Identifying Barriers to Address a Free Clinic’s High Missed Appointment Rates

Abstract

Need/Rationale: Addressing health disparities has been at the forefront of challenges faced in the medical field. Social determinants of health (SDOH) has a significant impact on patient populations, often contributing to health disparities. SDOH refers to environmental factors that contribute to one’s overall health and longevity (1). A person’s socioeconomic status, education, access to fresh, healthy foods, and many other factors contribute significantly to SDOH (2,3). It is estimated that SDOH account for 50% of the variation in health outcomes among individuals across our country. Intervening on factors that contribute to poor SDOH could have a profound impact on the lives of people across the nation. Matthew 25, a free clinic in Fort Wayne, Indiana, serves a large immigrant population and other Fort Wayne natives who are in a low socioeconomic status. While the clinic helps to bridge the gap in healthcare by providing free healthcare services, it is hypothesized that SDOH are influencing the quality of care the clinic can provide. Despite establishing long-term care with each patient, there is a high no-show rate, which makes it difficult to provide quality healthcare. Through administering written surveys to the patients, we hope to identify patterns in which we can intervene and mitigate disparities. This project aims to connect patients with community resources to meet their needs outside the clinic, increasing healthcare accessibility and decreasing no-show rates. Methods: This is a single-center prospective questionnaire-based research project designed to determine the reasons for missed appointments and what resources can assist in reducing the no-show rate. This study is pending approval from the Indiana University Institutional Review Board. A verbal explanation of the intention of the study will be given to potential participants before they complete the questionnaire. The questionnaire will be anonymous to promote participation. We plan to conduct this questionnaire for three months or until the target response of 100 is reached. The questionnaire consists of 10 questions. Any patient under the age of 18 years, communicates exclusively in any language other than English or Spanish, or has substantial cognitive impairment will be excluded. The data will be stored on Microsoft Excel Spreadsheet (Microsoft Corporation, USA). The ultimate objective of this project is to implement interventions that will mitigate the no-show rate at Matthew 25. Evaluation Plan: Prior to the start of the research project, a questionnaire gauging student interest and skill set such as Spanish fluency and data analysis will be given. At the end of the research project, a satisfaction survey will be provided to our community partner, Matthew 25, and to all the medical students involved in the research project. The satisfaction survey will determine the strengths and weaknesses of our planning, data collection, data analysis, and product creation processes to help improve for future research projects. In addition to satisfaction surveys, periodic email check-ins will be sent to our community partner and regular GroupMe messages will be sent to the participating medical students to further access project satisfaction and progress. Pre and post-surveys will be given to the medical students participating in the research project to measure their self-improvement in project planning, data collection, data entry and analysis, and presentation skills. Pre and post-surveys will be administered to assess medical students’ satisfaction on engaging in a community-based research project, learning how to administer and analyze survey data, understanding SDOH, and addressing real-world health-related community issues. Potential Impact: By identifying the challenges patients face when attending their clinic visits, this survey will reveal areas for improvement that can bolster healthcare accessibility. Enhancing patient access to healthcare allows patients to miss fewer appointments and have overall improved health outcomes. References:

Phelan JC, Link BG, Tehranifar P. Social conditions as fundamental causes of health inequalities: theory, evidence, and policy implications. J Health Soc Behav. 2010;51 Suppl:S28-S40. doi:10.1177/0022146510383498 Chang CD. Social Determinants of Health and Health Disparities Among Immigrants and their Children. Curr Probl Pediatr Adolesc Health Care. 2019;49(1):23-30. doi:10.1016/j.cppeds.2018.11.009 Adler NE, Newman K. Socioeconomic disparities in health: pathways and policies. Health Aff (Millwood). 2002;21(2):60-76. doi:10.1377/hlthaff.21.2.60