Effect of Automated and Personalized Outreach Messages on Well-Child Visit Catch Up: A Randomized Clinical Trial

To determine the effectiveness of text/telephone outreach messages and personal contact attempts on well-child care (WCC) scheduling and completion and measles, mumps, and rubella (MMR) vaccine receipt. We conducted an intent-to-treat, 2 × 2 factorial randomized clinical trial with 3 replications at 3 academic pediatric primary care practices from September 27, 2020 to August 6, 2021. We randomized participants to 1 of 4 groups: 1 automated message (group 1), 2 automated messages (group 2), 1 automated message plus personal contact attempts (group 3), or 2 automated messages plus personal contact attempts (group 4). Outcomes included: 1) scheduled WCC within 2 weeks (secondary outcome), 2) completed WCC within 8 weeks (secondary outcome), 3) receipt of first MMR by 15 months of age or second MMR within 3 months of first message for 4-year-olds (primary outcome). We randomized 1312 patients (mean [SD] age = 38.8 [19.3] months, 53.5% male, 72.8% non-Hispanic Black, 86.9% Medicaid-enrolled). Scheduling rates were significantly higher in groups with personal contact attempts compared to those without (1 = 15.2%, 2 = 12.5%, 3 = 29.3%, and 4 = 31.5%). WCC completion rates also differed across groups: 1 = 27.4%, 2 = 22.3%, 3 = 32.0%, and 4 = 29.4%, with groups 3 and 4 having significantly higher rates than group 2. Similarly, groups 3 (30.2%) and 4 (31.8%) had significantly higher rates of receiving the MMR vaccine compared to group 2 (23.5%) but not group 1 (28.0%). Outreach messages that were followed by personal contact attempts increased the rates of scheduling and completing WCCs and receiving the MMR vaccine, providing a useful tool to re-engage at-risk populations.