AllianceChicago presents the CHEC-UP project, which used Quincy chatbots to reduce disparities in well-child visits and immunization completion in vulnerable communities: a 13% absolute increase in visit completion, 27% higher likelihood of completing visits, and 88% of families reporting a positive experience.
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. Thank you, and good afternoon. 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, 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. Our project is entitled CHEC-UP, or Child Health Engagement and Coaching Using Patient-Centered Innovation.
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: remind families of upcoming well-child visits and immunizations, engage families proactively with evidence-based anticipatory guidance materials prior to their visit, and facilitate easy appointment scheduling.
The communication platform 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, a federally qualified health center in Chicago, was eager to pilot innovative approaches, and their patient families were instrumental partners, providing feedback throughout the project.
About the patient population at Heartland Health Centers: 82 percent of patients identify as racial and/or ethnic minorities, and 99 percent 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 due for a well-child visit.
Quincy is a completely customizable chatbot that does not require an app and can function on a mobile device or a computer. It allowed us to distribute handouts within the chatbot for anticipatory guidance, ask patients questions, and respond based on their answers. Families received a regular text message alerting them that their clinic wanted to discuss their child's next well visit, with a link into the secure communication platform, where they could request scheduling help or schedule themselves. We kept our chatbots fun, engaging, and personalized by mentioning developmental milestones their child might be experiencing.
We utilized a learning health systems framework, collecting feedback from QliqSOFT, Heartland Health Centers, and patients throughout, including a patient survey chatbot sent about one week after the initial outreach.
On results: compared with a control group of about 250 similar patients receiving no outreach, our intervention-and-engagement group, ages 0 to 17, saw a 13 percent absolute increase in well-child visit and immunization completion rates, and was 27 percent more likely to complete their visit.
The patient experience results were overwhelmingly optimistic: 88 percent of families noted a positive experience with the chatbot, 86 percent reviewed their anticipatory guidance handout prior to the visit, and 100 percent appreciated the appointment reminder.
We learned that outreach should be patient-centered, allowing patients options to communicate and schedule in ways that work for them. Communication technology should be sustainable and scalable, customizable, and easily adaptable to various departments, workflows, and patient populations. These solutions can enhance revenue and support value-based reimbursement by increasing visits and reducing no-show appointments, and they reduce staff burden by minimizing time spent on individual reminder calls.
The platform offered easy scheduling, escalation to synchronous communication for triage, and many other unique features; it was truly an all-in-one solution. Thanks to HRSA, the Maternal and Child Health Bureau, and the P4 Challenge team for sponsoring the challenge that allowed us to pilot this unique service to improve engagement with families in pediatric care, especially in vulnerable populations.
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