Twilio Well-Child Visit Pilot Open Trial

Study Overview
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Brief Summary
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This project will use Twilio as a platform for a text messaging campaign to implement timely follow up with parents/guardians of children ages 0 to 17 years who have no-showed for WCVs. The first phase of the study will be an open trial to assess feasibility and acceptability of three different reminder messages, analyze preliminary data, and collect feedback from participants using interviews to identify the top one or two performing messages. Each reminder message will at minimum direct parents/guardians to reschedule by phone or by the patient portal. These findings will be used to conduct the second phase of the study, a randomized controlled trial.

Detailed Description
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Well-Child visits (WCV) are an opportunity to maximize the health and future well-being and development of children. Missed visits, however, can result in negative outcomes for patients and families and for the healthcare system. For patients, missed primary care visits can result in greater Emergency Department (ED) visits and hospitalizations, and in delays in diagnosing a variety of medical conditions, including identification of child abuse and neglect. For healthcare systems, missed visits result in decreased efficiency, lower quality measures, decreased provider productivity, and loss in revenue. Although smart phones are nearly ubiquitous, even among more economically disadvantaged populations, literature to date has reported only on using text messages for pre-visit reminders. There is a tremendous opportunity to study use of text messaging to engage families in follow-up for missed WCV. Even more so, testing the use of text messages with different content is missing, as well as using text messages to invite patients to share reasons for missing the last WCV.

Official Title
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Text Message Follow-up for Patients Who Have Missed Well-Child Visits: Open Trial

Conditions
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Text Messaging, Child Health

Intervention / Treatment
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* Other: Text message reminders
* Other: Interviews
* Other: Survey


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patients included in text messaging campaign (caregivers receive text messages): Are 0-17 years No-showed for a well-child visit scheduled at one of five locations: Pediatrics-Downtown Health Plaza, Family Medicine-Piedmont Plaza, Pediatrics-Winston East, Family Medicine-Peace Haven, or Pediatrics-Clemmons Have a phone number on record for a primary caregiver With primary language for contact that is English or Spanish Caregivers must be 18 years or older Exclusion Criteria: Patients who: Are 18+ years old No-showed for a different type of visit, or no-showed for a WCV at a different practice location Already rescheduled their appointment by the time the sample list was generated Have primary language specified that is not English or Spanish. Caregivers who are under 18 years old

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Health Services Research
Intervention Model: Single Group Assignment
Interventional Model Description: The first phase of the study will be an open trial to assess feasibility and acceptability of three different reminder messages, analyze preliminary data, and collect feedback from participants using interviews to identify the top one or two performing messages. Each reminder message will at minimum direct parents/guardians to reschedule by phone or by the patient portal.
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Open Trial<br>Patients within the Wake Forest Baptist Health system who no-showed for scheduled well child visits at Pediatrics-Downtown Health Plaza, Family Medicine-Piedmont Plaza, Pediatrics-Winston East, Family Medicine-Peace Haven, and Pediatrics-Clemmons. | Other: Text message reminders<br>* Text messages will be sent to parents/guardians of children ages 0 to 17 years who no-showed for their well child visits.<br>Other: Interviews<br>* Interviews will be conducted with a subset of participants to identify the top one or two performing text messages.<br>Other: Survey<br>* Alongside notification text messages regarding no-showed visits, participants will be invited to participate in a survey about their experience with the health system. This survey will assess reasons for missing the WCV and primary caregiver's perspective on the experience at the prior visit.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Number of rescheduled well child visits | If parent/guardian rescheduled well child visit | 6 weeks after no-showed well child visit | 
| Number of completed (rescheduled) well child visits | If parent/guardian completed (rescheduled) well child visit | 6 weeks after no-showed well child visit | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Number of child patient emergency department visits | If child patient had an emergency department visit | 6 weeks after no-showed well child visit | 
| Number of child patient hospitalizations | If child patient required hospitalization | 6 weeks after no-showed well child visit | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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child health, well child visits, text messaging