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Strengthening the evidence base for maternal and child health programs

New: MCHbest strategies database for sample ESMs

Evidence Tools
MCH Best. NPM 10: Adolescent Well-Visit

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Strategy. Support Clinic Systems in Promoting Attendance of Well-Visits

Approach. Provide information and guidance to actively schedule, code, and remind patients about the adolescent well-visit.

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Overview. There is emerging evidence that supporting clinic systems to actively promote and document attendance of a well visit is effective. Specific strategies may include:

Evidence. Emerging Evidence/Expert Opinion. There is emerging evidence on the effectiveness of using patient reminders and invitations to increase access to and utilization of adolescent well-visits.1-4 This strategy has been tested more than once and results trend positive overall. More research is needed for conclusive results. Access the peer-reviewed evidence through the MCH Digital Library. In addition, experts in the field have noted that supporting clinic systems is an effective method of increasing attendence. See webinar on emerging evidence (Read more about understanding evidence ratings).

Target Audience. Provider/System.

Outcome. Percent of adolescents, ages 12 through 17, with a preventive medical visit in the past year. For detailed outcomes related to each study supporting this strategy, click on the peer-reviewed evidence link above and read the "Intervention Results" for each study.

Examples from the Field. Access descriptions of ESMs from across all states/jurisdictions that use this strategy directly or intervention components that align with this strategy. You can use these ESMs to see how other Title V agencies are addressing the NPM.

The Role of Title V. Title V agencies can support schools that offer comprehensive bullying prevention programming:

Four states participated in a CDC CoIIN engaged youth and parents to create well-visit marketing messages and materials. Iowa received a grant from the American Academy of Pediatrics to promote well-visits at atheletic events; while Mississippi partnered with a SBHC to educate teachers, coaches, studetns, and clinic staff about the importance of adolescent well-visits. In addition the Adolescent and Young Adult Health National Resource Center created a poster for parents to be used in clinics to increase awareness.

Sample ESMs. Using the approach “Provide information and guidance to actively schedule, code, and remind patients about the adolescent well-visit,” here are sample ESMs you can use as a model for your own measures using the Results-Based Accountability framework (for suggestions on how to develop programs to support this strategy, see The Role of Title V in Adapting Strategies):

Quadrant 1:
Measuring Quantity of Effort
("What/how much did we do?")

  • Number of clinics that were provided information on how to increase attendance of well-visits statewide.

Quadrant 2:
Measuring Quality of Effort
("How well did we do it?")

  • Percent of clinics that were provided information on how to increase attendance of well-visits statewide.

Quadrant 3:
Measuring Quantity of Effect
("Is anyone better off?")

  • Number of adolescents who received reminders of well-visits who then attended the visit.

Quadrant 4:
Measuring Quality of Effect
("How are they better off?")

  • Percent of adolescents who received reminders of well-visits who then attended the visit.

Note. ESMs become stronger as they move from measuring quantity to measuring quality (moving from Quadrants 1 and 3, respectively, to Quadrants 2 and 4) and from measuring effort to measuring effect (moving from Quadrants 1 and 2, respectively, to Quadrants 3 and 4).

Learn More. Read how to create stronger ESMs and how to measure ESM impact more meaningfully through Results-Based Accountability.


References:

1 Szilagyi, P.G., Gallivan, S., Albertin, C., Sandler, M., & Blumkin, A. Effectiveness of a citywide patient immunization program on improving adolescent immuninizations and preventive care visit rates. Arch Pediatr Adolesc Med. 2011;165(6):547-553.

2 Szilagyi, P.G., Schaffer, S., Barth, R., et al. Effect of telephone reminder/recall on adolescent immunization and preventive visits: results from a randomized clinical trial. Arch Pediatr Adolesc Med. 2006;160(2):157-163.

3 Knishkowy, B., Palti, H., Schein, M., Yaphe, J., Edman., R., Baras, M. Adolescent preventive health visits: a comparison of two invitation protocols. J Am Board Fam Pract. 2000;13(1):11-16.

4 Szilagyi, P.G., Albertin, C., Humiston, S.G., et al. A randomized trial of the effect of centralized reminder/recall on immunizations and preventive care visits for adolescents. Acad Pediatr. 2013;13(3): 204-213.

This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number U02MC31613, MCH Advanced Education Policy, $3.5 M. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.