Established Evidence Results

Intervention Components (click on component to see a list of all articles that use that intervention): Patient Reminder/Invitation PATIENT_CONSUMER

Intervention Description: To determine the effectiveness of patient portal outreach messages, with and without the date of the last WCC, on the scheduling and completion of WCC visits and completion of vaccinations.

Intervention Results: Nine hundred forty-five patients participated (mean [SD] age, 9.9 [3.3] years, 493 [52.2%] girls, 590 [62.4%] non-Hispanic Black, 807 [85.4%] publicly insured). Scheduling rates were 18.4% in the standard message group (adjusted risk ratio [aRR], 1.97; 95% CI, 1.32-2.84) and 14.9% in the tailored message group (aRR, 1.57; 95% CI, 1.02-2.34) compared with the control group (9.5%). Well child care visit completion rates were 24.1% in the standard message group (aRR, 1.92; 95% CI, 1.38-2.60) and 19.4% in the tailored message group (aRR, 1.52; 95% CI, 1.06-2.13) compared with the control group (12.7%). Among eligible children, rates of receiving the COVID-19 vaccine were 16.7% in the standard message group compared with 4.8% in the tailored message (aRR, 3.41; 95% CI, 1.14-9.58) and 3.7% in the control groups (aRR, 4.84; 95% CI, 1.44-15.12).

Conclusion: In this randomized clinical trial, outreach messages delivered via electronic health record patient portals increased the rates of scheduling and completing WCC visits and receiving the COVID-19 vaccine, providing a useful tool to help restore WCC in populations whose care was delayed during the pandemic.

Intervention Components (click on component to see a list of all articles that use that intervention): Patient Reminder/Invitation PATIENT_CONSUMER Notification/Information Materials (Online Resources, Information Guide) PARENT_FAMILY Text Messaging

Intervention Description: - Standard Message: Two automated outreach messages sent 24 hours apart (Thursday and Friday at 12:00 PM) via text or phone call based on parent preference, reminding parents that their child was due for an adolescent well-care visit and asking them to call to schedule using the number provided. - COVID-19 Vaccine Message: Two automated outreach messages sent 24 hours apart (Thursday and Friday at 12:00 PM) via text or phone call based on parent preference, including the standard message content plus mention that COVID-19 vaccine was available for both the child and parent during their future visit. - Control Group: No messages sent.

Intervention Results: - The standard message group had higher odds of scheduling adolescent well-care visits compared to the control and COVID-19 vaccine message groups. - There was no significant difference in the completion of adolescent well-care visits among the groups. - The standard message group showed a significant increase in COVID-19 vaccine receipt compared to the control group in per-protocol analyses. - Both message groups had higher odds of receiving Tdap and MCV4 vaccines compared to the control group among eligible patients.

Conclusion: The study found that outreach messages had a minimal effect on adolescent well-care visits and COVID-19 vaccine rates, indicating a need for more effective strategies to address disparities. The standard message was more effective than the COVID-19 vaccine message in scheduling visits, but not in completing them. Both message groups showed some positive impact on vaccine receipt, particularly for MCV4. The study suggests that messaging about COVID-19 vaccines might deter some families due to vaccine hesitancy. Qualitative research is needed to develop culturally relevant strategies for promoting COVID-19 vaccine uptake. The study has limitations, including its focus on a specific population, which may limit generalizability. Further research is needed to understand the timing and strategies for follow-up messages to address widening disparities.

Study Design: - Randomized clinical trial - Multiarm (three arms: 1:1:1 allocation) - Intent-to-treat (with sensitivity and per-protocol analyses) - Controlled - Stratified (by clinic location using block randomization with block size of 3) - Blinded (patients, parents, clinical practice teams, and outcome assessor) — though patients/parents were blinded by concealing the trial - Multi-site (3 academic pediatric primary care practices)

Setting: Three academic pediatric primary care practices serving a predominantly non-Hispanic Black, low-income population in Cincinnati, Ohio.

