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Evidence Tools
MCHbest. Adolescent Well-Visit.

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Strategy. Quality Improvement (QI) Initiatives to Increase Adolescent Well-Visits

Approach. Develop and adopt multicomponent QI initiatives within pediatric practices to increase annual well-visits for adolescents

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Overview. Quality improvement initiatives utilizing structured methodologies have demonstrated significant effectiveness in increasing adolescent well-visit rates across diverse practice settings. Studies show that pediatric practices implementing multicomponent QI programs can achieve substantial increases in adolescent well-care visits compared to practices without QI initiatives.[1] Practice facilitation models providing external QI coaching and support help practices implement sustainable workflow changes to increase adolescent engagement in preventive care.[1] Statewide QI networks that facilitate shared learning and provide technical assistance enable practices to adapt evidence-based strategies to their local contexts while maintaining fidelity to core QI principles, with participating practices showing measurable improvements in preventive visit completion rates.[2] QI initiatives focused on optimizing practice processes for preventive education delivery have shown particular success in improving both visit attendance and quality of care provided during adolescent well-visits.[3] These initiatives are most effective when they include regular data review cycles, stakeholder engagement at all levels, and iterative testing of change ideas through Plan-Do-Study-Act cycles.

Evidence. Moderate Evidence. Strategies with this rating are likely 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:

  • QI evaluation data on initiative development and implementation
  • Practice-level data on pediatric well-visits
  • Documentation of QI sustainability efforts

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

  • Access to/Receipt of Care. This strategy increases the ability for individuals to obtain healthcare services when needed, including preventive, diagnostic, and treatment services.
  • 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.

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. Coalition-Building (Read more about intervention types and levels as defined by the Public Health Intervention Wheel).

Intervention Level. Community-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 pediatric practices engaged by Title V agencies to participate in QI initiatives focused on increasing adolescent well-visits. (Measures the reach and scale of QI initiative adoption)
  • Number of pediatric practice staff, including providers, nurses, and administrators, who complete QI training and participate in adolescent well-visit improvement initiatives. (Measures the level of workforce engagement and development)

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

  • Percent of pediatric practices participating in QI initiatives that demonstrate high levels of fidelity and adherence to evidence-based QI principles and methodologies. (Measures the quality and consistency of QI implementation)
  • Percent of pediatric practice QI teams that include representation from clinical, administrative, and patient/family community partners. (Measures the patient-centeredness of QI team composition)

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

  • Number of partnerships and collaborations established between Title V agencies, pediatric practices, QI experts, and community community partners to support the design, implementation, and spread of adolescent well-visit QI initiatives. (Measures the level of multi-community partner engagement and collective impact)
  • Number of policy and systems changes implemented by Title V agencies and partners to create an enabling environment for QI, such as aligning payment incentives, reducing regulatory challenges, and promoting data interoperability. (Measures the broader systems-level support for QI initiative success)
  • Number of adolescents from communities with low well-visit rates who receive comprehensive well-visits as a result of tailored QI initiatives and outreach efforts by pediatric practices. (Measures the impact of QI on reducing gaps in well-visit access and utilization)
  • Number of preventable health conditions, risky behaviors, and psychosocial issues identified and addressed during adolescent well-visits at practices implementing QI initiatives. (Measures the impact of QI on early detection, intervention, and risk reduction)

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

  • Percent of adolescent well-visit QI initiatives that incorporate principles of trauma-informed care and youth engagement in their design and implementation. (Measures the responsiveness and youth-centeredness of QI approaches)
  • Percent of pediatric practices that engage adolescents and families as active partners in QI teams, advisory boards, and feedback process to ensure QI efforts are responsive to their needs and preferences. (Measures the level of youth and family partnership in QI governance and decision-making)
  • Percent reduction in gaps for adolescent well-visit rates and related health outcomes between practices participating in Title V-supported QI initiatives and those not participating (Measures the impact of QI on closing well-visit gaps)
  • Percent of adolescents who report increased trust, self-efficacy, and shared decision-making in their healthcare as a result of the patient-centered improvements driven by practice QI initiatives. (Measures the impact of QI on empowering and engaging youth in their 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] Rose, M., Maciejewski, H., Nowack, J., Stamm, B., Liu, G., & Gowda, C. (2021). Promoting Pediatric Preventive Visits Through Quality Improvement Initiatives in the Primary Care Setting. The Journal of pediatrics, 228, 220–227.e3.
[2] Thompson, E., Kressly, S., He, A., Rutman, L., Berhane, Z., & Turchi, R. M. (2025). Adolescents, well visits, and immunizations: can quality improvement move the needle? Discover Medicine, 2(1)
[3] Miliaresis, C., Misra, P., Friedman, D., Altman, R., & Gewitz, M. (2023). Increasing Utilization of the Preparticipation Physical Evaluation. Pediatrics, 151(3), e2020049673.

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.