Date of Degree


Document Type

Doctoral Project

Degree Name

Doctor of Nursing Practice (DNP)




Diana Beckmann-Mendez


Eduardo Sanchez


This quality improvement project aimed to improve routine well-child exam rates in accordance with the American Academy of Pediatrics and Texas Health Steps recommendations through the implementation of a parental notification system. Missed well-child appointments impact health care by disturbing continuity of care and complicating preventive care services. Implementation of the parental notification system during June 2017 to August 2017 consisted of 100 patients from birth to 18 years of age for scheduled well-child visits in a pediatric clinic with a large Hispanic and Medicaid population. Interventions consisted of staff training, reminder phone calls 24 to 48 hours prior to the appointment, distribution of appointment reminder cards, follow-up on missed appointments, and a parental caregiver questionnaire. Overall, 88% received an appointment reminder with 65% having spoken directly to a staff member and 23% receiving a voicemail. The well-child completed rate was at 64% with a well-child no-show rate of 21%, a cancellation rate of 9%, a reschedule rate of 6% and a recall rate of 62%. The parental notification system was found to not have an effect on scheduled well-child delivery (p = .243), however well-child visits were more likely to be completed when a parent spoke directly to a clinical staff member versus voicemail (p = .004). The increase in the well-child cancellation and reschedule rates provided the clinic with opportunities to schedule additional appointments. Parents found the reminders to be helpful, would like to continue receiving them, and recommend them.