Penaloza, Orlando J, MD, FACP

Sanchez-Medina, Veronica

Torres, Sheyla M

English

Lehigh Valley Health Network: LVHN Scholarly Works

Lehigh Valley Health NetworkLVHN Scholarly WorksDepartment of MedicineSMALL Changes Now, BIG Impact Later: “Non -Attendance” For Appointments In a PatientCentered Medical Home Model--Impact of aPersonalized Appointment Reminder In AVulnerable PopulationVeronica Sanchez-MedinaLehigh Valley Health Network, Veronica.Sanchez@lvhn.orgSheyla M. TorresLehigh Valley Health Network, Sheyla_M.Torres@lvhn.orgOrlando J. Penaloza MD, FACPLehigh Valley Health Network, Orlando_J.Penaloza@lvhn.orgFollow this and additional works at: http://scholarlyworks.lvhn.org/medicinePart of the Medical Sciences Commons, and the Medical Specialties CommonsThis Poster is brought to you for free and open access by LVHN Scholarly Works. It has been accepted for inclusion in LVHN Scholarly Works by anauthorized administrator. For more information, please contact LibraryServices@lvhn.org.Published In/Presented AtSanchez-Medina, V., Torres, S., & Penaloza, O. (2013, April 26). Small changes now, big impact later: "Non-attendance" for appointmentsin a patient centered medical home model--impact of a personalized appointment reminder in a vulnerable population. Poster presented at:The National Hispanic Medical Association, Washington, DC.Lehigh Valley Health Network, Allentown, PennsylvaniaSMALL Changes Now, BIG Impact Later: “Non -Attendance” For Appointments In a Patient Centered Medical Home Model--Impact of a Personalized Appointment Reminder In A Vulnerable Population.Veronica Sanchez-Medina, Sheyla Torres and Orlando J. Penaloza MD, Centro de Salud Latino Americano, Department of Internal MedicineBACKGROUND:OBJECTIVE:© 2013 Lehigh Valley Health Network•		To	conduct	a	practice-based	quality	improvement	project	to	determine	the	impact	of	a	customized	intervention	to	decrease	the	no	show	rateat	a	program	providing	care	for	a	predominently	Hispanic	patient	population.•		To	increase	patient	satisfaction	after	the	intervention.METHODOLOGY:All	scheduled	appointments	for	two	providers	in	a	five-provider	bicultural,	bilingual	internal	medicine	practice	that	serves	uninsured	and	underinsured	patients	were	analyzed	for	no	show	rates	during	the	period	between	March	2012	and	November	2012.		During	the	first	four-	RESULTS:There	were	a	total	of	2234	scheduled	appointments	for	the	two	providers	during	this	nine	month	period.	During	the	run-in	period	the	no	show	rates	for	Provider	#1	and	Provider	#2	were	similar	(22.67%	and	21.83%,	respectively	(p=	0.88).		During	the	intervention	period,	however,	the	no	show	rate	was	reduced	by	almost	30%	for	Provider	#2	(from	22.77%	to	15.83%)	compared	with	no	change	for	Provider	#1	(22.67%	vs.	222.77%;	p=0.01).	The	Patient	Satisfaction	Score	at	Outpatient	Health	Care	facilities	(Press-Ganey	Score)	of	the	practice	improved	after	the	implementation	of	intervention.	CONCLUSIONS:•		Our	quality	improvement	initiative	demonstrated	that	using	an	appointment	reminder	consisting	of	a	short	phone	call	message	with	the	recorded	voice	of	a	bilingual	healthcare	provider	(MD)	resulted	in	a	markedly	improved	no	show	rate	and	increased	patient	satisfaction	among	ethnic	minorities	and	vulnerable	populations	cared	for	in	our	medical	practice.	•		This	strategy	employed	by	this	program	was	simple	and	straightforward.•		Future	study	is	warrented	to	address	how	routine	“personalized”	reminder	systems	can	maximize	effectiveness,	reduce	cost	and	improve	patient	satisfaction	in	other	care	settings.•		Missed	medical	appointments	(commonly	known	as	“no-shows”)	represent	a	serious	problem	for	many	healthcare	providers.	•		Complete	financial	recovery	from	a	high	no-show	rate	is	most	likely	impossible.