Promoting Pediatric Prevention (P4) Challenge

Our third presentation today is going to come from Jennifer Morrison, a clinical research scientist from AllianceChicago, who is going to tell us about the CHEC-UP project. Jennifer, congratulations, and we are so glad you could join us. Thank you, and good afternoon, and thank you for the introduction, Dr. Warren. My name is Jennifer Morrison. I am a pediatric nurse practitioner at one of the community health centers in Chicago and also a clinical research scientist at AllianceChicago. I am delighted to be here today presenting on behalf of AllianceChicago. We are a health center–controlled network that provides health information technology, research, innovation, quality improvement, and clinical collaboration infrastructure for over 50 community health centers across the country, and our project is entitled CHEC-UP, or Child Health Engagement and Coaching Using Patient-Centered Innovation.

I would like to take a moment to acknowledge our wonderful team for this project. We were very blessed to have a highly skilled group of individuals in different roles and with a variety of expertise collaborating on the project. In addition to this team, there were many individuals at AllianceChicago and our partnering organizations who offered their support and feedback throughout the project. So let us get down to it. We sought to reduce disparities in well-child visits and immunization rates through an innovative, bidirectional, patient-centered communication platform that used artificial intelligence chatbots to accomplish three tasks: one, to remind families of upcoming well-child visits and immunizations; two, to engage families proactively with evidence-based anticipatory guidance materials prior to their visit; and three, to facilitate easy appointment scheduling.

We worked with a number of vital partners on the project. The communication platform that we used is the brainchild of QliqSOFT, a patient engagement technology organization. For this project, we communicated with patients using Quincy, their chatbot with customizable smartphone-based algorithms for outreach. Heartland Health Centers is one of our network health centers and a federally qualified health center in Chicago with an incredibly passionate and enthusiastic staff, and they were eager to pilot innovative approaches to improve patient care. Of course, we also consider their patient families instrumental as partners, because they provided feedback to us throughout the project, which was vital to the success of this innovative idea.

A little more about the patient population at Heartland Health Centers: 82 percent of patients identify as racial and/or ethnic minorities, and 99 percent of patients are at or below 200 percent of the federal poverty guideline. For this intervention, we sent chatbots to about 200 English- and Spanish-speaking families with children who were due for a well-child visit. Let us talk a little bit about our innovation. Quincy is a completely customizable chatbot that does not require an app and can function on a mobile device or a computer. You will see on the left side of the screen a mock-up of what one of our chatbots looked like. Quincy allows us to distribute handouts within the chatbot, which we used for the anticipatory guidance portion of this project. It allowed us to ask patients questions and then respond based on their answers.

For the purposes of this project, patient families received a regular text message on their phone alerting them that their clinic, Heartland Health Centers, wanted to discuss their child’s next well visit and then providing them with a link to click to enter the secure communication platform. Once in the platform, patients could request that the health center reach out to them to schedule the appointment or specify that they would prefer to schedule the appointment themselves. We really tried to keep our chatbots fun, engaging, and personalized by mentioning a few developmental milestones that their child might be experiencing at that time.

We utilized a learning health systems framework for this project. Throughout our intervention, we collected feedback not only from our partners at QliqSOFT and Heartland Health Centers, but also from patients, allowing us to make continuous adjustments and improvements. We gathered patient feedback through interviews and by leveraging the chatbot technology itself, creating a patient survey chatbot that was sent about one week after the initial outreach chatbot.

Just to touch briefly on our results, we examined three groups. Our dark blue control group consisted of about 250 patients with similar age ranges who were also due for a well visit during the project but did not receive any outreach using the chatbot technology. Our intervention group in the middle was the group of 200 patient families that received the intervention text message linking to the secure chatbot platform. Our intervention-and-engagement group, the light green group on the right, consisted of the patient families that chose to open the link and engage with the clinic through the chatbot. Ultimately, when looking at our entire intervention-and-engagement group, ages 0 to 17, we saw a 13 percent absolute increase in well-child visit and immunization completion rates compared with the control group, and this group was 27 percent more likely to complete their visit.

Equally important to us was understanding the patient experience with this innovative technology. Our user-feedback chatbots were sent to patients about a week after the initial outreach chatbot, and the results were overwhelmingly optimistic: 88 percent of families noted a positive experience with the chatbot, 86 percent took the time to review their anticipatory guidance handout prior to the visit, and 100 percent appreciated the appointment reminder. We learned quite a few important lessons during this challenge, chief among them the importance of eliciting feedback from stakeholders—especially patients—and making adjustments to our approach to strengthen our intervention. In addition, we found that collaboration with our partners and colleagues resulted in new ideas and stronger work.

From our patients and health center partners, we learned that outreach should be patient-centered when possible, allowing patients options to communicate and schedule in ways that work for them, because every family’s preferences and needs are different. Communication technology should be sustainable and scalable, customizable, and easily adaptable to various departments, workflows, and patient populations. We found that these solutions can enhance revenue and support value-based reimbursement by increasing visits and reducing no-show appointments. In a stressful pandemic environment, health centers welcome approaches that reduce staff burden; this platform minimizes time spent on individual reminder calls and engages patients in various ways prior to their visit to help streamline provider–patient interactions during their in-person visit.

The communication platform offered options for easy scheduling, escalation to synchronous communication for triage or other concerns, and many other unique features; it was truly an all-in-one solution. We were really excited by the positive feedback and results from this project, and we look forward to exploring other opportunities to leverage this technology in the community health center population, especially to expand opportunities for interactive and personalized education. I would like to take a moment to thank HRSA, the Maternal and Child Health Bureau, and the P4 Challenge team for sponsoring such a wonderful challenge. The P4 Challenge allowed us to implement this innovative idea in one of our partner health centers, pushed us to establish new partnerships and relationships with QliqSOFT and Heartland Health Centers, to collaborate internally with our partners, and to learn from other challenge participants.

Finally, the P4 Challenge allowed us to pilot a unique service within the community that will hopefully strengthen our knowledge of helpful communication strategies to improve engagement with families in pediatric care, especially in vulnerable populations. Thank you for this wonderful opportunity to present our project, and my contact information is there if you have any questions. Thank you.

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