Dataset Information

A weekday intervention to reduce missed appointments.

ABSTRACT: The burden of missed healthcare appointments is so great that even small reductions in Did Not Attend (DNA) rate can secure tangible benefits. Previous studies have identified demographic factors that predict DNA rate. However, it is not obvious that these insights can be used to improve attendance, as healthcare providers do not control patient demographics. One factor that providers do control is appointment scheduling. We previously reported that appointments at the beginning of the week are more likely to be missed than appointments at the end of the week. This observation suggests a simple intervention to reduce DNA rate: schedule appointments for later in the week. Using data from a UK mental health hospital, we compared attendance rates for 12-months before and 12-months after the intervention began (916 appointments in total). Overall DNA rate fell from 34.2% pre-intervention to 23.4% post-intervention [χ2 (1, N = 916) = 13.01, p < 0.001; Relative Risk Reduction, 31.6%]. This effect was carried mainly by female patients, for whom more appointments could be moved to later in the week. Our findings confirm that DNA rate can be significantly reduced by loading appointments onto high-attendance days.

SUBMITTER: Ellis DA

PROVIDER: S-EPMC9521897 | biostudies-literature | 2022

REPOSITORIES: biostudies-literature

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A weekday intervention to reduce missed appointments.

Ellis David A DA Sanders Jet G JG Jenkins Rob R McAuslan Linda L

PloS one 20220929 9

The burden of missed healthcare appointments is so great that even small reductions in Did Not Attend (DNA) rate can secure tangible benefits. Previous studies have identified demographic factors that predict DNA rate. However, it is not obvious that these insights can be used to improve attendance, as healthcare providers do not control patient demographics. One factor that providers do control is appointment scheduling. We previously reported that appointments at the beginning of the week are ...[more]

PMID: 36174010

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Project description:BackgroundMissed appointments ("no-shows") are a persistent and costly problem in healthcare. Appointment reminders are widely used but usually do not include messages specifically designed to nudge patients to attend appointments.ObjectiveTo determine the effect of incorporating nudges into appointment reminder letters on measures of appointment attendance.DesignCluster randomized controlled pragmatic trial.PatientsThere were 27,540 patients with 49,598 primary care appointments, and 9420 patients with 38,945 mental health appointments, between October 15, 2020, and October 14, 2021, at one VA medical center and its satellite clinics that were eligible for analysis.InterventionsPrimary care (n = 231) and mental health (n = 215) providers were randomized to one of five study arms (four nudge arms and usual care as a control) using equal allocation. The nudge arms included varying combinations of brief messages developed with veteran input and based on concepts in behavioral science, including social norms, specific behavioral instructions, and consequences of missing appointments.Main measuresPrimary and secondary outcomes were missed appointments and canceled appointments, respectively.Statistical analysisResults are based on logistic regression models adjusting for demographic and clinical characteristics, and clustering for clinics and patients.Key resultsMissed appointment rates in study arms ranged from 10.5 to 12.1% in primary care clinics and 18.0 to 21.9% in mental health clinics. There was no effect of nudges on missed appointment rate in primary care (OR = 1.14, 95%CI = 0.96-1.36, p = 0.15) or mental health (OR = 1.20, 95%CI = 0.90-1.60, p = 0.21) clinics, when comparing the nudge arms to the control arm. When comparing individual nudge arms, no differences in missed appointment rates nor cancellation rates were observed.ConclusionsAppointment reminder letters incorporating brief behavioral nudges were ineffective in improving appointment attendance in VA primary care or mental health clinics. More complex or intensive interventions may be necessary to significantly reduce missed appointments below their current rates.Trial numberClinicalTrials.gov, Trial number NCT03850431.

