School of Medicine and Health Sciences Poster Presentations

Title

Improving Show Rates for Mental Health Appointments in an Integrated Pediatric Primary Care Clinic

Poster Number

323

Document Type

Poster

Status

Medical Student

Abstract Category

Quality Improvement

Keywords

pediatrics, primary care, mental health, quality improvement

Publication Date

Spring 2018

Abstract

Background: Integrated mental health (MH) is relatively new in pediatrics but shows promise for increasing access to MH services. Barriers for families engaging in MH care are well described for traditional settings and include stigma, logistical barriers (e.g., child care), socioeconomic status, and parental MH problems. Families may face similar barriers when accessing MH care in the primary care setting. Little is known about ways to improve family engagement in an integrated setting. Objective: 1) Determine the current show rate for psychology appointments at two academic health centers within Children’s National Health System: the Children’s Health Center (CHC) and Adolescent Health Center (AHC). 2) Improve the psychology appointment show rate through creation of a pre-appointment, personal phone call reminder. Design/Methods: We used QI methodology with a PDSA cycle to implement a phone call reminder system one business day prior to a week’s worth of psychology appointments. A retrospective chart review allowed us to determine appointment show rates and no-show rates pre- and post-intervention. Results: At baseline, the psychologist saw 176 patients April-May, 2017, which reflects a combination of same-day and scheduled appointments. The show rate over this time period for scheduled appointments was 48%, the no-show rate was 43%, and 9% canceled/rescheduled. For context, the average show rate for medical visits is ~70%. The average interval between scheduling date and MH appointment date was 14.02 days (±8.49). The length of this interval did not impact attendance. There was also no difference in show rates for new consults vs. follow-ups. We were able to reach 54% of the families we attempted to contact to remind them of their scheduled MH appointment. The subsequent show rate for the following week was 33%, the no-show rate was 38%, and 29% canceled/rescheduled. Although the show rate did not improve, the no-show rate decreased as patients were able to reschedule appointments during the reminder phone calls. This intervention shows promise for improving utilization of the integrated psychologist by affording increased flexibility to provide same-day consultations during known cancellations. Conclusion(s): Families do seem to face barriers to attending MH appointments even in an integrated setting. This PDSA cycle laid a foundation for regularly collecting data on show rates for the psychologist and for future interventions to increase family engagement in MH care.

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Improving Show Rates for Mental Health Appointments in an Integrated Pediatric Primary Care Clinic

Background: Integrated mental health (MH) is relatively new in pediatrics but shows promise for increasing access to MH services. Barriers for families engaging in MH care are well described for traditional settings and include stigma, logistical barriers (e.g., child care), socioeconomic status, and parental MH problems. Families may face similar barriers when accessing MH care in the primary care setting. Little is known about ways to improve family engagement in an integrated setting. Objective: 1) Determine the current show rate for psychology appointments at two academic health centers within Children’s National Health System: the Children’s Health Center (CHC) and Adolescent Health Center (AHC). 2) Improve the psychology appointment show rate through creation of a pre-appointment, personal phone call reminder. Design/Methods: We used QI methodology with a PDSA cycle to implement a phone call reminder system one business day prior to a week’s worth of psychology appointments. A retrospective chart review allowed us to determine appointment show rates and no-show rates pre- and post-intervention. Results: At baseline, the psychologist saw 176 patients April-May, 2017, which reflects a combination of same-day and scheduled appointments. The show rate over this time period for scheduled appointments was 48%, the no-show rate was 43%, and 9% canceled/rescheduled. For context, the average show rate for medical visits is ~70%. The average interval between scheduling date and MH appointment date was 14.02 days (±8.49). The length of this interval did not impact attendance. There was also no difference in show rates for new consults vs. follow-ups. We were able to reach 54% of the families we attempted to contact to remind them of their scheduled MH appointment. The subsequent show rate for the following week was 33%, the no-show rate was 38%, and 29% canceled/rescheduled. Although the show rate did not improve, the no-show rate decreased as patients were able to reschedule appointments during the reminder phone calls. This intervention shows promise for improving utilization of the integrated psychologist by affording increased flexibility to provide same-day consultations during known cancellations. Conclusion(s): Families do seem to face barriers to attending MH appointments even in an integrated setting. This PDSA cycle laid a foundation for regularly collecting data on show rates for the psychologist and for future interventions to increase family engagement in MH care.