Performance improvement, telemedicine, patient engagement, and comparative no-show rates

Abstract

No-show patient visits should be considered risk events. No-shows impact the quality and continuity of patient care. Missed visits increase health care risks by deferred or missed diagnosis and treatment, and increases costs of care. This performance improvement project proactively implemented a telemedicine system of care during a public health emergency (PHE). The goal was to improve health care access and decrease health care disparities despite emergency management changes in organizational staffing and federal stay-at-home orders. Telemedicine visits also addressed known causes of historically high in-person no-show office rates—lack of transportation, childcare issues, mobility issues, and adverse weather conditions. Despite location in a Hospital Census Tract where 50% of our population is below the Federal Poverty Level, with less access to technology, telemedicine proved to be successful. The Revised Standards for Quality Improvement Reporting Excellence (SQUIRE 2.0) guidelines were the planning framework. The Model for Healthcare Improvement including Part 1 (AIM) and Part 2 (Plan-Do-Study-Act) was used to develop interventions, outcomes, and rationale for use. Data was collected from January 2020 thru March 2022, with 22,831 total scheduled visits (15,837 in-person, 6994 telemedicine). The average monthly no-show rate for in-person visits was 35% compared to 9% for telemedicine visits.