Appointment Rates Research Articles

Epidemiological Data from Patients Who Underwent Colonoscopy from High-Susceptibility Vacancies

Abstract Objective The objective of this study was to analyze the epidemiological profile of patients to propose measures that facilitate regulation and access to diagnostic imaging exams. Methods Data were collected from 157 scheduled exams for high-suspicion colonoscopy through regulation systems and electronic medical records from January to December 2023. Results: The data showed a higher rate of appointments among females, particularly in older age groups (71–80 years). There was a high rate of non-attendance on the day of the exam scheduled during the coldest months of the year. The most prevalent biopsy location was the colon region, with a predominance of low-grade adenomas and polyps. Conclusion Facilitating access to diagnostic imaging exams includes regionalization in scheduling. Monitoring results allows for the tracking of family members, enabling preventive action and early diagnosis.

The Impact of Educational Handouts on the Compliance Rate for Bariatric Patient Follow-Up Appointments.

Compliance rates for follow-up appointments are an issue for postoperative sleeve gastrectomy (SG) patients. Without consistent reinforcement and monitoring of patient progress, patients tend to gain the weight back, all of the medical improvements made are lost, and the ability to access patients for potential complications is denied. Patients need much reinforcement during their forever bariatric lifestyle, and the lack of consistent reminders may contribute to follow-up noncompliance and recidivism in SG patients. As time progresses, the follow-up appointment compliance rate decreases. Decreased follow-up can lead to a higher risk for complications such as asymptomatic esophagitis, and current recommendations suggest that esophagogastroduodenoscopy screening should occur 3years postoperatively. After 1 year, the follow-up compliance decreases dramatically so that by the 3-year postoperative period, very few patients are being seen and scheduled for interventions such as an esophagogastroduodenoscopy. The objective of this quality improvement project was to evaluate the effectiveness of a patient educational handout on SG bariatric patient follow-up visit compliance. A quasi-experimental design and retrospective chart review was chosen. An educational handout was developed. Preintervention retrospective chart review consisted of 441 SG patients expecting a follow-up in 12 to 48months. Postintervention included 3months of the handout intervention with data collection totaling 198 patients. Follow-up compliance for 4 year visits noted 0% preintervention/12.2% postintervention (P =.008), for 3 year visits 13.4% preintervention/12% postintervention (P =.846), for 2 year visits 26.3% preintervention/28.6% postintervention (P =.755), for 18months visits 26.3% preintervention/32.6% postintervention (P =.365), and for 12months visits 54.2% preintervention/34.1% postintervention (P =.011). In this quality improvement project, educational handouts did not have a statistical impact on follow-up compliance.

Managing no-shows in healthcare: insights from an urban Health District in Northern Italy

Abstract Background Non-attendance at healthcare appointments, known as no-show, poses significant challenges to healthcare systems, disrupting patient care continuity, exacerbating waiting times, and straining resources. Addressing this issue is crucial for optimizing health care delivery and containing costs. This study explores the phenomenon of patient no-shows and aims to identify factors associated in a densely populated healthcare district in Turin, Northern Italy. Methods Data were extracted from the healthcare management system covering outpatient care appointments in the health district in 2022 and 2023. The analysis included various patient and service-related variables. Missing information on key variables were managed with listwise deletion. Descriptive statistics provided an overview of missed appointment rates, while multivariate analysis explored various patient and service-related variables. Results A 5.1% (n = 6198) no-show rate was observed out of 120,405 records. The total cost incurred due to missed appointment fees amounted to €127,244. Several factors were associated with a significantly increased likelihood of no-show (p < 0.05), including initial visit (OR = 1.11), deferred priority (OR = 1.22), non-exempt status from healthcare co-payments (OR = 1.36), exemption based on income (OR = 1.82), age under 18 (OR = 2.46) and under 65 (OR = 2.32), male gender (OR = 1.17), residency outside the Piedmont Region (OR = 1.31) and outside Italy (OR = 2.46), and longer waiting time (OR = 1.01). Conclusions This study sheds light on the widespread issue of patient no-shows and its economic implications. It provides clear direction for implementing tailored interventions in healthcare settings. As a response to these findings, a telephone recall project was launched. Its efficacy will be evaluated in subsequent assessments to determine if it can effectively alleviate the burden of no-shows, thus enhancing healthcare efficiency and ensuring continuity of care for patients. Key messages • The no-show phenomenon has important implications both organizationally and economically. • The magnitude and major determinants of patient no-shows must be recognized to guide the deployment of tailored interventions in a real-world setting.

