Personalized phone call reminders to reduce PCP appointment no-shows.

Clear and concise explanation of the significance of the problem? Any suggestions?

Problems

• No-shows in vulnerable communities with multiple chronic illnesses are high (Ruggeri et al., 2020).
• No-shows exacerbate chronic illnesses, increase adverse health outcomes and increase the risk of premature death, (Marbouh et al., 2020).
• No-shows disrupt continuity of patient care, reduce the utilization of resources, and lower the quality of healthcare services patients receive (Marbouh et al., 2020).
• No shows increase economic loses; in the United States, no-shows have accounted for approximately 150 billion dollars translating to an average cost of 200 dollars in lost revenue per no-shows for the physician's office (Chung et al., 2020, Kheirkhah et al., 2016).

Claim stated as empirical statement, clear, concise, includes all required elements, expected results included? Any suggestions?

Claim

Phone call reminders three days to one day before PCP appointment day reduce no-shows by 2.5% among adults with chronic illnesses living in medically underserved areas in eight weeks.

IV: Phone call reminders one to three days prior to day of PCP appointment.

DV: No-shows.

S: Adults with chronic illnesses living in medically underserved areas.

R: Reduce no-shows by 2.5%.

Three articles presented. In appropriate format. Empirical statement provided for each, results presented in appropriate statistics format with all required elements? Any suggestions?

Evidence

• A Reminder phone call to patients one day before appointment day is associated with a reduction in no-shows in an outpatient palliative medicine clinic in four months (Lagman et al., 2021).

- Rate_before = 11.8% and Rate_after= 6.3% (p <0.001).

• A reminder phone call one day before appointment date is associated with reduced no-shows in a safety-net medicine clinicwithin seven months(Vera et al., 2020).

- Rate_before = 23.9% and Rate_after = 21.0% (absolute reduction 2.9%, 95% CI (2.2,

- 3.6),p<0.001)

• A reminder phone call intervention 2-3 days before the visit is associated with a significant improvement in appointment show rate in an underserved lupus clinic in eight weeks (Kumthekar & Johnson, 2018).

- Rate_before = 58.8 % and Rate_after = 74.8% p < - 0.0062.

Reasoning clearly connects evidence to claim and justifies evidence support of claim. No new evidence presented. Therefore statement reports appropriate statistical test? Any suggestions?

Reasoning

• The consequences and reasons for no-shows to pcp appointments in adults with chronic illnesses living in medically underserved areas have the same similarities to those of patients with no-shows in an underserved lupus clinic, a safety net clinic, and an outpatient palliative clinic (Lagman et al., 2021; Vera et al., 2020; Kumthekar & Johnson, 2018).
• An underserved lupus clinic, a safety net clinic, and an outpatient palliative clinic reduced their no-show rate by 2.9% - 16% in eight weeks to four months using phone call reminders one to three days before pcp appointment day (Lagman et al., 2021; Vera et al., 2020; Kumthekar & Johnson, 2018).
• Therefore, in a paired-sampled t-test comparing the rate of no-shows before and 8 weeks after reminder phone calls one to three days before pcp appointment day, no-show rate in adults with chronic illnesses in a medically underserved area should show an average reduction of about 2.5%.

Synthesizes data to provide a clearly appropriate justification to the audience.? Any suggestions?

Implications

• If reminder phone calls can reduce the rate of no-shows in adults with chronic illnesses in medically underserved areas, we may see a reduction in the high rate of no shows in these areas leading to reduced chronic illness exacerbation, adverse health outcomes and risk of premature deaths (Parikh et al., 2009)
• We may also see an improvement in the continuity of care, increased patient-physician engagement, increased preventative and health screening activities, and increased quality of care services (Kheirkhah et al., 2016 Nguyen et., 2013).
• We may also see savings in healthcare cost and increased utilization of resources corresponding with overall improved health and a reduction in health inequalities in these communities (Kheirkhah et al., 2016).

