WIP 139 - Improving Primary Care No-Show Rates Among Children with Special Health Care Needs Receiving Supplemental Security Income using Payor-Funded Community Health Worker Outreach and Transportation

Poster Number: WIP 139
Publication Number: WIP 139.2506

Background: Children with special health care needs (CSHCN) who receive supplemental security income are impacted by poverty and medical disability. Ensuring completion of at least one ambulatory visit per calendar year for CSHCN receiving SSI is a quality performance measure incentivized by the Maryland Department of Health through the Population Health Incentive Program (PHIP). Decreasing no-show rates for these children improves primary care access and quality. Barriers to access for CSHCN receiving SSI include limited transportation, financial constraints, and competing medical and social needs. Community health workers (CHWs) help bridge the gap between underserved communities and healthcare systems by addressing social determinants of health.

Objective: We aim to decrease the percentage of primary care visit no-shows from a baseline of 34% to 25% by December 2023, among CSHCN on SSI with scheduled appointments in two pediatric primary care clinics, through payor funded CHW outreach and transportation to visits.

Design/Methods: We applied Lean Sigma methodology with iterative Plan-Do-Study-Act (PDSA) cycles. An interdisciplinary QI team performed an Ishikawa cause and effect analysis, process map, and a key driver diagram. Interventions included integration of patient lists into the electronic medical records (EMR), electronic surveys for transportation assessment, payor funded CHWs for outreach, and payor funded transportation. The outcome measure is the percent of no show visits among CSHCN receiving SSI with scheduled appointments. The process measure is the percent of CSHCN receiving SSI with scheduled appointments who received outreach. Outcome and process measures for the identified 407 patients are collected weekly through EMR review. Statistical process control (SPC) charts will be used to display and analyze data.