Effect of outreach messages on adolescent well-child visits and coronavirus disease 2019 vaccine rates: A randomized, controlled trial.

OBJECTIVE: To determine effectiveness of text/telephone outreach messages, with and without coronavirus disease 2019 (COVID-19) vaccine information. STUDY DESIGN: We conducted an intent-to-treat, multiarm, randomized clinical trial with adolescents aged 12-17 years. Eligible patients did not have an adolescent well-care visit in the past year or scheduled in the next 45 days or an active electronic health record portal account. We randomized participants to the standard message, COVID-19 vaccine message, or no message (control) group and delivered 2 text messages or telephone calls (per family preference) to the message groups. The primary outcome was adolescent well-care visit completion within 8 weeks, and secondary outcomes were adolescent well-care visit scheduled within 2 weeks and receiving COVID-19 vaccine within 8 weeks. RESULTS: We randomized 1235 adolescents (mean age, 14 ± 1.5 years; 51.6% male; 76.7% Black; 4.1% Hispanic/Latinx; 88.3% publicly insured). The standard message group had higher odds of scheduling an adolescent well-care visit compared with the control group (OR, 2.07; 95% CI, 1.21-3.52) and COVID-19 vaccine message group (OR, 1.66; 95% CI, 1.00-2.74). The odds of completing an adolescent well-care visit did not differ significantly (standard message group vs control group; OR, 1.35; 95% CI, 0.88-2.06; COVID-19 vaccine message group vs control group, OR, 1.33; 95% CI, 0.87-2.03). In per-protocol analyses, adolescents in the standard message group were twice as likely as the control group to receive the COVID-19 vaccine (OR, 2.48; 95% CI, 1.05-5.86). CONCLUSIONS: Outreach messages were minimally effective. Efforts are needed to address widening disparities. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov: NCT04904744.

Effect of Electronic Outreach Using Patient Portal Messages on Well Child Care Visit Completion: A Randomized Clinical Trial.

Importance: Outreach messages to patients overdue for well child care (WCC) can be delivered different ways (ie, telephone calls and text messages). Use of electronic health record patient portals is increasingly common but their effectiveness is uncertain. Objective: 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. Design, Setting, and Participants: An intention-to-treat, multigroup, randomized clinical trial was conducted at 3 academic primary care practices from July 30 to October 4, 2021. The population included predominantly non-Hispanic Black, low-income children (age, 6-17 years) whose parent had an active portal account. Interventions: Participants were randomized to the standard message, tailored message, or no message (control) group. Two messages were delivered to those in the message groups. Main Outcomes and Measures: Outcomes included WCC visit scheduled within 2 weeks of the first intervention message, WCC visit completed within 8 weeks (primary outcome), and receipt of COVID-19 vaccine within 8 weeks. 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). Conclusions and Relevance: 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. Trial Registration: ClinicalTrials.gov Identifier: NCT04994691.

Effect of Outreach Messages on Adolescent Well Child Visits and COVID-19 Vaccine Rates: An RCT

Objective To determine effectiveness of text/telephone outreach messages, with and without COVID-19 vaccine information. Study design We conducted an intent-to-treat, multi-arm, randomized clinical trial with adolescents aged 12-17 years. Eligible patients did not have an AWC visit in the past year or scheduled in the next 45 days or an active electronic health record portal account. We randomized participants to the Standard Message, COVID-19 Vaccine Message, or No Message (control) group and delivered two text/telephone calls (per family preference) to the message groups. The primary outcome was AWC visit completion within 8 weeks, and secondary outcomes were AWC visit scheduled within 2 weeks and receiving COVID-19 vaccine within 8 weeks. Results We randomized 1235 adolescents (mean [SD] age = 14 [1.5] years, 51.6% male, 76.7% Black, 4.1% Hispanic/Latinx, 88.3% publicly insured). The Standard Message group had higher odds of scheduling an AWC visit compared with the control group (OR, 2.07 [95% CI: 1.21 to 3.52]) and COVID-19 Vaccine Message group (OR, 1.66 [95% CI: 1.00 to 2.74]). The odds of completing an AWC visit did not differ significantly (Standard Message group vs. control group, OR = 1.35 [95% CI: 0.88 to 2.06];COVID-19 Vaccine Message group vs. control group, OR = 1.33 [95% CI: 0.87 to 2.03]. In per-protocol analyses, adolescents in the Standard Message group were twice as likely as the control group to receive the COVID-19 vaccine (OR, 2.48 [95% CI: 1.05 to 5.86]). Conclusion Outreach messages were minimally effective. Efforts are needed to address widening disparities.