title: A multi-method intervention to reduce no-shows in an urban residency clinic.
abstract: OBJECTIVE
  Missed appointments can create financial, capacity, and continuity issues in primary care. An urban family medicine residency teaching clinic with a large culturally diverse population of low-income patients struggled for decades with a persistent no-show rate of 15%--17% despite multiple attempts to remind patients or otherwise address the problem. This study sought to measure the effects of a multi-method approach to decreasing the overall clinic no-show rate over time.
  
  
  METHODS
  A team of clinicians and staff undertook a systematic review of the literature to identify an approach to decreasing the number of no-show appointments while maintaining a commitment to the population and quality of care. The team implemented a three-stage process: an interview with the cohort of patients with the highest number of repeated no-show appointments, a double booking process for patients with a history of frequent missed appointments, and a change in the entire schedule to a modified advanced access schedule.
  
  
  RESULTS
  A cohort of 141 patients (2% of the practice population) accounted for almost 17% of the total missed appointments. The cohort differed from the overall clinic, being largely African American women on Medicaid with a large burden of medical comorbidities and a high prevalence of mental health issues. After the intervention, the rate of no-show appointments in the cohort fell from 33.3% to 17.7%, and the overall clinic rate fell from 10% to 7%; this decrease persisted for the 33-month observation period after the intervention and has been maintained to this date. The largest improvement in appointment keeping came after a modified advanced access schedule was implemented clinic-wide.
  
  
  CONCLUSIONS
  Indentifying a large at-risk population for no-shows and using a multi-method approach to addressing the issue can show persistent improvement and could be used in other residency training and community clinic settings.
authors.affiliation: Medical College of Wisconsin.
authors.forename: Clark
authors.initials: C
authors.lastname: DuMontier
authors.forename: Kirsten
authors.initials: K
authors.lastname: Rindfleisch
authors.forename: Jessica
authors.initials: J
authors.lastname: Pruszynski
authors.forename: John J
authors.initials: JJ
authors.lastname: Frey
mesh_terms: D000293:Adolescent; D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D000368:Aged; D000554:Ambulatory Care Facilities; D001071:Appointments and Schedules; D002648:Child; D002675:Child, Preschool; D005194:Family Practice / Q000193:education / Q000379:methods*; D005260:Female; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007396:Internship and Residency; D008297:Male; D008484:Medicaid; D006278:Medicare; D008875:Middle Aged; D010349:Patient Compliance / Q000706:statistics & numerical data*; D010352:Patient Dropouts / Q000706:statistics & numerical data*; D010353:Patient Education as Topic / Q000379:methods*; D014481:United States; D014505:Urban Population; D044465:White People / Q000706:statistics & numerical data; D055815:Young Adult