Postoperative Access and Compliance Following Medial Patellofemoral Ligament Reconstruction in Hispanic Adolescents Mirrors the Non-Hispanic Adolescent Population.

Disparity in surgical care of patellar instability patients has not been fully investigated in the adolescent Hispanic population. This demographic has been shown to have differences in their care, including a lower rate of surgical treatment for patellar instability. Socioeconomic factors have been cited as a factor that influences patient outcomes and its relationship with ethnicity in context of patellar instability has not been evaluated. Review performed of patients <19 years of age who underwent MPFL reconstruction between September 2008 and December 2015. Demographics, patient median household income data, and clinical variables were collected. Generalized linear mixed model (GLMM) with subject as random effects factor was utilized to evaluate differences between ethnicity groups due to nonindependence of data. It was then expanded to incorporate interactions between ethnicity and income. Ninety-five patellar dislocation events met criteria in 85 adolescents (mean age: 15.5y). Thirty-four (40%) adolescents identified as Hispanic. In univariate analysis no differences were found between Hispanic and non-Hispanic patients. The multivariate GLMM demonstrated a significant interaction between ethnicity and income. The Hispanic group in the >100% State median income category had the highest rate of postoperative clinic appointments attended ( P =0.019). The Hispanic group in the <100% State median income category had the lowest rate of physical therapy appointments attended ( P =0.044). No differences were observed for duration of follow-up ( P =0.57) or final Kujala score ( P =0.75). Hispanic ethnicity alone is not associated with inferior postoperative management after MPFL reconstruction in adolescents. However, when socioeconomic status is considered, Hispanic patients of lower-income backgrounds are found to have lower compliance with postoperative rehab recommendations. Level III.

Assessing the need for specialty consultation for isolated medial orbital wall fractures

ObjectiveThis objective was to assess if the current practice of interfacility transfer and immediate specialty consult is justified by the rate of surgical repair for isolated medial orbital wall fractures. Study DesignThis is a retrospective descriptive study utilizing the records of all patients with isolated medial orbital wall fractures who presented to the ED at Boston Medical Center from January 2014 to December 2022. A descriptive analysis was completed. Results65 patients with isolated medial orbital wall fractures were identified. No patient underwent surgical intervention for repair of their fracture. 15% of the patients were transferred from an outside facility. The facial trauma team was consulted for 70% of the patients. Concomitant consultation of the ophthalmology and facial trauma teams occurred for 54% of the patients. Patients with no specialty consult had the shortest average length of ED stay. The no-show rate for follow-up appointments was 70%. ConclusionsThe absence of surgical repair for isolated medial orbital wall fractures across multiple surgical specialties, multiple attending providers, a wide age range, and all mechanisms of injury along with a 70% follow-up no-show rate may call into question the conventional approach of interfacility transfer and specialty consult for these fractures.

Effectiveness of text message reminders on paediatric appointment adherence: a systematic review and meta-analysis.

Attending health appointments is important for the paediatric population, as it allows for earlier detection of health issues and subsequent necessary treatments. It also ensures timely immunisations while also allowing patients or their parents to raise health concerns. Hence, it is crucial to take steps to ensure that such medical appointments are attended.To evaluate the effectiveness of text message reminders (TMRs) in improving paediatric patients' adherence to their appointments.A systematic review and meta-analysis were conducted. The search spanned across eight online databases from their inception dates to January 2024. The random-effects model was utilised to conduct the meta-analysis, where risk ratio was used as the effect measure. Subgroup analyses were conducted for age, number of TMRs sent, and type of appointments attended.In total, 13 studies were included. Compared to standard care (involving non-text message reminders or no reminders), TMRs were significantly more effective in improving appointment attendance among the paediatric population. Significant subgroup differences were found in the type of appointments attended, where TMRs were more effective for medical appointments compared to vaccination appointments. No differences in adherence to appointments were found across age groups or the number of TMRs sent. Conclusion: Sending TMRs can be a potentially cost-effective way to improve the attendance rate of paediatric medical appointments, given the ease of implementation and the extensive mobile phone usage globally. Future studies should compare TMRs to other modes of automated reminders such as telephone messages or emails, to identify the most optimal method of delivery. Trial registration: PROSPERO (CRD42023464893).

