CHEC-UP: A Digital Intervention to Reduce Disparities in Well-Child and Immunization Completion in Community Health

Abstract

Objective
 Well-child visits and immunizations among children in the U.S. declined at the pandemic’s onset and vulnerable populations have been disproportionately affected. This pilot projects tested an innovative mechanism to use chatbots to engage caregivers in evidence-based preventive care for children. 
 Design 
 We used artificial intelligence (AI)-enabled chatbots to personalize messages and facilitate appointment scheduling over a five-month period. Chatbots introduced a novel way to connect vulnerable populations to care and challenged traditional convention of provider-patient engagement.
 Setting
 The pilot study was conducted at a Community Health Center in Chicago, Illinois that serves roughly 10,500 children, and 82% of patients are racial and/or ethnic minorities. 
 Participants 
 We targeted outreach to 200 English and Spanish-speaking families with children 0-17 years of age for proactive outreach using chatbots promoting well-child visit completion and up-to-date immunization status; moreover, a special emphasis was placed on the 0-2 age group as the first two years represent a critical time for primary prevention of vaccine-preventable diseases.
 InterventionsThe intervention focused on pre-visit engagement by launching an AI-enabled chatbot to deliver personalized messages and facilitate appointment scheduling via mobile devices. CHEC-UP also provided evidence-based anticipatory guidance prior to an appointment. Coaching in preparation for the visit with trusted information has the potential to educate, improve confidence and promote shared decisions between the parent and provider. Patient experience was measured via surveys deployed via the chatbot.
 Main Outcome Measures & Results
 Chatbots facilitated a relative increase in well-child visits and immunizations by 27% in the intervention group. Well-child visits and immunizations in the intervention group increased 13% compared to the control group. Survey results and patient interviews indicated a high level of patient satisfaction using the chatbot. In addition to a favorable perception of the chatbots, patients also identified future use cases for chatbots.
 Conclusions Engaging patients with chatbots improved vaccination and well-child uptake. Patients were highly satisfied with chatbot engagement. By engaging patients and caregivers, chatbots present the potential to proactively engage patients in care and optimize vaccination uptake and realize one of societies’ greatest public health achievements: decreasing the spread of communicable diseases.