Targeted Live-Reminder Calls by Medical Assistants Combined with Automated Calls to Reduce Patient Nonattendance: An Ambulatory Care Quality Improvement Initiative

Aim: Patient nonattendance remains a significant issue in ambulatory care. The primary aim of this quality improvement project was to reduce same-day cancelation and no-show rates in a specialty clinic on an academic medical campus by implementing a live, targeted reminder call intervention. Methods: This project utilized medical assistants in calling patients at risk for nonattendance daily, 7 days prior to their appointment. Risk stratification was achieved by utilizing the department appointment report feature of Epic and sorting based on historical no-show rate; patients with no historical data defaulted to a zero-percent no-show rate. The top ~20%–25% of the patients from this list were assigned to medical assistants who were provided education and resources to assist in productive conversations. The no-show rate and no-show same-day cancelation rate were collected on a weekly basis through departmental reports and compared with baseline data. Results: Using guidelines from the Institute for Healthcare Improvement, a shift was demonstrated where the clinic no-show rate declined from 11.3% to 7.2% over the 16-week intervention period with a mean difference of −4.1 percentage points, p < .001, 95% CI [−3.1% to −5.1%]. 3,120 patients were targeted to receive a live call during the project, and 3,105 were called by the medical assistants for a 99.5% fidelity to intervention rate. Of those calls, 49.1% were reached by the medical assistants, 41.5% received a voicemail, and 0.4% were unable to be reached. Conclusion: A live, targeted reminder call intervention conducted by ancillary staff is feasible and, when combined with automated reminders, has the potential to improve patient nonattendance. Reducing nonattendance with the targeted intervention represents a potential strategy to improve patient access and clinic productivity.