Building Bridges: Increasing Access to Care and Continuation of Medication for Opioid Use Disorder Through Community Partnerships

The opioid epidemic continues to pose a formidable challenge to public health, necessitating innovative approaches to enhance access to care and support continuity of treatment for individuals with opioid use disorder (OUD). Opioid overdose-related deaths in Detroit have increased over four-fold from 1999 to 2019, yet the rate of medication for opioid use disorder (MOUD) prescriptions in Detroit has been half the rate compared to Michigan as a whole. Limited access to care remains a major factor in continued opioid use, which is driven in part by an individual’s insurance coverage. As the largest payer of substance use disorder services in the United States, Medicaid plays a central role in efforts to address the opioid epidemic. Over half of the Detroit population is either enrolled in Medicaid or uninsured. Henry Ford Hospital (HFH) continues to treat hospitalized patients with OUD. Post-discharge follow-up appointments for continuation of MOUD have been shown to increase rates of prolonged abstinence, reduce rates of readmission, and decrease mortality rates. Despite HFH’s significant community impact, there have been limitations on which insurance carriers are accepted at our institution when patients try to establish outpatient primary care or specialty addiction medicine services for MOUD. This insurance-driven barrier has consequently limited our ability to provide best practices in supporting patients with OUD. To address this disparity, we aimed to investigate the impact of leveraging our partnership with Community Health and Social Services (CHASS) Clinic, a local Federally Qualified Health Center network, as an opportunity for underinsured and non-insured patients with OUD to have increased access to post-discharge follow-up appointments with qualified providers for continuation of MOUD. In collaboration with the HFH Addiction Medicine Consult team, HFH Primary Care Physicians, and CHASS MOUD providers, we designed a multifaceted intervention to improve the continuum of care for patients with OUD. We established a post-discharge referral pathway between HFH and CHASS, enhancing communication channels to facilitate care coordination. If a patient was admitted to HFH with a diagnosis of OUD and received an Addiction Medicine consult, the primary team was advised to arrange a post-discharge follow-up appointment for MOUD. The location of the appointment was determined by the patient’s insurance. Patients already established with HFH, or with commercial insurance, were scheduled with HFH providers for MOUD. Patients with Medicaid or no insurance were scheduled with CHASS MOUD providers. In the six months prior to implementation, only 3 of 60 (5%) of patients with a diagnosis of OUD that received an Addiction Medicine consult were scheduled to have a post-discharge follow-up for MOUD. In three months after implementation, 8 of 32 (25%) patients received post-discharge follow-up for MOUD. By utilizing the partnership between HFH and CHASS, our intervention was associated with a five-fold higher rate of follow-up appointments for continuation of MOUD. These findings underscore the effectiveness of community partnerships in addressing barriers to care and enhancing treatment for individuals with OUD.

Enhancing Continuity of Physiotherapy Care: Investigating the Impact of Missed Follow-up Appointments in Outpatient Settings

Background: Physiotherapy is essential in managing chronic diseases in musculoskeletal, neurological and cardiovascular domains. These conditions have high morbidity rates and hence need therapeutic interventions that enhance the quality of life. However, poor adherence to review appointments diminishes treatment effectiveness and healthcare productivity. Evidence from developed countries reveals varying missed appointment (MA) rates, thereby calling for targeted treatments embedded in contextual factors. Methods: This was a retrospective study using clinic data to identify MA rates and associated variables that included age, gender, and residential origins. The effect of each variable on appointment adherence was investigated. An intervention plan was designed to reduce MA through appointment reminders and patient education. Incentives were also foreseen. Descriptive statistics, Pearson’s correlation and cost-benefit analysis was conducted using SPSS version 23. Results: The rate of MA was 22% initially, significantly reducing to 12% after the intervention (p&lt;0.001). The demographic variables significantly relating to appointment adherence were age group and residential location (p&lt;0.001, 0.012) respectively. Seasonality and referral sources played their role in attendance patterns, which align with earlier studies on healthcare use determinants. Conclusion: This study provides deep insights from physiotherapy appointment adherence in Pakistan and depicts successful measures for reducing MAs and improving treatment delivery. The findings represent the values of patient-centred treatments, which result in a better functional outcome for patients, with a smooth running of clinic operations. Keywords: Appointments, Follow-up, Physiotherapy, Records.