•		In	the	U.S.	over	one	third	of	surveyed	practices	had	a	no-show	rate	of	over	21%.1•		More	recently,	multiple	studies	have	reported	high	no-show	rates	ranging	from	23%	to	34%	in	outpatient	clinics.2-4	•		Patient	no-shows	represent	a	significant	problem	that	follows	from	unreliable	schedules:	the	administration	is	inconvenienced	and	clinicians’	time,	which	could	have	been	used	to	serve	other	patients,	is	wasted.	Both	of	these	problems	reduce	the	efficiency	of	care	delivery.5-6•		Many	interventions	assume	a	“one-size-fits-all”	approach;	that	is,	by	implementing	phone	or	SMS	appointment	reminder	systems,	all	patients	receive	their	reminders	in	the	same	fashion.	However,	prior	efforts	suggest	that	the	effectiveness	of	a	reminder	system	is	dependent	on	the	patient	population,	the	modality	of	the	reminder,	and	the	service	type.6•		Consumers’	preferences	for	reminder	systems	in	health-care	settings	might	be	impacted	by	their	preferences	for	reminder	systems	from	other	service	providers.	•		No-show	rates	are	lowest	when	patients	called	by	a	human	being.	References:1.	 	Hixon	AL,	Chapman	RW,	Nuovo	J.	Failure	to	keep	clinic	appointments:	implications	for	residency	education	and	productivity.	FamMed.	1999;	31(9):627-30.	2.	 	Geraghty	M,	Glynn	F,	Amin	M,	Kinsella	J.	Patient	mobile	telephone	“text”	reminder:	a	novel	way	to	reduce	non-attendance	at	the	ENT	out-patient	clinic.	J	Laryngol	Otol.	2008;122(3):296-8.	3.	 	Dreiher	J,	Froimovici	M,	Bibi	Y,	Vardy	DA,	Cicurel	A,	Cohen	AD.	Nonattendance	in	obstetrics	and	gynecology	patients.	Gynecol	Obstet	Invest.	2008;66(1):40-3.	4.	 	Parikh	A,	Gupta	K,	Wilson	AC,	Fields	K,	Cosgrove	NM,	Kostis	JB.	The	effectiveness	of	outpatient	appointment	reminder	systems	in	reducing	no-show	rates.	Am	J	Med.	2010;123(6):542-8.	5.	 	Ulmer	T,	Troxler	C.	The	economic	cost	of	missed	appointments	and	the	open	access	system.	Community	Health	Scholars.	2004.6.	 	Stacey	R,	Finkelstein,	Nan	Liu,	Beena	Jani,	David	Rosenthal,	Lusine	Poghosyan	(2012)		Columbia	University	Mailman	School	of	Public	Health.	Appointment	Reminder	Systems	and	Patient	Preferences:	Patient	Technology	Usage	and	Familiarity	with	Other	Service	Providers	as	Predictive	Variables.		Forthcoming	in	Health	Informatics	Journal.	month	run-in	period,	a	standardized,	automated	appointment	reminder	system	was	used	for	all	patients	scheduled	for	both	providers.		During	the	second	four-month	period	(ie,	the	practice	intervention	period),	all	patients	scheduled	for	Provider	#1	continued	to	receive	appointment	reminders	in	the	same	manner;	whereas	patients	for	Provider	#2	received	a	short	phone	call	message	with	the	recorded	voice	of	the	bilingual	health	care	provider	reminding	them	of	their	upcoming	appointment	and	an	additional	reminder	to	bring	their	medications	along	to	the	visit.		“No	show”	rates	were	analyzed	and	compared	for	both	providers	during	both	the	run-in	and	practice	intervention	periods.No Show RatePre-Practice and Post-Practice InterventionNo Show RatePre-Practice and Post-Practice Intervention0%5%10%15%20%25%30%35%Mar Apr May Jun Jul Aug Sep OctProvider #2Provider #10.00%5.00%10.00%15.00%20.00%25.00%Provider#1 Provider#2Pre-PracticeInterventionPost-PracticeInterventionNo Show RatePre-Practice and Post-Practice InterventionPatient Satisfaction Trend PostPatient Satisfaction YTD (n=number responses)%Overall908580Jul ‘12 Aug ‘12 Sep ‘12 Oct ‘12 Nov ‘12 Dec ‘12 Jan ‘13 Feb ‘13Threshold Target OverallProvider Pre-PracticeInterventionPost-PracticeIntervention P-valueProvider 1 22.67% 22.77% p=0.88Provider 2 21.83% 15.83% p=0.01

SMALL Changes Now, BIG Impact Later: “Non -Attendance” For Appointments In a Patient Centered Medical Home Model--Impact of a Personalized Appointment Reminder In A Vulnerable Population

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SMALL Changes Now, BIG Impact Later: “Non -Attendance” For Appointments In a Patient Centered Medical Home Model--Impact of a Personalized Appointment Reminder In A Vulnerable Population

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