Improving Initial Visit No-Show Rate in a Pediatric Weight Management Clinic

Background: Tertiary care pediatric Weight Management Clinics (WMC) have a high no-show rate for the first appointment. Limited evidence suggests that an orientation session prior to the first WMC visit can improve attendance rates. Methods: A multidisciplinary team utilized an A3 quality improvement framework to identify root causes and continuous improvement approaches. Our first Plan-Do-Study-Act cycle included design of a virtual WMC pre-visit group orientation (JUMP START) which included information about WMC components, providers, visit frequency, lifestyle intervention, advanced treatment options, and key nutrition changes associated with healthier weight (August 2021). Follow-up qualitative interviews were done with a subset of parents/ caregivers. Primary outcome measure is no-show rate for initial WMC visits. Results: 479 patients (50% of referrals) attended JUMP START in the first 8 months. Insurance status was 36% commercial, 61% Medicaid and 3% self-pay. The WMC initial visit no-show rate decreased from a baseline mean of 39% (April-July 2021) to a mean of 12.9% (October 2021 -March 2022). Among patients attending JUMP START, 55% scheduled and attended an initial WMC appointment (insurance type: 42% commercial, 57% Medicaid and 1% self-pay). During qualitative interviews, parents/caregivers favorably rated their JUMP START visit. Areas for improvement identified included not being able to discuss specific questions about their child due to the group nature of the session and technical issues with connection and participation. Conclusions: A pre-initial visit virtual orientation session led to improvements in no show rates at initial WMC visits. However, health disparities in WMC attendance rates persist and ongoing improvement is needed. Next steps include exploring additional root causes, decreasing disparities in initial WMC visit attendance rate, and addressing parent/caregiver identified barriers to virtual orientation attendance.