Comparing Technological and Relational Approaches to Support Families After a Missed Well Child Visit - Well-Child visits (WCV) are an opportunity to maximize the health, development, and future well-being of children. Scheduled but not attended (“no-showed”) visits can lead to negative health and economic consequences for patients and families (delayed preventive care including screening and immunizations, and avoidable ED visits and hospitalizations) and for the healthcare system (decreased efficiency and productivity, lower quality measures, productivity, and revenue loss). Though adherence to the recommended WCV schedule has improved for the U.S. population over time, disparities persist. Children who are less adherent to the WCV schedule are more often identified to be Black or African American, as Hispanic or Latino, or whose families are lower-income and may be uninsured or publicly-insured. There is a need to identify high impact, cost-effective approaches to engage families who have missed WCV, especially among these populations. Health systems increasingly utilize text messaging technology or personnel such as community health workers (CHWs) to interact with patients or caregivers, and both approaches indicate positive effects. Indeed, pilot work from this research team comparing text message follow-up only to usual care suggested that sending text messages contributed to greater completion of a WCV within six weeks of no-show for some families, but that there is a need to look at patterns over a full year to eliminate seasonal variation. CHWs are most typically engaged following provider referral, hospitalization, or recurring ED utilization, and so there is a need to explore deploying CHW resources more proactively through outreach following a missed visit. No-shows may reflect barriers to care such as lack of transportation or competing priorities like food insecurity, which CHWs are well-positioned to address, thus through a relational approach CHWs may help promote improved engagement in preventive care for families. In turn, economic evaluation of technological and relational follow-up combined with trial data about which strategy(ies) works for whom can help inform resource allocation. The aims of this exploratory study are to: (1) demonstrate feasibility of merging a new referral protocol into existing resources for CHW outreach following WCV no-show; (2) compare WCV attendance following no-show between families who receive care-as-usual, text message (low-touch), and CHW outreach (high-touch) interventions, using a year-long randomized controlled trial; and (3) define costs and cost-effectiveness of using a low-touch or high-touch intervention to improve WCV attendance compared to care-as-usual. The study will reach a demographically varied, urban population, in English and Spanish. Findings from the proposed study will help inform a future, larger scale trial that expands into rural areas and other health system markets, tests tailored strategies for no-show follow-up, and incorporates advanced economic simulation methods to consider implications of applying such strategies to even larger populations, all with the long-term goal of reducing disparities in pediatric preventive care.
