Application of Rapid Cycle Improvement Methods to Optimize Recruitment Strategies for the National Children's Study

The National Children's Study is a large-scale longitudinal study of the effects of the environment and genetics on children's health, growth and development. An early challenge for the study has been the identification of effective recruitment strategies. During a one-year pilot phase 30 NCS Study Centers implemented three alternative recruitment schemes to evaluate the relative merits of each. In order to accelerate the learning process among a sub-group of Study Centers, UCLA led a Collaborative Improvement Network designed to rapidly test small scale changes in recruitment tactics to achieve improvements in measured outcomes. To the authors' knowledge, this was the first application of a collaborative improvement model in the context of a multi-site longitudinal research study. Within a 9-month period, the UCLA Study Center successfully tested a variety of recruitment tactics, including door-hangers in study neighborhoods, priority vs. regular mail envelopes, pre vs. post cash incentives, campaign style marketing mailers, community baby showers, earned exposure on radio and television and outdoor advertising. Armed with a nimble and responsive data system and a dashboard of metrics, the Study Center team was able—in short order— to produce quantitative results for a summary report on recommended strategies for optimizing recruitment of participants into the study. The results of this work not only highlight specific promising strategies for recruiting pregnant women into a longitudinal cohort study but also demonstrate the successful application to a multi-site longitudinal research study of a collaborative improvement method with a proven track record in clinical quality improvement initiatives.