Project description:BackgroundSMS texting systems have been considered a potential solution to reduce missed appointments in primary care. Existing research in this area focuses on qualitative studies investigating the attitudes of SMS text users and receivers.ObjectiveThis study aimed to examine appointment data from an independent general practitioner (GP) surgery in Wrexham, United Kingdom, with approximately 15,000 patients, to determine the impact of text messaging systems on reducing missed appointments. The objective of this study was to investigate whether the use of text messages can effectively reduce missed appointments.MethodsTo collect data for the study, SQL reports were run on EMIS Web, the United Kingdom's most widely used clinical system. The data spanned 10 years, from September 1, 2010, to March 31, 2020. Data accuracy was verified by cross-referencing with appointment diary records. Mann-Whitney and Kruskal-Wallis tests, chosen for their suitability in comparing groups in nonparametric settings, were conducted in Microsoft Excel due to its accessibility.ResultsStatistical analyses were conducted to compare data before and after implementation of the text messaging system. The results revealed a significant 42.8% reduction in missed appointments (before: 5848; after: 3343; P<.001). Further analysis of demographic characteristics revealed interesting trends, with no significant difference in missed appointments between genders, and variations observed across different age groups. The median number of missed appointments was not significantly different between genders (women: 1.55, IQR 1.11-2.16; men: 1.61, IQR 1.08-2.12; P=.73). Despite the prevalence of mobile phone use among young adults aged 20-25 years, the highest rates of missed appointments (848/7256, 11.7%) were noted in this group, whereas the lowest rates were noted in the 75-80 years age group (377/7256; 5.2%; P<.001). Analysis by age and gender indicated inconsistencies: women aged 20-25 years (571/4216) and men aged 35-40 years (306/3040) had the highest rates of missed appointments, whereas women aged 70-75 years (177/4216) and men aged 75-80 years (129/3040) had the lowest rates (P<.001 for both).ConclusionsThis study demonstrates that SMS text messaging in primary care can significantly reduce missed appointments. Implementing technology such as SMS text messaging systems enables patients to cancel appointments on time, leading to improved efficiency in primary care settings.

Project description:BackgroundMissed appointments diminish the continuity and quality of care.ObjectiveTo determine whether missing scheduled appointments is associated with characteristics of the populations in places where patients reside.DesignRetrospective cross-sectional study using data extracted from electronic health records linked to population descriptors for each patient's census tract of residence.PatientsA total of 58,981 patients ≥18 years of age with 275,682 scheduled appointments during 2014-2015 at a multispecialty outpatient practice.Main measuresWe used multinomial generalized linear mixed models to examine associations between the outcomes of scheduled appointments (arrived, canceled, or missed) and selected characteristics of the populations in patients' census tracts of residence (racial/ethnic segregation based on population composition, levels of poverty, violent crime, and perceived safety and social capital), controlling for patients' age, gender, type of insurance, and type of clinic service.Key resultsOverall, 17.5% of appointments were missed. For appointments among patients residing in census tracts in the highest versus lowest quartile for each population metric, adjusted odds ratios (aORs) for missed appointments were 1.27 (CI 1.19, 1.35) for the rate of violent crime, 1.27 (CI 1.20, 1.34) for the proportion Hispanic, 1.19 (CI 1.12, 1.27) for the proportion living in poverty, 1.13 (CI 1.05, 1.20) for the proportion of the census tract population that was Black, and 1.06 (CI 1.01, 1.11 for perceived neighborhood safety.ConclusionsCharacteristics of the places where patients reside are associated with missing scheduled appointments, including high levels of racial/ethnic segregation, poverty, and violent crime and low levels of perceived neighborhood safety. As such, targeting efforts to improve access for patients living in such neighborhoods will be particularly important to address underlying social determinants of access to health care.

