Date of Graduation
5-2026
Document Type
Capstone
Keywords
Social determinants of health, SDOH, community resource referral platform, CRRP, primary care, federally qualified health center, FQHC, appointment adherence
Degree Name
Doctor of Nursing Practice (DNP)
Degree Level
Graduate
Advisor/Mentor
Ballentine, Hope
Committee Member
Taylor, Megan
Abstract
Appointment non-adherence in primary care is closely linked to social determinants of health (SDOH), including food insecurity, housing instability, and lack of transportation. These barriers are especially prevalent among patients served by federally qualified health centers (FQHCs) in Northwest Arkansas. This quality improvement project aimed to improve appointment adherence by implementing a standardized SDOH screening and referral protocol integrated with a community resource referral platform (CRRP) at a local FQHC. Guided by the Iowa Model of Evidence-Based Practice, the intervention included routine PRAPARE screening during intake, electronic referral to community resources with patient consent, and staff education to support workflow adoption. A quasi-experimental pre-post design was used to compare appointment adherence, no-show rates, and cancellation rates before and after implementation. Additional measures included referral volume, referral completion, patient and staff satisfaction, and the types of SDOH needs identified. Results showed a 5.37% decrease in no-show appointments and a 4.17% decrease in canceled appointments from April 2025 and March 2026. Nearly all patients screened had at least one unmet social need, and those connected to the CRRP often received support for multiple concerns. Patient and staff feedback indicated that the workflow was feasible, acceptable, and supported by targeted education, EHR integration, and leadership engagement. These findings suggest that embedding standardized SDOH screening and community referral workflows into routine primary care may improve care coordination and support appointment adherence in FQHC settings.
Citation
Dillard, B. N., Ballentine, H., & Taylor, M. (2026). Improving Appointment Adherence in a FQHC by Addressing SDOH. The Eleanor Mann School of Nursing DNP Capstone Projects. Retrieved from https://scholarworks.uark.edu/nursstudent/50
