Improving the “Show Rate” For Case Management Appointments

1. Improving the “Show Rate” For Case Management Appointments AIDS Center Queens County Presenter: Mr. Claude Sidoli

2. AIDS Center Queens County STORYBOARD Background Case management services are provided at each of our primary service sites in Rego Park, Jamaica, and Far Rockaway. Each month, approximately 1,500 case management client contacts take place with an active case management load averaging 450 clients. Our case managers assist program participants in assessing their needs, provide supportive counseling, crisis intervention, treatment education and referral services to other ACQC services as well as a variety of other agencies, with whom ACQC has referral and linkage agreements. These services are provided both on-site at our agency and off-site. Like many case management programs ACQC struggles with improving the “show rate” for appointments held both on-site and externally. In an attempt to address our no-show rate, ACQC adapted a project that had been previously piloted as a collaborative initiative within the AIDS Institute COBRA Quality Initiative. The decision to apply this project at ACQC was based upon the dramatic improvement that this collaborative measured. The intention was to borrow some of the strategies and tools of this initiative and modify them to address the systems at ACQC. The project was to be tested small scale with the intention of spreading any measurable improvement throughout the COBRA and Ryan White funded case management programs.

3. AIDS Center Queens County 1) Improvement Goal/Team Charter Reduce client “no show” rate for scheduled staff appointments regardless of the location of the appointment. Include appointments at the agency or off-site scheduled appointments with case management staff. • “Show-Rate” = Anytime a client is scheduled to meet with a CM team member, regardless of location • “No-ShowRate” = Anytime a client does not show for their appointment without having previously notified the CM • 2) Organize Improvement Project Team • Team Leader: Program Director • Members: Case Manager (CM), Case Manager Technician (CMT), and Community Follow-Up Worker (CFW)

4. AIDS Center Queens County 3) Review Appointment Process (PRIOR TO REMINDER CALLS): Appointment Scheduled Face to Face By Phone Client is verbally advised of appointment date, time, location, caseworker Client is verbally advised of appointment date, time, location, caseworker Client is advised to contact team as early as possible if unable to keep appointment and to reschedule 4) Select and Test Improvement Strategies • CM will be asked to make reminder calls to patients at least one day in advance of the patients scheduled appointment. Calls will be made for both on-site and off-site appointments with the case managers. • CM will utilize the “client no-show” data (see attachment) form to collect information on no-show rate. • When making follow up calls to those clients who do not show for their appointments, the Case Manager will document the reason the client gives for missing the appointment. • The reminder calls will be implemented on a small scale basis (3 teams) and for a period of 3 weeks. CM adds appointment to the appointment tracking form Appointment

5. AIDS Center Queens County 5) Measure Results of Improvement Baseline – No Reminder Calls (3 weeks of measurement): Case Management Team 1: 76% Show Rate Case Management Team 3: 85% Show Rate Case Management Team 5: Excluded due to vacation Avg = 80.5% Show Rate Reasons given for failure to keep appointment: Forgot (1); Personal Problem (1); Went to Store (1); Ambulette did not come (1); Had class (1); Had Something else to do (1); Fell asleep (1); Had another appt (1); unkown (2) 3Weeks of Pilot Testing – Reminder Calls Made: Case Management Team 1: 76% Show Rate Case Management Team 3: 88% Show Rate Case Management Team 5: Excluded due to vacation Avg = 82% Show Rate Reasons given for failure to keep appointment: Forgot (2); Family Emergency (1) Not feeling well (3); Went to ER (1) Had Something else to do (2); Had to wait for landlord (1); Had another appt (1); unknown (0) Staff Feedback: Currently, quantitative data collection is no longer occurring, however, case managers are reporting that they’re seeing an increase in the number of clients showing for their appointments.

6. AIDS Center Queens County 6. Lessons Learned  After implementing the reminder calls we did not see a significant improvement to this show rate. However at baseline, prior to instituting the reminder calls ACQC measured a fairly high show rate. 7. Next Steps The team will meet to review the data and will decide whether to extend the measurement period for an additional 3 weeks to see if there if there is a measurable improvement in show rate, as per the staff report. Program Director will reach out to other provider sites to benchmark ACQC’s show rate against similar programs in New York. Based upon this data the team will decide whether to test another change, or to celebrate their high show rate. Possible changes: (1) Modify patient/appointment-tracking form to include the day that the reminder call was made. (2) Modify data collection tool to indicate whether an appointment was on-site or off-site.