For many people, going to the doctor is a minor inconvenience. For some, especially those disadvantaged by poverty, it can be a major undertaking. Reducing the barriers to care for these patients can increase their sense of connection with their health care providers and improve compliance and outcomes.
With three locations in north central Colorado, La Clinica Campesina Family Health Services serves about 15,000 patients, 40 percent of whom are Hispanic, 50 percent of whom are uninsured, and 100 percent of whom are medically underserved. Because diabetes is more prevalent among Hispanics, Clinica has a higher-than-normal proportion of diabetic patients who require regular visits to manage their disease.
Many patients would faithfully make appointments at appropriate intervals, says Clinica’s vice president Cory Sevin, RN, MSN, but would fail to keep them. “Our no-show rate was up to about 35 percent, which is typical for community health centers,” she says.
Many of the reasons for no-shows had to do with patients’ life situations, says Sevin. “They might have transportation or childcare problems. Most have little empowerment to leave their jobs for appointments.” Sevin and her colleagues knew they couldn’t change those things, but they could change their system to be more accommodating.
“When the only appointment you can get is three or four weeks away, you take it. You have no idea if you’ll actually be able to make it on that day and that time,” she says. So Clinica began to move toward a model of advanced access scheduling they learned through IHI that keeps the majority of appointments open for same-day visits. They watched their no-show rate begin to plummet.
“Now, chronic care patients are much more likely to get appointments when they want and need them,” says Sevin. Providers are much happier and more productive, she says, because the clinic no longer has to double or triple book to compensate for the high level of no-shows. “The chaos is gone. They are able to review their registries, reach out to patients who need to be seen, and devote more time to planned care such as immunizations and screenings.”
Further Reading
Read more about Clinic Campesina's improvement efforts:
Member Report: Redesigning Diabetes Care Delivery System
