Abstract
BackgroundDemand for endoscopic procedures scheduled with anesthesia is increasing and no-show to appointments carries significant patient health and financial impact, yet little is known about predictors of no-show.MethodsWe performed a 16-month retrospective observational cohort study of patients scheduled for outpatient endoscopy with anesthesia at a county hospital serving the safety-net healthcare system of San Francisco. Multivariate logistic regression analysis was performed to evaluate associations between attendance and predictors of no-show.ResultsIn total, 511 patients underwent endoscopy with anesthesia during the study period. Twenty-seven percent of patients failed to attend an appointment and were considered “no-show”. In multivariate analysis, higher no-show rates were associated with patients with a prior history of no-show (odds ratio [OR] 6.4; 95 % confidence interval [CI], 2.4- 17.5), those with active substance abuse within the past year (OR 2.2; 95 % CI 1.4-3.6), those with heavy prescription opioids/benzodiazepines use (OR 1.6; 95 % CI 1.0-2.6) and longer wait-times (OR 1.05; 95 % CI 1.00-1.09). Inversely associated with patient no-show were active employment (OR 0.38; 95 % CI 0.18-0.81), patients who attended a pre-operative appointment with an anesthesiologist (OR 0.52; CI 0.32-0.85), and those undergoing an advanced endoscopic procedure (OR 0.43; 95 % CI 0.19-0.94).ConclusionIn a safety-net healthcare population, behavioral and social determinants of health, including missed appointments, active substance abuse, homelessness, and unemployment are associated with no-shows to endoscopy with anesthesia.
Highlights
Demand for endoscopic procedures scheduled with anesthesia is increasing and no-show to appointments carries significant patient health and financial impact, yet little is known about predictors of no-show
We examine predictors of no-show amongst patients undergoing outpatient diagnostic and therapeutic endoscopy scheduled with anesthesia support at a county hospital in San Francisco
Patients who attended a pre-operative appointment with an anesthesiologist, and patients undergoing an advanced procedure (ERCP, endoscopic ultrasound (EUS), or single balloon enteroscopy) were less likely to miss their endoscopic procedure
Summary
Demand for endoscopic procedures scheduled with anesthesia is increasing and no-show to appointments carries significant patient health and financial impact, yet little is known about predictors of no-show. The efficiency of healthcare is reduced and patients experience longer wait times for healthcare [1, 2]. Longer wait times in turn may reduce healthcare quality and patients who routinely miss appointments experience poorer health outcomes [3, 4]. Because increased utilization of safety-net healthcare settings is anticipated due to Medicaid expansion through the Affordable Care Act, Endoscopy is an important setting in which to examine attendance because of its limited availability among many patient populations and the substantial financial impact of appointment no-show by patients [15]. Few studies have examined factors contributing to patient non-attendance
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