Date of Conferral

9-3-2025

Degree

Doctor of Nursing Practice (DNP)

School

Nursing

Advisor

Catherine Fant

Abstract

This Doctor of Nursing Practice (DNP) project was designed to develop a clinical practice guideline (CPG) to enhance appointment adherence among adults with depression in an outpatient mental health clinic, thereby improving outcomes. The practice-focused question was Will a CPG utilizing a multimodal reminder system improve appointment adherence? Missed appointments in outpatient mental health care contribute to delayed treatment, increased symptom severity, and higher rates of emergency care utilization. These disruptions not only compromise clinical outcomes but also financially burden healthcare systems and disrupt continuity of care. The CPG was developed using the Johns Hopkins evidence-based practice model and a systematic review of the literature. Studies were appraised using the Johns Hopkins hierarchy of evidence to evaluate strength and quality. The guideline incorporated multimodal reminders (phone, text, email), positively framed messaging, and predictive modeling to identify high-risk patients. The panel of expert reviewers found the tool satisfactory with a mean item rating of 6.22 based on a Likert scale of 1 = Strongly disagree for failing to meet the item criteria and 7 = Strongly agree for exceptional quality for meeting the item criteria. Reviewers recommended improving stakeholder engagement, enhancing transparency in evidence appraisal, and clarifying editorial independence. The final product includes implementation strategies, staff training, and monitoring plans. Designed for dissemination in outpatient settings, the guideline promotes evidence-based care, improves appointment adherence, and contributes to positive social change through improved access, equity, and patient-centered outreach.

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