2). | After Secondary: The number of other contacts with traditional public primary care (Y1.2). Tertiary: The total number of public primary care contacts (Y1.3) An indicator for having any public digital clinic contact during the follow-up (D.2). |
| Field Secondary Outcomes (Explanation) | Before Y1.2: We expect that the substitution rate between digital clinics and traditional PPC is higher with respect to this outcome, compared to in-person visits (Y1.1). Other traditional PPC contacts involve remote contacts (e.g., phone calls between professionals and patients and professional-to-professional interactions) and are likely to be a closer substitute for digital clinic contacts than in-person visits. Y1.3: We expect that the digital clinic access will increase the total number of contacts to PPC, including the digital clinic and the traditional PPC. The question is: by how much? D.2: The purpose of adding this outcomes is to allow interested readers to construct the Local Average Treatment Effect (LATE) parameter by dividing reduced-form estimates on Y1.1 and Y1.2 by D.2. In other words, this outcome is an alternative approach for estimating the impact of using the public digital clinic on the utilization of traditional PPC. | After Y1.2: This outcome includes care needs assessments, remote appointments to nurses and physicians, and professional-to-professional interactions between nurses and physicians in traditional public primary care clinics. Y1.3: This outcome includes in-person visits to nurses and physicians, care needs assessments, remote appointments to nurses and physicians, and professional-to-professional interactions between nurses and physicians in digital and traditional public primary care clinics. D.2: This outcome includes care needs assessments, remote appointments to nurses and physicians (via chat and video), and professional-to-professional interactions between nurses and physicians in digital public primary care clinics. |
| Field | Before | After |
|---|---|---|
| Field Document | Before |
After
2025_03_pap_final_ENA.pdf
MD5:
6475464436dd5e12b20212d48f4e4bdf
SHA1:
0128f952957500a0bd37df301e1f634e055efe61
|
| Field Title | Before | After Pre-analysis plan (March 28, 2025) |
| Field | Value |
|---|---|
| Field Document |
Value
2025_03_pap_final_ENA.pdf
MD5:
d8cf18cd473f8c0338ed0e6908f1bd26
SHA1:
6923d938bcc1689c86a0fa20330a6a0cb07e6bbe
|
| Field Title | Value Pre-analysis plan (March 17, 2025) |