Prioritizing child health: Promoting adherence to well-child visits in an urban, safety-net health system during the COVID-19 pandemic

Background: After discovering racial/ethnic disparities in adherence to well-child visits, UMass Memorial Health worked to identify and mitigate barriers to adherence for patients and families across 53 primary care practices in central Massachusetts. Methods: When the systemwide goal to reduce racial/ethnic disparities in well-child visit adherence was established, a multidisciplinary team of leaders from UMass Memorial Health worked together to engage patients and stakeholders to identify obstacles to adherence. Transportation, language, and scheduling were identified as barriers. The team employed a number of countermeasures to address these barriers: A new workflow was created for requesting free curb-to-curb transportation for Medicaid patients, practices were provided with tip sheets for accessing interpreter services, and a protocol for scheduling appointment reminders was developed. In addition, the team leveraged robust data analytics to communicate real-time data to practices to keep them informed of their progress toward the system's health equity goal. Primary data results are reported from October 1, 2020, to September 30, 2021. Results: For patients who identified as Hispanic/Latinx, adherence rose from 64.3% at baseline to 74.1% (p < 0.001); and for patients who identified as Black/African American, adherence rose from 58.7% at baseline to 71.9% (p < 0.001). The gap in adherence to well-child visits for Black/African American and Hispanic/Latinx children compared to White children narrowed (12.4 percentage points to 5.1; p < 0.001; 6.8 percentage points to 2.9; p < 0.001). Conclusion: Through a unique partnership between health system leaders, frontline staff, and the system's informatics team and by engaging caregivers to identify and address barriers to well-child visits, UMass Memorial Health was able to improve adherence to well-child visits among patients who identify as Black/African American or Hispanic/Latinx.