Abstract A84: Do patient follow-up improvements, at hospitals caring for medically underserved patients, impact no-show rates
Authors: Weldon Christine B. , Francois Teena L. , Trosman Julia R. , Roggenkamp Betty , Dupuy Danielle M. , Knight Jimmie T. , Ansell David A. , Murphy Anne Marie 
Published: May 2015

Background: In Chicago Black women are 62% more likely to die from breast cancer than White women. Previous data from 39 Chicago hospitals suggested the existence of significant variation in mammography quality across facilities (Chicago Breast Cancer Quality Consortium, 2010). We developed process improvement recommendations for sites that participated in our care process assessment (Weldon CB, et al, ASCO-Abstract-6120-2012). This study was funded through a generous grant from the Susan G. Komen for the Cure Foundation. Appointment reminder calls and follow-up calls to patients that do not attend their appointments are effective in increasing breast cancer screening and diagnosis completion rates of (Goel A, et al, JHCPU 2008). We provided technical assistance to implement breast imaging care process improvements and compared pre and post process improvement appointment no-show rates and follow-up call rates at 14 sites.

Procedures: Using Deming's PDCA cycle for continuous improvement, we created care process improvement recommendations for 27 Chicago institutions with the patient base averaging more than 50% medically underserved patients (22 community, 3 academic and 2 public hospitals), 17 of the sites are safety net institutions. Recommendations were based on analysis across sites, literature, and input from institution staff. We provided 14 of the sites with technical assistance to implement “rapid cycle” care process improvements (RCI sites). Sites were selected for technical assistance based on their need and their commitment to improving breast imaging care processes. Thematic and statistical analyses were performed using simple frequencies, and McNemar's test.

Summary of Results: Detailed results are shown in the table below. Technical assistance was utilized by 14 of 17 safety net sites (RCI sites) to which it was offered. 10 sites adjusted their processes to conduct appointment reminder calls to patients. 12 sites implemented processes to conduct follow up phone calls with patients who missed an appointment, with a focus on answering patient questions and to schedule a new appointment. 6 sites adjusted their processes to conduct phone calls to inform patients of abnormal breast screening results (BIRADS 0, 4, 5) in addition to sending each patient a letter (MQSA requires at least a letter). Working with the 14 sites resulted in an improvement in no-show rates from 29% to 21%.

Appointment reminder call:

baseline 48% (13/27) all sites, 21% (3/14) RCI sites

post-improvement 85% (23/27) all sites, 93% (13/14) RCI sites

pvalue = 0.0044, Chi squared: 8.100 w 1 degree of freedom

Call no-show patients :

baseline 19% (5/27) all sites, 0% (0/14) RCI sites

post-improvement 63% (17/27) all sites, 86% (12/14) RCI sites

pvalue = 0.0015, Chi squared: 10.083 w 1 degree of freedom

Call to follow up with patients who have abnormal results:

baseline 56% (15/27) all sites, 50% (7/14) RCI sites

post-improvement 78% (21/27) all sites, 93% (13/14) RCI sites

pvalue = 0.0412, Chi squared: 4.167 w 1 degree of freedom

No show rate for screening mammograms

baseline 22% all sites, 29% RCI sites :

post-improvement 18% all sites, 21% RCI sites

Conclusions: Conducting phone calls to remind patients about appointments improves no-show rates at sites that care for the medically underserved. Further analysis may show a reduction in loss-to-follow-up for sites that implement follow up phone calls to patients who miss appointments and to patients who need additional diagnostic assessment. Findings from this study have generalizable application to health facilities beyond breast imaging sites. Given persistent and growing disparities in health outcomes for vulnerable populations and the limited resource availability; these findings suggest that implementation of basic patient tracking strategies have substantial benefit to improve patient outcomes and health care quality.

Citation Format: Christine B. Weldon, Teena L. Francois, Julia R. Trosman, Betty Roggenkamp, Danielle M. Dupuy, Jimmie T. Knight, David A. Ansell, Anne Marie Murphy. Do patient follow-up improvements, at hospitals caring for medically underserved patients, impact no-show rates. [abstract]. In: Proceedings of the Sixth AACR Conference: The Science of Cancer Health Disparities; Dec 6–9, 2013; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2014;23(11 Suppl):Abstract nr A84. doi:10.1158/1538-7755.DISP13-A84