Improving Attendance in the Pediatric Weight Management Clinic Claudia Fox, MD, MPH MMRB presentation 10-11-18

Disclosure Funding: none

Quality Gap Childhood obesity is a chronic medical condition Obesity treatment requires regular contact with treatment team Patient attendance at appointments is poor Cancellations No-shows Consequences of poor attendance include poor patient outcomes and limited clinic access

Quality Gap Identify patient no-show rate and test strategies to reduce no show rate

AIM “Our aim is to reduce the no-show rate of patients attending the Pediatric Weight Management Clinic by 20% by September 1, 2018.” Measures: - Clinic No-show rate (outcome – process) - # of patients who no-showed/tot # scheduled

Interventions Reminder phone calls Informing patient of no-show policy Students call all new and f/u patients on Dr. Fox’s schedule for month of 10/2016 Up to 3 attempts Left message on 3rd attempt Outcome measured 11/2016 Informing patient of no-show policy No-show policy: after 2 no shows for new appt and 3 for a f/u appt, pt is asked to seek care elsewhere Scheduler verbally discusses this policy with all patients in month of 5/2018 Outcome measured 8/2018

Outcomes – No-show rate Cycle 1 Before intervention 21% (16/75) After intervention 21% (18/86) Cycle 2 Before intervention 17% (11/59) After intervention 15% (11/72)

Spread, Sustain, Impact We stopped student led reminder calls We continue to remind patients of no-show policy at time of making appointments This activity has not made significant impact on my individual practice as there continues to be unscheduled slots in schedule Surprised by relatively low no-show rates Next gap to address is late cancellations