| Description |
Background: No-show appointments present a significant challenge in primary care, particularly among underserved populations, leading to poorer health outcomes and increased healthcare costs. Research indicates that men, younger individuals, women, geriatric patients, those with mental health conditions, and lower socioeconomic groups have higher no-show rates. Missed appointments contribute an estimated $150 billion in annual healthcare costs, negatively impacting healthcare delivery and resource allocation. Local Problem: There are five student-led clinics in Salt Lake City, where medical and DNP students provide care under faculty supervision. These clinics offer hands-on experience across multiple specialties, equipping students with a broad understanding of medicine and the healthcare system. However, no-show rates ranged from 10-30%, affecting patient care and limiting learning opportunities for students working with underserved populations. Methods: To address the high no-show rates, an automated text notification system was implemented to remind patients of their appointments at seven, two, and one day before their appointments. Additionally, medical students conducted phone reminders one week before appointments, using a standardized script to confirm appointments, assess transportation needs, and provide information on insurance assistance. Students logged patient responses and notes into an Excel spreadsheet for consistent tracking. Patients needing assistance received transportation vouchers to mitigate access barriers. Interventions: The intervention combined automated text reminders (seven, two, and one day before appointments) with student-led phone reminders one week prior. Calls followed a standardized script to confirm attendance, assess transportation needs, and provide insurance assistance. Students documented phone call responses in an Excel spreadsheet for tracking, and transportation vouchers were offered as needed. Students underwent structured training to ensure consistency, including a PowerPoint presentation on the call script, documentation, and patient engagement strategies. Additionally, Redcap surveys were used to evaluate patient engagement and the effectiveness of reminders, supporting ongoing improvements to the intervention. Results: The total number of patients seen increased from 275 (baseline) to 483(post-intervention), with appointment completion rates improving slightly from 59.3% (n=163) to 60.2% (n=292). Confirmed cancellations decreased from 27.6% (n=76) to 21.7% (n=105). However, no-show rates increased from 12.4% (n=34) to 17.6% (n=85), indicating that more patients were scheduled and came to their appointments, yet there were also more no-shows. Males had higher overall appointment completion rates of 53.3% (n=155) than females at 46.7% (n=136). Female no-show rates also increased from 41.2% (n=14) to 48.2% (n=41), suggesting that the intervention was more effective for male patients. Appointment confirmation was strongly linked with appointment completion as confirmed patient no-show rates were lower, 2.9% (n=1) to 12.9% (n=11) than non-confirmed patients, 97.1% (n=33) to 87.1%(n=74). Conclusion: Overall, this DNP-QI project improved appointment adherence and reduced cancellations, yet decreasing the number of no-shows continues to be challenging. There were continual issues with language barriers and students not completing phone reminders during the holidays. Overall, the intervention was valuable, as patients who confirmed their appointments during telephone calls from the students were more likely to attend the scheduled appointment. However, sustainability remains a challenge due to student turnover and limited experience. To help ensure consistency, a sustainability plan should include faculty oversight and structured student training. |