Clearly defines sample, recruitment strategy, and the population it is drawn from. Any suggestions?

Sample

• I recruited 40 adults with chronic illness and a history of no-shows from a medically underserved clinic who have upcoming appointments within two months.
• Descriptive statistics will be used to analyze the impact the variables have on show and no-show rate.
• Participants will be mandated to participate as part of the Show Up And Show Out initiative to improve show rate in the medically underserved clinic.
• Participants will sign optional waiver form to confirm participation.

Appropriately identifies outcome and predictor variables and levels or measurement.

Variables

• Demographic variables:

- Age, race, marital status, gender, phone ownership, poverty level, education level, employment status.

• Insurance:

- Commercial, HMO, Medicare/Medicaid, self-pay, other

• Appointment characteristics:

- Appointment time, appointment day, appointment month, wait time from scheduling to appointment

day, prior no-show.

• Dependent variables:

- Appointment compliance (representative of the dependent variable, no-show, with categories including kept appointment and no-show)

• The pre-intervention no-show rate and post-intervention no show rate variables will be analyzed using the paired samples t-test for outcome rate.

Presentation is engaging, and communicates clearly using appropriate professional tone, grammar, spelling, and punctuation.

Would you say presentation is engaging, and communicates clearly using appropriate professional tone, grammar, spelling, and punctuation? Any suggestions?

References

Chung, S., Martinez, M.C., Frosch, D.L., Jones, V.G., & Chan, A.S. (2020). Patient-centric scheduling with the implementation of health information

technology to improve the patient experience and access to care: Retrospective case-control analysis. Journal of Medical Internet Research,

22(6), e16451.

Kheirkhah, P., Feng, Q., Travis, L. M., Tavakoli-Tabasi, S., & Sharafkhaneh, A. (2016).

Prevalence, predictors and economic consequences of no-shows.BMC health services research,16, 13. https://doi.org/10.1186/s12913-015-1243-z

Kumthekar, A., & Johnson, B. (2018). Improvement of appointment compliance in an underserved lupus clinic.BMC health services research,18(1), 610.

https://doi.org/10.1186/s12913-018-3429-7

Lagman, R. L., Samala, R. V., LeGrand, S., Parala-Metz, A., Patel, C., Neale, K., Carrino, C., Rybicki, L., Gamier, P., Mauk, M. E., & Nowak, M. (2021). "If

You Call Them, They Will Come": A Telephone Call Reminder to Decrease the No-Show Rate in an Outpatient Palliative Medicine Clinic.The

American journal of hospice & palliative care,38(5), 448-451. https://doi.org/10.1177/1049909120952322

Marbouh, D., Khaleel, I., Al Shanqiti, K., Al Tamimi, M., Simsekler, M., Ellahham, S., Alibazoglu, D., & Alibazoglu, H. (2020). Evaluating the Impact of Patient

No-Shows on Service Quality.Risk management and healthcare policy,13, 509-517. https://doi.org/10.2147/RMHP.S232114

Ruggeri, K., Folke, T., Benzerga, A., Verra, S., Bttner, C., Steinbeck, V., Yee, S., & Chaiyachati, K. (2020). Nudging new york: Adaptive models and the limits

of behavioral interventions to reduce no-shows and health inequalities. BMC Health Services Research, 20(1). https://doi.org/10.1186/s12913-020-05097-6

Steiner, J. F., Shainline, M. R., Dahlgren, J. Z., Kroll, A., & Xu, S. (2018). Optimizing number

and timing of appointment reminders: a randomized trial.The American journal of managed care,24(8), 377-384.

Vang, M., Linzer, M., Freese, R., Vickery, K., Shippee, N. D., & Coffey, E. (2020). Facilitating

Visit Attendance with Staff Reminder Calls in a Safety-Net Clinic.Journal of general

internal medicine,35(4), 1317-1319. https://doi.org/10.1007/s11606-020-05655-y