The success of behavioral economics in improving patient retention within an intensive primary care practice

Background A minority of the U.S. population comprises a majority of health care expenses. Health system interventions for high-cost populations aim to improve patient outcomes while reducing costly over-utilization. Missed and inconsistent appointments are associated with poor patient outcomes and increased health care utilization. PEAK Health— Mount Sinai’s intensive primary care clinic for high-cost patients— employed a novel behavioral economics-based intervention to reduce the rate of missed appointments at the practice. Behavioral economics has accomplished numerous successes across the health care field; the effect of a clinic-based behavioral economics intervention on reducing missed appointments has yet to be assessed. Methods This was a single-arm, pre-post trial conducted over 1 year involving all active patients at PEAK Health. The intervention consisted of: a) clinic signage, and b) appointment reminder cards containing behavioral economics messaging designed to increase the likelihood patients would complete their subsequent visit; appointment cards (t1) were transitioned to an identical EMR template (t2) at 6 months to boost provider utilization. The primary objective, the success of scheduled appointments, was assessed with visit adherence: the proportion of successful over all scheduled appointments, excluding those cancelled or rescheduled. The secondary objective, the consistency of appointments, was assessed with a 2-month visit constancy rate: the percentage of patients with at least one successful visit every 2 months for 1 year. Both metrics were assessed via a χ2 analysis and together define patient retention. Results The visit adherence rate increased from 74.7% at baseline to 76.5% (p = .22) during t1 and 78.0% (p = .03) during t2. The 2-month visit constancy rate increased from 59.5% at baseline to 74.3% (p = .01) post-intervention. Conclusions A low-resource, clinic-based behavioral economics intervention was capable of improving patient retention within a traditionally high-cost population. A renewed focus on patient retention— employing the metrics described here— could bolster chronic care efforts and significantly improve the outcomes of high-cost programs by reducing the deleterious effects of missed and inconsistent appointments.

Cost of Cleft Team Care at an Academic Children’s Hospital

Background The financial burden of cleft-craniofacial team care is substantial, and high costs can hinder successful completion of team care. Solution Collaboration with multiple stakeholders including providers, insurers, and patient guardians, as well as hospital administrators, is critical to increase patient retention and improve final clinical outcomes. What We Do That is New At our cleft and craniofacial center, charges for a team care visit fall into one of three categories—hospital fees, professional fees, or external fees. There are four types of hospital fees depending on (1) whether the patient is new or returning, and (2) whether the patient saw ≤4 or ≥5 providers. To further elucidate the financial burden (out-of-pocket costs) directly borne by families of children with cleft lip and/or palate, we conducted a retrospective review of billing records of team care visits made between September 2019 and March 2020. Out-of-pocket costs for a single team care visit (on a commercial insurance plan) ranged from $4 to approximately $1220 and had a median (IQR) of $445 ($118, $749).

The Necessity of a Trauma-Informed Paradigm in Substance Use Disorder Services

OBJECTIVE To raise awareness and understanding about the role of trauma in the development of substance use and to define and clarify the need for trauma-informed care within the treatment of patients with substance use disorders (SUDs). METHOD This article reviews the up-to-date literature on how and why traumatic life experiences promote a neurobiological vulnerability to development of SUDs and combines this with a discussion of the principles of trauma-informed care for SUDs, as well as a review of the role of stigma and structural violence as foundational concepts in the implementation of trauma-informed care for people with SUDs. RESULTS Shifting to a trauma-informed care paradigm in treating SUDs more effectively serves patients by improving patient experiences and accounting for a chronic disease model, wherein multiple episodes of SUD care are often necessary. CONCLUSIONS This article reviews the ways in which nurses and other service providers can increase SUD patient retention and decrease recurrence by understanding the role of trauma in the development of SUDs, exploring the role of stigma, and identifying and interrupting structural violence as it relates to SUDs. This article also offers actionable steps that all nurses can take now as well as areas for further inquiry into trauma-informed care substance use services.

