No-Show Prevention Practices in Dental Care Settings Serving Underserved Populations

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Project Summary/Abstract Dental settings have been plagued with persistent no-show rates that are associated with low quality of care, inadequate care access, and inefficient use of organizational resources for the patients and organizations that need them most. Patient appointment no-shows are particularly pronounced in organizations that service underserved populations. Studies documenting strategies to reduce no-shows in dental settings are limited, with organizations reporting difficulty in replicating the findings, particularly in diverse patient populations. In this study, a team of researchers from the Marquette University School of Dentistry and the Center for Health Enhancement Systems Studies (the Center) at the University of Wisconsin–Madison College of Engineering will test the effectiveness of three no-show reduction strategies using an innovative full factorial design that allows for the simultaneous testing of different combinations of the no-show strategies. The intervention strategies include a) using Motivational Interviewing techniques when scheduling appointments, b) conducting reminder calls 24 and 48 hours before an appointment, and c) applying open-access scheduling, along with other practices found to reduce no-shows in other sectors of health. The practices to test emerged from a pilot conducted by the study team with dental clinics that primarily serve underserved populations. A significant aspect of this study is the use of the NIATx Organizational Change Model (the NIATx model) to facilitate and provide a standardized evidence-based strategy for no-show practice implementation and to address the concern of the inability to apply proven no-show strategies. The UG3 will require a full two years to finalize the study protocol and operations manual and formalize partnerships with 40 dental clinics. The UH3 will test if different combinations of the no-show strategies of Motivational Interviewing, reminder calls, and scheduling practices can improve no-show rates compared to treatment as usual (Aim 1). A mediational analysis will examine whether using the NIATx model with fidelity and Organizational Readiness for Change mediates no- show rates (Aim 2). The qualitative portion of the study will aid in interpretation of quantitative results and will be used to gain a more in-depth understanding of the factors that promote or impede the implementation of the no-show strategies (Aim 3). This trial will be among the first RCTs to test a combination of no-show strategies in health care that is focused on the underserved populations where no-shows are most pronounced and have the greatest adverse clinical consequences. The investigative team has successfully conducted a pilot study on this subject and has considerable experience with large clinical trials. In summary, the study intends to provide an evidence-based replicable approach to reduce no-show rates, with the goal of helping the dental care field make organizational changes that support evidence-based care and improve care access.