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Application of the Health Promotion Model to Reduce No-Shows in an Ambulatory Setting: A Quality Improvement
Sherrie Bragg1, Brigitte Cypress, Thomas Dahan
1Author Affiliations: Department of Nursing (Ambulatory), AtlantiCare, Egg Harbor Township, New Jersey, USA (Dr Bragg); and Rutgers University, School of Nursing, Camden (Drs Cypress, and Dahan).
Background:
No-shows in ambulatory clinics negatively impact patient care, operational resources, and health outcomes.
Local Problem:
The average no-show rate of the local endocrinology medical practice office was consistently above its benchmark of 8%.
Methods:
A quality improvement project utilized Plan-Do-Study-Act cycles and Pender's Health Promotion Model (HPM) to reduce no-shows.
Interventions:
Interventions included identifying no-show appointment trends, educating nurse navigators on HPM and associated guidelines, conducting telephone call outreach to patients at high risk for no-shows, and implementing holistic nurse-patient interactions.
Results:
Telephone call outreach had a 50.6% connection rate. No-show rates decreased from 14.9% to 13.9% over 8 weeks. Telephone calls provided insights into perceived experiences and social determinants of health factors.
Conclusion:
The project reaffirmed the importance of a multimodal approach and human interaction in reducing no-shows, as well as highlighting the value of nursing care, evidence-based promotion, and the incorporation of theory when implementing operational improvements.
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