Improving No-Show Rates in a Community Health Center

Background: Community health centers are patient-centered medical sites that provide a comprehensive set of primary care services to medically underserved areas. These centers are particularly important for those who are economically vulnerable, a group that often includes persons of color. Like many other healthcare practices, health centers face challenges to care such as high no-show rates (i.e., patients not appearing for a scheduled appointment). However, when compared to private medical practices, community health centers may suffer worse consequences of no-show rates. For example, the growth of the clinic and continuity of care for the patient depend on reimbursement from public programs like Medicaid, which requires that patients be seen by a provider. Limited research has been done on the implications of no-show rates on community health centers, thus this study examined the no-show phenomenon in this setting.

Methods: This research study utilized a cross-sectional, mixed methods research design. De-identified quantitative data (n = 1,243 patients) using case records was analyzed using regression, t tests, and ANOVA to examine if demographic characteristics (race, gender, age, and zip code) were correlated with no-show rates. The sample was 61% female, included more people of color than white participants (e.g., 64% Black, 22% white), had a mean age of 52.3 years old, and included participants from predominantly from urban areas (e.g., 60% urban, 32% suburban). A qualitative survey was also used to understand participants’ (n = 30) perceptions of how to overcome barriers to keeping scheduled appointments and decrease no-show rates. Participants identified as 70% female, 83% Black, and had an average age of 47. Interviews for the survey were completed and audio recorded for transcription both in a medical office and over the phone with patient consent. Data were analyzed using thematic analysis with an inductive approach.

Results: Younger patients were more likely to demonstrate higher no-show rates, as well as patients who identified as Black/African American. The qualitative survey identified barriers such as: (a) family barriers (sick family members, lack of childcare, family emergencies); (b) personal issues (trouble remembering, work, personal illness, conflicting appointments, school, or lack of money; and (c) societal barriers (lack of transportation or insurance). In regard to patient recommendations for improvements to the community health center, most had small recommendations like later appointment times, more reminders, the clinic scheduling an advance appointment for the client, and having staff who are more understanding of patients’ needs. Otherwise, a number of participants felt that the patients were the ones primarily responsible for missed appointments.

Implications: It appears that there are both patient-level and societal barriers impacting patient access to care. Clinics may want to consider providing transportation to scheduled appointments, increasing exposure of social services provided by the clinic, educating patients on the importance of preventative health care, and implementing minimal facility improvements. Future research should examine what types of changes are associated with improved client outcomes, particularly for those who are of low-income or identify as a person of color.