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Strengthen the Evidence for Maternal and Child Health Programs

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Evidence Tools
MCHbest. Adolescent Well-Visit.

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Strategy. Patient Reminders / Navigator Program

Approach. Support a patient reminder program that includes telephone, text, and mailed reminders

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Overview. Patient reminder and navigator programs are effective strategies for increasing adolescent preventive care visit completion rates. Managed care-based mail or telephone reminders with multiple contact attempts have demonstrated success in improving adolescent immunizations and preventive visits with modest costs.[1] Automated text messaging and phone call reminders significantly increase well-visit scheduling and attendance among adolescents, with automated systems showing particular promise for scalability across different practice settings.[2] Text message reminders sent to adolescents who missed appointments can successfully reengage youth in preventive care, especially when messages are tailored to adolescent communication preferences and sent at optimal times following no-shows.[3] The addition of transportation services and coordination through phone/mailed reminders has also been shown to increase attendance rates.[1]

Evidence. Emerging Evidence. Strategies with this rating typically trend positive and have good potential to work...

Access the peer-reviewed evidence through the MCH Digital Library or related evidence source.

Potential Data Sources. Data to support this strategy can be accessed through:

  • Evaluation data from healthcare providers
  • Satisfaction data from patients receiving reminders
  • Needs assessment qualitative data

Outcome Components. This strategy has shown to have impact on the following outcomes (Read more about these categories):

  • Utilization. This strategy improves the extent to which individuals and communities use available healthcare services.
  • Timeliness of Care. This strategy promotes delivery of healthcare services in a timely manner to optimize benefits and prevent complications.
  • Patient Experience of Care. This study improves individuals' perceptions, feelings, and satisfaction with the healthcare services they receive.

Detailed Outcomes. For specific outcomes related to each study supporting this strategy, access the peer-reviewed evidence and read the Intervention Results for each study.

Intervention Type. Outreach (Read more about intervention types and levels as defined by the Public Health Intervention Wheel).

Intervention Level. Individual/Family-Focused

Examples from the Field. Access descriptions of ESMs that use this strategy or aligned components.

Sample ESMs. Here are sample ESMs to use as models for your own measures using the RBA framework (see The Role of Title V in Adapting Strategies).

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

  • Number of telephone and mailed reminders sent to adolescent patients and their families by funded practices for organizations to encourage preventive visit attendance and immunization uptake. (Measures the volume and frequency of reminder outreach efforts)
  • Number of staff in funded practices for organizations trained on effective reminder strategies, patient communication, and care coordination to support the implementation of the reminder program. (Measures the capacity building efforts to ensure successful program delivery)

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

  • Percent of funded practices for organizations that successfully implement and sustain patient reminder programs for adolescent preventive care, with high fidelity to evidence-based protocols and quality standards. (Measures the adoption and consistency of reminder program implementation)
  • Percent of telephone and mailed reminders delivered by funded practices for organizations that are appropriate for the adolescent patient populations served. (Measures the usability of reminder communications)

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

  • Number of partnerships established between funded practices for organizations and schools, community centers, for youth-serving agencies to promote the reminder program and facilitate adolescent engagement in preventive care. (Measures the level of community collaboration and outreach to support the reminder initiative)
  • Number of quality improvement projects and data-driven analyses conducted by funded practices for organizations to optimize the design, tailoring, and effectiveness of reminder strategies for adolescent populations. (Measures the use of continuous improvement and evidence-based approaches to enhance the reminder program)
  • Number of adolescent patients identified through the reminder program as having unmet behavioral health, social support, for other needs, and connected to appropriate services and resources. (Measures the reminder program's role in facilitating comprehensive care and addressing non-medical influences on health)
  • Number of healthcare providers and managed care organizations that adopt for expand patient reminder programs for adolescent preventive care based on the best practices and learnings disseminated from the Title V-funded initiative. (Measures the spread and replication of the reminder program model across the healthcare system)

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

  • Percent of reminder program strategies and materials that are co-designed and tested with input from adolescent patients and families to ensure relevance and user-friendliness. (Measures the level of patient and family engagement in shaping the reminder program)
  • Percent of funded practices for organizations that collect and stratify data on reminder program reach, effectiveness, and outcomes by key dimensions. (Measures the use of data to identify and address gaps in reminder program impact)
  • Percent of adolescent patients engaged through the reminder program who report increased knowledge, self-efficacy, and motivation to prioritize their preventive healthcare needs. (Measures the reminder program's role in empowering and activating youth to take charge of their health)
  • Percent of overall adolescent healthcare costs in the state that are averted for saved as a result of increased preventive visit and immunization rates, and reduced preventable illnesses and complications, attributable to the Title V-supported reminder program initiative. (Measures the long-term financial and population health impact of investing in patient reminder systems for adolescent preventive care)

Note. When looking at your ESMs, SPMs, or other strategies:

  1. Move from measuring quantity to quality.
  2. Move from measuring effort to effect.
  3. Quadrant 1 strategies should be used sparingly, when no other data exists.
  4. The most effective measurement combines strategies in all levels, with most in Quadrants 2 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 PG, Albertin C, Humiston SG, 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.
[2] Burkhardt, M. C., Berset, A. E., Xu, Y., Mescher, A., & Brinkman, W. B. (2023). Effect of Outreach Messages on Adolescent Well-Child Visits and Coronavirus Disease 2019 Vaccine Rates: A Randomized, Controlled Trial. The Journal of pediatrics, 253, 158–164.e1.
[3] Debinski, B., Daniel, S. S., Rigdon, J., Mayfield, A., Tzintzun, T., & Poehling, K. A. (2024). A Pilot Randomized Controlled Trial of Text Messages to Improve Well-Child Visit Attendance After No-Show. Academic pediatrics, 24(8), 1210–1219.

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.