Population of Focus: Adolescents aged 12-17 years who were due for preventative services (had not completed an adolescent well-care visit in the past year and had no visit scheduled in the next 45 days).

Sample Size: - Total sample size: 1235 - Standard message group: 412 - COVID-19 vaccine message group: 411 - Control group: 412

Age Range: 12-17 years (mean age: 14 ± 1.5 years)

Intervention Components (click on component to see a list of all articles that use that intervention): PARENT_FAMILY Text Messaging Notification/Information Materials (Online Resources, Information Guide)

Intervention Description: - Intervention group: Up to three automated text messages sent to caregivers one week apart via REDCap and Twilio. Messages included the patient's first name, details of the missed appointment (time, date, location), and instructions on how to reschedule via clinic-specific phone number or patient portal. Messages were sent in English or Spanish based on EHR preference and varied by time of day (mid-morning, early afternoon, late afternoon). Messages stopped if the appointment was rescheduled. Caregivers could opt-out by responding ""STOP."" - Care-as-usual comparison group: No systematic text message outreach. Clinical practices may reach out by phone or letter in limited circumstances, though this was not standard practice.

Intervention Results: - Text messaging significantly improved the completion of well-child visits (WCVs) within 6 weeks after a no-show, with a risk difference of +2.83% (95% CI: 1.66, 4.00) and an odds ratio of 1.86 (95% CI: 1.09, 3.19; p=.02). - The proportion of rescheduled WCVs within 6 weeks was higher in the text message group, but this difference was not statistically significant, with a risk difference of +1.98% (95% CI: -1.85, 5.81) and an odds ratio of 1.21 (95% CI: 0.79, 1.84; p=.38). - Post-hoc analysis showed text messaging significantly increased rescheduling when time limits were removed (any rescheduled WCV): risk difference +8.1% (95% CI: 4.6, 11.6); OR 1.68 (95% CI: 1.21, 2.33; p=.02). - Outcomes varied significantly by clinic location and patient age, with younger children and smaller clinics showing better results. - No significant differences in secondary outcomes (ED visits or inpatient hospitalizations).

Conclusion: Text message reminders positively impacted attendance at well-child visits when rescheduled within 6 weeks following a no-show. The intervention significantly improved completed WCV rates but did not significantly increase rescheduling within the 6-week window. However, when time restrictions were removed, rescheduling rates improved significantly. This low-cost, low-touch, and low-risk intervention is suitable for widespread implementation and could be automated throughout health systems. Future research should explore longer follow-up periods, seasonal variations, and comparisons with more intensive interventions such as community health workers. No significant harms or unintended effects were found.

Study Design: - Pilot randomized controlled trial (RCT) - Two parallel arms (1:1 allocation) - Stratified by preferred language (English/Spanish) - Intent-to-treat analysis (primary), with sensitivity and per-protocol analyses - Blinded (caregivers and clinical practice teams were blinded to group allocation) - Multi-site (5 practices)

Setting: - Geographical Setting: Southeast US, Atrium Health Wake Forest Baptist Health System - Physical Setting: Five clinics (three pediatrics, two family medicine) in Winston-Salem, NC - Population Setting: Patients under 18 years old - Temporal Setting: May 6 to July 19, 2022 (late spring and summer)

Population of Focus: - Patients under 18 years old (0-17 years) who: - Had a scheduled well-child visit that they missed (""no-showed"") between May 6–July 19, 2022 - Did not have another scheduled or completed WCV documented in the EHR one week later - Had preferred language listed as English or Spanish in the EHR

Sample Size: - Total sample size: 720 - Text message intervention group: 361 - Care-as-usual comparison group: 359

Age Range: 0-17 years (pediatric patients)

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER Patient Reminder/Invitation

Intervention Description: In the context of a new adolescent preventive health program in a family practice setting, we compared attendance rates using two invitation protocols, the protocols differing in their emphasis on adolescent autonomy vs parental responsibility.

