Comparing Technological and Relational Approaches to Support Families After a Missed Well Child Visit

Wake Forest University (WFU)

Status: Invitation-only

Conditions: Well-child Care Visits

Treatments: Behavioral: High-touch: Community health worker outreach; Behavioral: Low-touch: texting

Study type: Interventional

Funder types: Other; NIH

Identifiers

NCT06686849

IRB00118696

1R21MD019434-01A1 (U.S. NIH Grant/Contract)

Details and patient eligibility

About

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.

Full 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.

Enrollment: 5,885 estimated patients

Sex: All

Ages: Under 17 years old

Volunteers: No Healthy Volunteers

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

Trial design

Primary purpose: Health Services Research

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Single Blind

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5,885 participants in 3 patient groups

Care as Usual

No Intervention group

Description:

In the comparison group, patients' caregivers will not be subject to any standardized follow-up procedure.

Low-touch: Text messaging only

Experimental group

Description:

The patients' primary caregiver will receive a text message that includes details about the missed appointment, and guidance on rescheduling. Up to three total reminders will be sent, spaced one week apart, if the appointment is not rescheduled in the interim.

Treatment:

Behavioral: Low-touch: texting

High-touch: Community Health Worker outreach

Experimental group

Description:

Regardless of rescheduling status, the Community Health Worker (CHW) will reach out to the primary phone number on file within approximately 1 week of enrollment in the study. Per usual team protocol, up to three phone call attempts will be made to the primary phone number on file, followed by an attempt to the secondary phone number on file. The CHW will screen the families' needs per their usual protocol and inquire about reasons for no-showing for the scheduled appointment; additional questions will include whether they can provide support for rescheduling the no-showed visit and helping to attend it. The CHW will also have a discretionary fund available through this project to help support the family in addressing instrumental needs if existing resources are not available through the hospital, governmental services, or other organizations.

Treatment:

Behavioral: High-touch: Community health worker outreach