ABSTRACT
Background: The COVID-19 pandemic has highlighted the importance of telehealth to maintain access to care. In our geriatric primary care clinic affiliated with an urban safety net hospital, we observed high rates of missed telehealth visits (no-shows). We undertook a quality improvement project to decrease the number of telehealth no-show visits by 25% in three months. Methods: We interviewed stakeholders to understand the process of scheduling telehealth visits and providing appointment reminders. Patients received a reminder phone call a few days before all scheduled appointments, whereas they also received a reminder letter ahead of in-person visits. We called a representative sample of patients who had missed their telehealth visit to understand barriers to attendance and preferred method of visit reminders. One recurring theme was that patients preferred reminder letters. Therefore, for our first Plan-Do-Study Act (PDSA) cycle, we implemented a reminder system that standardized the use of letters for all telehealth visits two weeks prior to scheduled visit time. Results: During the 8 weeks prior to our process change, chart review demonstrated that the practice's telehealth no-show rate was 13.6% (73 per 536 scheduled telehealth visits), compared with our in-person no-show rate of 7.8% (69 per 874 scheduled in-person visits). Post-intervention telehealth no-show rate was 9.1% (47 per 519 scheduled telehealth visits) over 6 weeks. The in-person no-show rate over the same time period was 7.3% (36 per 493 scheduled in-person visits). Our intervention was associated with a 33.1% reduction in telehealth no-show rate whereas the no-show rate for in-person visits decreased by 8% over the same time period. Conclusions: Standardized letter reminders, such as those used for in-person visits, can help improve telehealth show rates in a primary care geriatric clinic. Future PDSA cycles will focus on addressing technological challenges and educating patients on the utility of telehealth visits.