*In community health centers, missed appointments lead to lack of continuity of care, poorer patient health outcomes, compromised resident education, impacted clinic flow
*Farrell Health Center is home clinic for New York Presbyterian- Columbia University Family Medicine Residency
*Multifaceted factors for missed appointments at Farrell : access issues, financial concerns, wait times, high ED utilization, familial responsibilities.
*Farrell serves migratory population with changing numbers and addresses
*Prior work shows reminder calls improve appointment rates
BACKGROUND
.
METHODS
RESULTS
*Lack of correct patient contact information poses barriers in placing reminder calls, sending appointment letters, and following up on missed appointments
*Up to date phone numbers is a thus a critical component of improving missed appointments
*Combined with phone call reminders, a sign to update contact information appears to be a useful strategy
*Missed appointments at Farrell are still multifaceted, requiring various types of interventions
REFERENCES
Daggy J1, Lawley M, Willis D, Thayer D, Suelzer C, DeLaurentis PC, Turkcan A, Chakraborty S, Sands L. (2010) Using no-show modeling to improve clinic performance. Health Informatics Journal, 16(4):246-59.
Hixon AL1, Chapman RW, Nuovo J.(1999). Failure to keep clinic appointments: implications for residency education and productivity. Family Medicine,(9):627-30.
Moore CG1, Wilson-Witherspoon P, Probst JC. (2001).Time and money: effects of no-shows at a family practice residency clinic. Family Medicine,33(7):522-7.
ACKNOWLEDGEMENTS
Ms. Keri Ann Lounse
Farrell Staff
Farrell Patients
Sujana Bhattacharyya, DO; Heather Belle, MD; Rebecca Leeds, MD; Ahmed Amari, MD Rebecca Halvorsen, MD; Jeanette Qablawi, MD; Connor Carmichael, MD; Urmi Desai, MD; Heather Paladine, MD
A Quality Improvement Project To Improve Missed Appointment Rates At An Urban Family Medicine Residency Clinic
*Created intervention based on interviews and process chart:
*Identified lack of updated patient info contribute to no shows
*On 9/6/18, implemented Tunstall automated appointment reminder system
*On 3/4/19, placed “update info” reminder sign at front desk
*Primary: Reduce missed clinic appointments from 52% to 49% in 3 months.
*Secondary: Increase percentage of patients contacted for appointment reminders from 93% to 96% in 3 months.�
SMART AIMS
INTERVENTION:PDSA
CONCLUSIONS
LIMITATIONS
*Intervention only 1 month long, will continue for 2 more months
*Pending Missed Appointment rates from clinic system
* Reaching “Answering machine” did not ensure correct number *Currently no daily tracking system for contacted vs who did not show up for appointments
FUTURE STEPS
* PDSA cycles with different interventions for updated contact
* Intervention to improve patient ability to call clinic to cancel/reschedule appointments
*Intervention to help patient identify primary physician and schedule follow ups with primary
*More accurately assess patients reached by Tunstall reminders
QUALITY IMPROVEMENT
*QI Methods: Stakeholder Interviews, Process chart, PDSA cycle
*Stakeholders: Interviewed stakeholders, obtained qualitative data
depicted below in Figure 1
*Process Chart: Visualized how Farrell appointments are made
**Farrell’s estimated missed appointment rates:52%**
*
Table 2: Comparison of percentage of patients successfully reached before and after intervention. Patients successfully reached included voicemails. Data calculated from Tunstall appointment reminder system.
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