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

项目概要/摘要 牙科设置一直困扰着与低质量的护理， 医疗服务不足，患者和组织的组织资源利用效率低下， 最需要他们。病人预约不显示是特别明显的组织， 服务不足的人群。记录减少牙科治疗中不出现的策略的研究是有限的， 组织报告说，很难复制这些发现，特别是在不同的患者群体中。在 在这项研究中，来自马奎特大学牙科学院和健康中心的一组研究人员 威斯康星大学麦迪逊分校工程学院增强系统研究（中心） 将使用创新的全因子设计来测试三种减少未入住率策略的有效性， 允许同时测试未出现策略的不同组合。干预 策略包括a）在安排约会时使用动机性面试技巧，B）进行 预约前24小时和48小时的提醒电话，以及c）应用开放访问调度，沿着 发现其他做法减少了其他卫生部门的缺席率。要测试的实践来自一个试点项目， 由研究小组与主要服务于服务不足人群的牙科诊所进行。显著 本研究的一个方面是使用NIATx组织变革模型（NIATx模型），以促进和 提供一个标准化的基于证据的战略，为不出现的做法的实施，并解决 担心无法应用行之有效的不出现策略。UG 3将需要整整两年的时间来完成 并与40个牙科诊所正式建立伙伴关系。UH 3将测试是否 动机性面试、提醒电话和日程安排等不出现策略的不同组合 与常规治疗相比，常规治疗可以提高未出现率（目标1）。中介分析将 检查是否使用NIATx模型与保真度和组织的变化准备介导没有- 显示率（目标2）。研究的定性部分将有助于解释定量结果， 用于更深入地了解促进或阻碍执行《联合国千年宣言》的因素。 不显示策略（目标3）。该试验将是首批测试未就诊策略组合的RCT之一 在医疗保健方面，重点是服务不足的人群，这些人群中没有出现的情况最明显， 最大的不良临床后果。调查小组成功地进行了一项试点研究， 在这个问题上，并有相当丰富的经验，与大型临床试验。总而言之，本研究旨在 提供一种基于证据的可复制方法，以降低未就诊率，目的是帮助牙科医生 护理领域进行组织变革，支持循证护理，改善护理服务。

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.