Abstract
BackgroundMissed healthcare appointments (no-shows) are costly and operationally inefficient for health systems. No-show rates are particularly high for vulnerable populations, even though these populations often require additional care. Few studies on no-show behavior or potential interventions exist specifically for Federally Qualified Health Centers (FQHCs), which care for over 24 million disadvantaged individuals in the United States. The purpose of this study is to identify predictors of no-show behavior and to analyze the effects of a reminder intervention in urban FQHCs in order to design effective policy solutions to a protracted issue in healthcare.MethodsThis is a retrospective observational study using electronic medical record data from 11 facilities belonging to a New York City-based FQHC network between June 2017 to April 2018. This data includes 53,149 visits for 41,495 unique patients. Seven hierarchical generalized linear models and generalized additive models were used to predict no-shows, and multiple regression models evaluated the effectiveness of a reminder. All analyses were conducted in R.ResultsThe strongest predictor of no-show rates in FQHCs is whether or not patients are assigned to empaneled providers (z = − 91.45, p < 10− 10), followed by lead time for appointments (z = 23.87, p < 10− 10). These effects were fairly stable across facilities. The reminder had minimal effects on no-show rates overall (No show rate before: 41.6%, after: 42.1%). For individuals with appointments before and after the reminder, there was a small decrease in no-shows of 2%.ConclusionsThe limited effects of the reminder intervention suggest the need for more personalized behavioral interventions to reduce no-shows. We recommend that these begin with increasing the use of empaneled providers for preventive care appointments and reducing the lag time between setting the appointment and the actual date of the appointment, at least for individuals with a high rate of no-show. By complementing these with low-intensity, low-cost behavioral interventions, we would expect greater impacts for improved access to care, contributing to the well-being of vulnerable populations.
Highlights
IntroductionMissed healthcare appointments (no-shows) are costly and operationally inefficient for health systems
Missed healthcare appointments are costly and operationally inefficient for health systems
What predicts no-shows? This study has identified predictors of no-shows as a function of the borough of patient residence, the healthcare center they attended, empaneled provider, and lead
Summary
Missed healthcare appointments (no-shows) are costly and operationally inefficient for health systems. Few studies on no-show behavior or potential interventions exist for Federally Qualified Health Centers (FQHCs), which care for over 24 million disadvantaged individuals in the United States. Missed healthcare appointments are costly and operationally inefficient for health systems [1]. People with lower socioeconomic status are more likely to miss medical appointments [3], but are likely to require more outpatient care [4]. In the United States, Federally Qualified Health Centers (FQHCs) are a key provider of safety-net services for over 24 million low-income people who otherwise might not receive care [6]. FQHCs typically provide care for disadvantaged populations in underserved areas at little or no direct cost to patients, with a large number of patients qualifying for Medicare/Medicaid. Given the at-risk population they serve, access to preventive care is especially critical in FQHCs, which must provide care regardless of patients’ ability to pay
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