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Clinical Trial
. 2021 Dec 22;22(1):253.
doi: 10.1186/s12875-021-01593-8.

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

Phillip Groden  1 , Alexandra Capellini  2 , Erica Levine  3 , Ania Wajnberg  4 , Maria Duenas  4 , Sire Sow  4 , Bernard Ortega  4 , Nia Medder  4 , Sandeep Kishore  5
Affiliations
Clinical Trial

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

Phillip Groden et al. BMC Fam Pract. .

Abstract

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.

Keywords: Behavioral economics; Chronic care; High-cost populations; Patient retention.

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Conflict of interest statement

SK serves as a consultant for Resolve to Save Lives and has led partnerships on chronic conditions supported by the Arnhold Institute for Global Health at the Icahn School of Medicine at Mount Sinai and Teva Pharmaceuticals.

Figures

Fig. 1
Fig. 1
a Template of the clinic signage component of the behavioral economics intervention, featured within PEAK Health’s waiting and exam rooms. b Template of the appointment reminder card component of the behavioral economics intervention, located next to each provider workstation. The format and language were mirrored within an EMR template that was introduced at 6-months post-implementation to boost adoption
See this image and copyright information in PMC

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