No Show Clinic Visits in Pediatric GI: Impact of Wait Time, Insurance Status, and Rising Gasoline Prices

Abstract

Purpose: Missed outpatient appointments cause significant burden on healthcare due to decreased productivity, wasted clinic slots, and lost healthcare dollars. These “no show” visits have averaged 12% of total appointments in the primary care setting, but there is limited data on this topic in relation to subspecialty care. We characterized patterns of non-attendance behavior at two pediatric gastroenterology (GI) clinics. Methods: Comprehensive computer appointment data was collected from two university-affiliated pediatric GI clinics. A total of 5,047 appointments in April and May of both 2010 and 2011 were studied. Independent variables examined included patient age, appointment type (new or return), day of the week on which the appointment occurred, average distance of travel to the appointment, type of insurance coverage, and length of time between appointment scheduling and the actual clinic visit (wait time). Data from both a hospital-based clinic and a community practice clinic was compared. Distance of travel was cross-analyzed with statistics on average gasoline prices (U.S. Energy Information Administration) during ths study period to estimate additional costs incurred by patients. This study was IRB approved. Results: The overall no show rate was 11% (561 appointments), with a higher default rate at the hospital-based clinic (12.5%) compared to the community practice clinic (9.1%; p<0.001). Patient age, type of insurance coverage, and wait time were most strongly associated with no show behavior. Patients aged 0-2 years old were more likely to complete their scheduled appointment, while those aged 3-5 years old (toddlers) were more likely to default (p<0.001). No show patients were more likely to be self-pay or have medical assistance and had an average wait time that was approximately 9 days longer than those who completed their appointment. Of all patients studied at the community practice site with a required distance of travel that was over 100 miles, a higher proportion missed their appointment in 2011 compared to 2010, when the average price per gallon of regular gasoline was approximately $1 lower. Conclusion: Over 10% of pediatric GI clinic visits in this study were no shows. Higher no show rates among toddler-aged patients may be related to compounding variables inherent to this age group (i.e. parents' lost wages, use of daycare, etc.). Increasing gas prices can cause additional burden on self-pay patients or those with medical assistance and may lead to more no show visits. Longer wait times may result in more forgotten appointments, added emergency room visits, and possibly higher rates of hospitalization. Societal factors appear to play a critical role in no show behavior in pediatric GI.