Well-child Care Visits
Conditions
Keywords
Well-Child care, Community Health Workers, Missed healthcare appointments, Text message follow-up
Brief summary
The overall goal of this study is to compare the effectiveness of different follow up protocols for scheduled but not attended ("no-show") Well-Child Visits, relative to care-as-usual (no standardized or typical follow up procedure). The main goals are to: * Demonstrate feasibility of merging a new referral protocol following Well-Child visit no-show into existing health system Community Health Worker resources. * Compare Well-Child Visit attendance following no-show between patients randomized to care-as-usual (comparison), text message only (low-touch intervention), and community health worker outreach (high-touch intervention) groups. * Define the costs and cost-effectiveness of different follow-up protocols.
Detailed description
Well-Child visits (WCV) are at the core of preventive care in pediatrics. These Visits are an important opportunity for patients to be engaged with the healthcare system, for assessing child health and development, and for screening and counseling for prevention. Missed WCVs have been associated with negative health outcomes as well as avoidable healthcare costs and may occur for a variety of different reasons. There is room for improving follow-up with families to re-engage patients after not attending a scheduled WCV ("no-show"). This study will test and compare a text messaging intervention and community health worker outreach intervention to care-as-usual (no standard follow-up) as strategies for proactively engaging families in care after no-show to promote rescheduling and visit attendance. Evaluating effectiveness and cost-effectiveness of both interventions will inform clinical practice and decision-making in healthcare to help ultimately improve pediatric preventive care.
Interventions
BEHAVIORALLow-touch: texting
Text message: The patients' primary caregiver will be sent up to three text messages spaced one week apart, starting at one week post no-show. The message will identify the child by the first name and give information about the missed visit (date, time, clinic location) and how to reschedule (by clinic-specific phone number, and/or directing the patient to myatriumhealth.org). If a patient has a newly scheduled well-child visit on file prior to all three text messages being sent, messages will be stopped.
BEHAVIORALHigh-touch: Community health worker outreach
Community health worker (CHW) outreach: Within approximately one week of patient enrollment and randomization to the high-touch intervention arm, the community health worker will call the primary phone number in the patient's record. Up to three phone call attempts will be made and logged for this number, then a fourth and final attempt will be made to reach the secondary contact phone number in the patient's health record. If the caregiver is successfully reached, the CHW intervention will be limited to one phone call in which the CHW will assess reason(s) why the patient missed the appointment, will screen for social and other needs, and will assist in rescheduling the missed appointment and addressing potential barriers to attendance.
Sponsors
Wake Forest University Health Sciences
National Institute on Minority Health and Health Disparities (NIMHD)
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
SINGLE (Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
No minimum to 17 Years
Healthy volunteers
No
Inclusion criteria
* Are 0-17 years * No-showed for a well-child visit scheduled at a family medicine or general pediatrics practice in Forsyth County, North Carolina * Have a phone number on record for a primary caregiver * With primary language for contact that is English or Spanish
Exclusion criteria
\- Already rescheduled their appointment by the time the sample list was generated
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Proportion of Patients of All Ages with any Completed Well-Child Visits | Week 6 post missed well-child visit | Whether any Well-Child visit was completed by each patient (yes/no) following usual care, text intervention or community health worker intervention |
| Proportion of Patients Under 3 Years Old with any Completed Well-Child Visits | Week 6 post missed well-child visit | Whether any Well-Child visit was completed by each patient (yes/no) following usual care, text intervention or community health worker intervention |
| Proportion of Patients 3 Years and Older with any Completed Well-Child Visits | Week 6 post missed well-child visit | Whether any Well-Child visit was completed by each patient (yes/no) following usual care, text intervention or community health worker intervention |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Proportion of Patients of All Ages with Any Rescheduled Well-Child Visit | Week 6 post missed well-child visit | Whether any Well-Child visit was rescheduled by each patient (yes/no) following usual care, text intervention or community health worker intervention |
| Proportion of Patients 3 Years and Older with Any Rescheduled Well-Child Visit | Month 3 post missed well-child visit | Whether any Well-Child visit was rescheduled by each patient (yes/no) following usual care, text intervention or community health worker intervention |
| Proportion of Patients of All Ages with Vaccination status up-to-date | 6 weeks post missed well-child visit | Whether each patient is up-to-date on all age-appropriate vaccinations (yes/no) |
| Proportion of Patients 3 Years and Older with Vaccination status up-to-date | Month 3 post missed well-child visit | Whether each patient is up-to-date on all age-appropriate vaccinations (yes/no) |
| Proportion of Patients of All Ages with Any Completed Encounter | 6 weeks post missed well-child visit | Whether each patient had any completed healthcare encounter within the same health system (yes/no) |
| Proportion of Patients 3 Years and Older with Any Completed Encounter | Month 3 post missed well-child visit | Whether each patient had any completed healthcare encounter within the same health system (yes/no) |
| Proportion of Patients of All Ages with Any Non-Well-Child Primary Care Visit | 6 weeks post missed well-child visit | Whether each patient had any completed non-Well-Child primary healthcare visit within the same health system (yes/no) |
| Proportion of Patients 3 Years and Older with Any Non-Well-Child Visit Primary Care Visit | Month 3 post missed well-child visit | Whether each patient had any completed non-Well-Child primary healthcare visit within the same health system (yes/no) |
| Proportion of Patients of All Ages with Any Specialist Visit | 6 weeks post missed well-child visit | Whether each patient had any completed non-Well-Child specialist visit within the same health system (yes/no) |
| Proportion of Patients 3 Years and Older with Any Specialist Visit | Month 3 post missed well-child visit | Whether each patient had any completed non-Well-Child specialist visit within the same health system (yes/no) |
| Proportion of Patients of All Ages with Any Emergency Department Visit | 6 weeks post missed well-child visit | Whether each patient had any Emergency Department visit within the same health system (yes/no) |
| Proportion of Patients 3 Years and Older with Any Emergency Department Visit | Month 3 post missed well-child visit | Whether each patient had any Emergency Department within the same health system (yes/no) |
| Proportion of Patients of All Ages with Any Hospitalization | 6 weeks post missed well-child visit | Whether each patient had any hospitalization within the same health system (yes/no) |
| Proportion of Patients 3 Years and Older with Any Hospitalization | Month 3 post missed well-child visit | Whether each patient had any hospitalization within the same health system (yes/no) |
Countries
United States
Contacts
PRINCIPAL_INVESTIGATORBeata Debinski, PhD
Wake Forest University Health Sciences
Outcome results
None listed