Reducing patient no-shows: An initiative at an integrated care teaching health center

Abstract

Background: Patient no-shows impede the effectiveness and efficiency of health care services delivery. Objective: To evaluate a 2-phase intervention to reduce no-show rates at an integrated care community health center that incorporates a teaching program for osteopathic family medicine residents. Methods: The Elmont Teaching Health Center (ETHC) is 1 of 5 community-based health centers comprising the Long Island Federally Qualified Health Centers. In August 2015, the ETHC implemented a centerwide No-Show Rates Reduction Initiative divided into an assessment phase and implementation phase. The assessment phase identified reasons most frequently cited by patients for no-shows at the ETHC. The implementation phase, initiated in mid-September, addressed these reasons by focusing on reminder call verification, patient education, personal responses to patient calls, institutional awareness, and integration with multiple departments. To assess the initiative, monthly no-show rates were compared by quarter for 2015 and against rates for the previous year. Results: We recorded 27,826 appointments with 6147 no-shows in 2014 and 31,696 appointments with 5690 no-shows in 2015. No-show rates in the first 3 quarters of 2015 (range, 18.2%-20.0%) were slightly lower than the rates in 2014 (20.1%- 23.4%) and then changed by an increasingly wide margin in the last quarter of 2015 (15.3%), leading to a significant year (2014, 2015) by quarter (Q1, Q2, Q3, Q4) interaction (P=.004). Also, the change observed in Q4 in 2015 differed significantly from Q1 (P=.017), Q2 (P=.004), and Q3 (P=.027) in 2015, while Q1, Q2, and Q3 in 2015 did not significantly differ from one another. Conclusion: No-show rates were successfully reduced after a 2-phase intervention was implemented at 1 health center within a larger health care organization. Future directions include dismantling the individual components of the intervention, evaluating the role of patient volumes in no-show rates, assessing patient outcomes (eg, costs, health) in integrative care settings that treat underserved populations, and evaluating family medicine residents’ training on continuity of care and no-show rates.