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

项目摘要/摘要 牙科设置一直受到与低护理质量相关的持续缺勤率的困扰， 为患者和组织提供的护理机会不足和组织资源利用效率低下 他们是最需要的。在提供服务的组织中，患者预约缺席的现象尤为明显 服务不足的人群。记录减少牙科环境中缺勤的策略的研究有限， 组织报告在复制这些发现方面存在困难，特别是在不同的患者群体中。在……里面 这项研究是由马凯特大学牙科学院和健康中心的研究人员组成的 威斯康星大学麦迪逊工程学院增强系统研究(中心) 将使用创新的全析因设计测试三种缺勤减少策略的有效性 允许同时测试缺席策略的不同组合。干预措施 策略包括a)在安排约会时使用激励性面试技巧，b)进行 提醒在预约前24小时和48小时呼叫，以及c)应用开放访问时间表，以及 其他被发现可以减少其他卫生部门缺勤的做法。要测试的做法来自于一名飞行员 由研究团队与主要为服务不足的人群提供服务的牙科诊所进行。一个重要的 这项研究的一个方面是使用NIATx组织变革模型(NIATx模型)来促进和 为未到场实践的实施提供标准化的循证策略，并解决 担心无法应用经过验证的缺席策略。UG3将需要整整两年的时间才能敲定 研究规程和操作手册，并与40家牙科诊所正式建立伙伴关系。UH3将测试是否 励志面试、提醒电话和日程安排等缺勤策略的不同组合 与通常的治疗相比，实践可以提高缺勤率(目标1)。一项调解分析将 检查使用具有保真度和组织变革就绪性的NIATx模型是否会 显示费率(目标2)。研究的定性部分将有助于对定量结果和意愿的解释 用来更深入地了解促进或阻碍执行《 缺席策略(目标3)。这项试验将是第一批测试缺勤策略组合的RCT之一 在医疗保健方面，重点关注未得到充分服务的人群，这些人群的缺席最为明显，并已 最大的不良临床后果。调查组已成功地进行了一项初步研究 并在大型临床试验方面有相当丰富的经验。总而言之，这项研究打算 提供一种基于证据的可复制方法，以降低缺勤率，目的是帮助牙科医生 护理领域进行组织变革，以支持循证护理并改善护理的可及性。

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.