Introduction
Recruiting representative populations for clinical trials remains a persistent challenge.¹ ² Electronic health records (EHRs) and patient portals offer new opportunities to streamline recruitment by securely messaging potentially eligible participants. However, the demographic factors influencing engagement with this digital recruitment approach are not yet well understood.
Methods
Since 2022, the University of Texas Southwestern (UTSW), a quaternary academic medical center, has leveraged its EHR system—MyChart (Epic Systems Co)—to identify and invite potential research participants. Adult patients with an active MyChart account (614,110 individuals, representing 65% of the active patient population) are eligible to receive research invitations unless they have opted out. The centralized recruitment office sends bulk messages to these patients, informing them about the study, noting their potential eligibility, and prompting them to click a button if they wish to be contacted by the study team. Notifications via email or phone alert patients to new research opportunities available in their portal.
This quality improvement study examined characteristics of individuals who viewed recruitment messages, expressed interest, and ultimately enrolled in clinical studies that used portal-based messaging between January 2022 and December 2024. Enrollment data were sourced from the institutional clinical trial management system, excluding three studies with unavailable data. The analysis relied on de-identified data collected as part of routine recruitment quality monitoring and was deemed not to involve human subjects research by the UTSW Institutional Review Board.
To assess associations between demographic factors and recruitment outcomes, participant-level multivariable mixed-effects logistic regression models were used. Variables included age, sex, race, and ethnicity (as recorded in the EHR), and a random effect was included to account for variability across studies. Statistical significance was defined as a two-sided P value < 0.05. Results Across 23 clinical studies, recruitment messages were sent to 84,062 individuals (43.0% female [36,109]; 3.7% Asian [3,068], 19.0% Black [15,947], 9.5% Hispanic [7,990], and 62.6% White [52,640]; median age 62.5 years [IQR, 55.5–70.6]). Overall, 29,231 individuals (34.8%) viewed the recruitment message. Of those, 6,237 (21.3%) expressed interest in participation, representing 7.4% of all individuals who were sent a message. For studies with available enrollment data, 1,213 participants were ultimately enrolled—equating to 19.7% of those who expressed interest (1,213 of 6,168) and 1.2% of the total individuals initially contacted (1,213 of 82,066). Significant differences in message view rates, interest in participation, and enrollment were observed across sex, age, race, and ethnicity (Figure). In multivariable analyses:
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Lower odds of viewing the message were associated with:
- Male sex
- Younger age
- Hispanic ethnicity
- Black race
- Asian race
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Lower odds of expressing interest, among those who viewed the message, were associated with:
- Asian race
- Older age
Note: Black race and Hispanic ethnicity were not significantly associated with interest at this stage.
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Lower odds of enrollment, among those who expressed interest, were associated with:
- Male sex
- Black race
When considering the entire recruitment funnel (from message receipt to enrollment), male sex, Hispanic ethnicity, and Black race were each associated with reduced odds of eventual enrollment.
