Improving No-Show Rates at a Federally Qualified Health Center (FQHC)

The purpose of this quality improvement project was to improve no-show and missed appointments among adult patients at a federally qualified health center (FQHC) located in greater Houston, TX in the adult medicine department. This intervention aimed to decrease no-show and missed appointment rates to 20% or below to improve productivity, yield less staff burnout, and improve patient healthcare outcomes. A 4-week initiative was completed to identity top reasons and to reduce no-shows. A no-show outreach initiative was developed and used in the electronic health record (EHR) and targeted to patients identified as most likely to not show cancel an appointment within 24 hours of the scheduled time. The Plan-Do-Study-Act (PDSA) method was used for two cycles to improve implementation. In addition, a validated tool to assess provider burnout, called the Provider Fulfillment Index (PFI). There was a total of 338 combined no-show and missed appointments over an 8-week period. The high-risk no-show intervention reduced the combined no-show and missed appointment rate from 33% to 15.6%. There was no significant change to provider burnout throughout the project. It is important to address no-show behavior unique to organizational culture such as an FQHC to improvement health care outcomes and productivity. A personalized and tailored reminder system for future appointments requires team effort, patient involvement, and long-term consistency to be effective.