Project description:Background and objectiveThe Coronavirus Aid, Relief, and Economic Security Act led to the rapid implementation of telemedicine across health care office settings. Whether this transition to telemedicine has any impact on missed appointments is yet to be determined. This study examined the relationship between telemedicine usage and missed appointments during the COVID-19 pandemic.MethodThis retrospective study used appointment-level data from 55 Federally Qualified Health Centre clinics in Texas between March and November 2020. To account for the nested data structure of repeated appointments within each patient, a mixed-effects multivariable logistic regression model was used to examine associations between telemedicine use and missed appointments, adjusting for patient sociodemographic characteristics, geographic classification, past medical history, and clinic characteristics. The independent variable was having a telemedicine appointment, defined as an audiovisual consultation started and finalized via a telemedicine platform. The outcome of interest was having a missed appointment (yes/no) after a scheduled and confirmed medical appointment. Results from this initial model were stratified by appointment type (in-person vs. telemedicine).ResultsThe analytic sample included 278,171 appointments for 85,413 unique patients. The overall missed appointment rate was 18%, and 25% of all appointments were telemedicine appointments. Compared to in-person visits, telemedicine visits were less likely to result in a missed appointment (OR = 0.87, p < .001). Compared to Whites, Asians were less likely to have a missed appointment (OR = 0.82, p < .001) while African Americans, Hispanics, and American Indians were all significantly more likely to have missed appointments (OR = 1.61, p < .001; OR = 1.19, p = .01; OR = 1.22, p < .01, respectively). Those accessing mental health services (OR = 1.57 for in-person and 0.78 for telemedicine) and living in metropolitan areas (OR = 1.15 for in-person and 0.82 for telemedicine) were more likely to miss in-person appointments but less likely to miss telemedicine appointments. Patients with frequent medical visits or those living with chronic diseases were more likely to miss in-person appointments but less likely to miss telemedicine appointments.ConclusionsTelemedicine is strongly associated with fewer missed appointments. Although our findings suggest a residual lag in minority populations, specific patient populations, including those with frequent prior visits or chronic conditions, those seeking mental health services, and those living in metropolitan areas were less likely to miss telemedicine appointments than in-person visits. These findings highlight how telemedicine can enable effective and accessible care by reducing missed healthcare appointments.KEY MESSAGESTelemedicine was associated with 13% lower odds of missed appointments.Patients with frequent medical visits or those living with chronic diseases were less likely to miss telemedicine appointments but more likely to miss in-person appointments.Patients seeking mental health services were less likely to miss telemedicine appointments but more likely to miss in-person appointments.Similarly, those living in metropolitan areas were less likely to miss telemedicine appointments but more likely to miss in-person appointments.

Project description:BackgroundRecently, studies have examined the underlying patient and practice factors for missed appointments, but less is known about the impact on patient health. People with one or more long-term conditions who fail to attend appointments may be at risk of premature death. This is the first study to examine the effect of missed primary healthcare appointments on all-cause mortality in those with long-term mental and physical health conditions.MethodsWe used a large, nationwide retrospective cohort (n = 824,374) extracted from routinely collected general practice data across Scotland over a 3-year period from September 2013 until September 2016. This data encompasses appointment history for approximately 15% of the Scottish population, and was linked to Scottish deaths records for patients who had died within a 16-month follow-up period. We generated appointment attendance history, number of long-term conditions and prescriptions data for patients. These factors were used in negative binomial and Cox's proportional hazards modelling to examine the risk of missing appointments and all-cause mortality.ResultsPatients with a greater number of long-term conditions had an increased risk of missing general practice appointments despite controlling for number of appointments made, particularly among patients with mental health conditions. These patients were at significantly greater risk of all-cause mortality, and showed a dose-based response with increasing number of missed appointments. Patients with long-term mental health conditions who missed more than two appointments per year had a greater than 8-fold increase in risk of all-cause mortality compared with those who missed no appointments. These patients died prematurely, commonly from non-natural external factors such as suicide.ConclusionsMissed appointments represent a significant risk marker for all-cause mortality, particularly in patients with mental health conditions. For these patients, existing primary healthcare appointment systems are ineffective. Future interventions should be developed with a particular focus on increasing attendance by these patients.

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A weekday intervention to reduce missed appointments.

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A weekday intervention to reduce missed appointments.

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