The impact of a reminder email on the return to care behavior of infertility patients after a first office visit: A quality improvement project

RESEARCH QUESTION: Prior research has determined that up to half of infertility patients attend one visit with an infertility specialist but do not return for a diagnostic workup or treatment. As part of a quality-of-care improvement project, patients who had not returned after one visit with an infertility specialist received an email which asked why they had not returned. The return to care behavior was then compared to a period of time when the email was not sent out, to answer the question as to whether or not the email had a significant impact on behavior. DESIGN: From July 2017 to March 2018, 301 eligible patients who attended one visit but did not return to care received an email; 657 subsequent patients from April to December 2018 did not receive one. The email asked questions about that visit, offered support, contact information for the employee sending the email and why they had not returned. RESULTS: All patients were followed for 11 months after their initial visit. Forty-one percent of the email group returned to care, compared to 32% who did not (P < 0.0014). For those who gave a reason why they hadn't returned, 32% of the respondents conceived on their own, 3% transferred to another infertility center, 31% were taking a break, 3% were unhappy with their care, and 31% made a return to care appointment. Thus, the email was associated with a significant increase in return to care when compared to women who did not receive an email. The most common reason why patients did not return was spontaneous conception closely followed by taking a break. CONCLUSIONS: A compassionate email sent after one visit may increase return to care behavior.