The Success Of Behavioral Economics In Improving Patient Retention Within An Intensive Primary Care Practice

BackgroundA minority of the U.S. population comprises a majority of health care expenses. Health system interventions for high-cost populations aim to improve patient outcomes while reducing costly over-utilization. Missed and inconsistent appointments are associated with poor patient outcomes and increased health care utilization. PEAK Health— Mount Sinai’s intensive primary care clinic for high-cost patients— employed a novel behavioral economics-based intervention to reduce the rate of missed appointments at the practice. Behavioral economics has accomplished numerous successes across the health care field; the effect of a clinic-based behavioral economics intervention on reducing missed appointments has yet to be assessed.MethodsThis was a single-arm, pre-post trial conducted over one year involving all active patients (286) at PEAK Health. The intervention consisted of: a) clinic signage, and b) appointment reminder cards containing behavioral economics messaging designed to increase the likelihood patients would complete their subsequent visit; appointment cards (t1) were transitioned to an identical EMR template (t2) at 6 months to boost utilization of this component. The primary objective, the success of scheduled appointments, was assessed with visit adherence: the proportion of successful over all scheduled appointments, excluding those cancelled or rescheduled. The secondary objective, the consistency of appointments, was assessed with a 2-month visit constancy rate: the percentage of patients with at least one successful visit every two months for one year. Both metrics were assessed via a χ² analysis and together define patient retention. ResultsThe visit adherence rate increased from 74.7% at baseline to 76.5% (p= .22) during t1 and 78.0% (p= .03) during t2. The 2-month visit constancy rate increased from 59.5% at baseline to 74.3% (p= .01) post-intervention.ConclusionsA low-resource, clinic-based behavioral economics intervention was capable of improving patient retention within a traditionally high-cost population. A renewed focus on patient retention— employing the metrics described here— could bolster chronic care efforts and significantly improve the outcomes of high-cost programs by reducing the deleterious effects of missed and inconsistent appointments.

Assessing Intrinsic Mechanism of Service Quality Factors and it Effect on Patient Retention in Ghanaian Private Hospitals

The achievement of patient retention by a healthcare facility can be established by the provision of quality service delivery. The main objective of this paper is to assess the intrinsic mechanism of service quality factors and it effect on patient retention in Ghanaian private hospitals. The sample size of the study was 880 patients. Data collection was done among inpatient and outpatients of four selected private hospitals in the Ashanti region of Ghana. Due to population density of private hospitals, most of the respondents hailed from the Greater Accra, Ashanti, Western-South, Central and Eastern Regions from Ghana. The questionnaires used for the study were made up of 37 items that include 33 items on intrinsic mechanism of service quality; two items on trust and 4 items of patient satisfaction were use as mediators of service quality factors and patient retention, lastly, 4 items on Patient retention. The validity and reliability of the data was confirmed. SPSS statistical software and WarpPLS software were use to analysis the data. It was revealed that there is a strong relationship between the factors of service quality (Empathy, Safety, Improvement of care and Efficient) and patient retention. The mediators (trust and patient satisfaction) shown positive significant between factors service quality and patient retention. This study recommends that if private hospitals management pays much attention to the above factors of service quality, they are going to retain most of their patients. This paper further stress that trust and patient satisfaction should be the benchmark of every private hospitals to retain their patients.

Optimising retention success: a research team’s experience of following-up participants recruited to a pilot trial through community pharmacies in England

Background: The CHAMP-1 (Community pharmacy: Highlighting Alcohol use in Medication aPpointments) pilot trial aimed to explore an intervention discussing alcohol during medication consultations with community pharmacists. It presented various challenges regarding patient retention, as participants were recruited by their pharmacist and followed-up remotely by a trained researcher, who they had not met, two months later. We discuss our actions and experiences of completing follow-up activities. Methods: Community pharmacists recruited patients aged 18 and over, attending a Medicine Use Review (MUR) or New Medicine Service (NMS) consultation, and drinking alcohol at least twice per week. Pharmacies were randomised to conduct their consultations as usual (control), or to incorporate the Medicines and Alcohol Consultation (MAC) intervention. All participants were followed-up by a researcher after two months to complete data collection via telephone or post. We employed standard follow-up strategies, including a plan to text participants with a reminder in advance of their follow-up. Results: Forty-seven of 51 participants (92%) completed the two month follow-up. Thirty-eight (81%) responses were provided by telephone and nine (19%) by post. Of the 38 follow-up calls completed by telephone, 17 (45%) participants were reached at first attempt; 16 (42%) at second attempt; and five (13%) at the third attempt. We observed a high percentage of data completion across telephone and postal collection methods. Participants were willing to discuss potentially sensitive issues, such as alcohol consumption, anxiety, and depression, with a researcher who was external to the pharmacy team. Conclusions: The results suggest that patients recruited to a trial by community pharmacists are willing to take part in data collection activities, and remote follow-up can be successfully conducted by researchers. The techniques employed to encourage high levels of retention should be investigated further in a larger study, alongside consideration of optimal strategies to collect data within community pharmacies.