Intervention Results: The spontaneous response rate was 21%, the agreement to attend rate was 75%, and the attendance rate was 44%. Attendance rates were higher for the girls compared with the boys (54% vs 35%, P = .08) and for the seventh graders compared with the tenth graders (53% vs 31%, P = .03). The spontaneous response rate was lower among the tenth graders using protocol 2 (8% vs 37.5% with protocol1, P = .04), while the agreement to attend rate and attendance rate did not differ for the two protocols.

Conclusion: Nearly one half of this population of adolescents attended preventive health visits at the family nurse's and physician's initiative. A follow-up telephone call after the initial written invitation resulted in increased participation, while approaching the teenager or parent initially did not make a difference in attendance. This pilot study shows the potential for initiating an adolescent health program in the family practice setting.

Study Design: QE: non-equivalent control group

Setting: Family practice clinic in an urban, mainly lower-middle class, Jewish neighborhood in West Jerusalem

Population of Focus: Teenagers ages 12 to 18 (7th graders and 10th graders) years who live with their parents in the neighborhood (all patients have national health insurance and visits are free of charge)

Data Source: Clinic attendance records

Sample Size: Total (N=106) Protocol 1: (n=47) Protocol 2: (n=59)

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER Patient Reminder/Invitation

Intervention Description: To assess the impact of a managed care-based patient reminder/recall system on immunization rates and preventive care visits among low-income adolescents.

Intervention Results: Significantly higher rates of annual preventive care visits in the mailed reminder group vs control group (Hazard ratio=1.2; CI=1.1- 1.3; p<.01 Significantly higher rates of annual preventive care visits in the telephone reminder group vs control group (Hazard ratio=1.1; CI=1.0-1.2; p<.05)

Conclusion: Managed care-based mail or telephone reminder/recall improved adolescent immunizations and preventive visits, with modest costs and modest impact.

Study Design: RCT

Setting: Monroe Plan for Medical Care, a not-for-profit managed care organization in upstate New York

Population of Focus: Adolescents ages 10.5 through 17 years enrolled in Monroe Plan on December 31, 2009, with a primary care provider in a participating practice

Data Source: Managed care organization’s claims files

Sample Size: Total (N=4115) Mailed reminder (n=1396) Telephone reminder (n=1423) Control (n=1296)

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER Patient Reminder/Invitation Home Visits Transportation Assistance

Intervention Description: To assess the impact of a tiered patient immunization navigator intervention (immunization tracking, reminder/recall, and outreach) on improving immunization and preventive care visit rates in urban adolescents.

Intervention Results: Significant increase in preventive care visit rates in the intervention group vs control group (p<.01)

Conclusion: A tiered tracking, reminder/recall, and outreach intervention improved immunization and preventive care visit rates in urban adolescents.

Study Design: RCT

Setting: 8 urban primary care practices in Rochester, New York

Population of Focus: Adolescents ages 11-15 enrolled in one of the practices

Data Source: Medical record review

Sample Size: Total (N=7546) Intervention (n=3707) Control (n=3,839)

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER Patient Reminder/Invitation

Intervention Description: To measure the effect of telephone-based reminder/recall on immunization and well-child care (WCC) visit rates among adolescents in urban practices.

Intervention Results: No significant increase in adolescent well visit rates

Conclusion: An intensive telephone reminder and recall system was only minimally successful in improving immunization and WCC visit rates among urban adolescents. Lack of success was largely owing to changed or inaccurate telephone numbers.

Study Design: RCT

Setting: 4 urban primary care clinics in Rochester, New York

Population of Focus: Adolescents ages 11-14 with one or more visits at each site

Data Source: Medical record review

Sample Size: Total (N=3006) Intervention (n=1496) Control (n=1510)

Age Range: Not specified