Implementation and Evaluation of the Enhanced Maintenance Reminder Staff Training Module in Improving Objection Handling Skills of Newly Hired Toyota Dealer Personnel

This study describes the implementation and evaluation of the enhanced Maintenance Reminder Staff (MRS) training module to improve objection handling skills of newly hired Toyota dealer personnel. The research study employs a quasi-experimental design with two groups of newly hired MRS. The MRS were categorized into two groups that will undergo different treatments: (1) With Pre/Post Test, With Training, With Post-Test, and (2) With Pre and Post Test, with Training (Enhanced MRS Module), With Post Test. The participants were evaluated using the identified Knowledge and Skill Level Indicators (KSLIs): (1) Pre/post Test Score, (2) Mystery Shop Results, (3) CSI Result, (4) Booked Appointment Rate, and (5) Toyota Dealer Success Program (TDSP) Score. The study findings shed light on the effectiveness of the implemented enhanced training module on objection handling skills of newly hired MRS, as well as its implications for educational practice in the corporate setting, highlighting its potential to positively contribute to the overall success of Toyota.

Risk Factors for Missed Follow-up Appointments among Facial Trauma Patients.

A retrospective case-control study was performed to characterize the rate of missed follow-up appointments after facial trauma and identify associated risk factors.Follow-up appointments for facial trauma over a 3-month period at a single, safety net hospital were analyzed. Appointment-specific, sociodemographic, trauma, and management data were compared between cases (missed appointments) and controls (attended appointments). Univariate testing and multivariable logistic regression were employed.A total of 116 cases and 259 controls were identified, yielding a missed appointment rate of 30.9% (116/375). Missed appointments were significantly associated with initial clinic appointments compared to return visits (odds ratio [OR] 2.21 [1.38-3.54]), afternoon visits compared to morning (OR 3.14 [1.94-5.07]), lack of private health insurance (OR 2.91 [1.68-5.18]), and presence of midface fractures (OR 2.04 [1.28-3.27]). Missed appointments were negatively associated with mandible fractures (OR 0.56 [0.35-0.89]), surgical management (OR 0.48 [0.30-0.77]), and the presence of nonremovable hardware (OR 0.39 [0.23-0.64]). Upon multivariable logistic regression, missed appointments remained independently associated with afternoon visits (adjusted OR [aOR] 1.95 [1.12-3.4]), lack of private health insurance (aOR 2.73 [1.55-4.8]), and midface fractures (aOR 2.09 [1.21-3.59]).Nearly one-third of facial trauma patients missed follow-up appointments, with the greatest risk among those with afternoon appointments, lacking private health insurance, and with midface fractures.

Telemedicine as a Referral Bridge: A Nurse Practitioner–Led Intervention to Increase Initial Psychiatric Appointment Attendance

Patients with depression and anxiety symptoms present to urgent care settings and receive psychiatric referrals. Referred patients often have difficulty establishing care, leading to low attendance at initial appointments and impacting outcomes. This quasi-experimental study implemented a telemedicine-based intervention in which a nurse practitioner (NP) engaged patients every 2 weeks while awaiting psychiatry. Patients who declined the intervention but consented to follow-up were the comparison group. The intervention group demonstrated an 87% completion rate of psychiatric appointments compared with 0% in the comparison group. The average duration of referral was 63.7 days. Patients with mental illness need support while awaiting psychiatry. Patient engagement from an NP using telemedicine promotes successful transition of patients from urgent care to psychiatry. This NP-led approach promotes referral loop closure and can be used by NPs in various clinical settings, emphasizing positive patient outcomes.

The Impact of Telemedicine on Human Immunodeficiency Virus (HIV)-Related Clinical Outcomes During the COVID-19 Pandemic

The coronavirus disease of 2019 (COVID-19) pandemic exacerbated barriers to care for people living with human immunodeficiency virus (HIV) (PLWH). The quick uptake of telemedicine in the outpatient setting provided promise for care continuity. In this study, we compared appointment and laboratory no-show rates in an urban outpatient HIV clinic during three time periods: (1) Pre-COVID-19: 9/15/2019–3/14/2020 (predominately in-person), (2) “Early” COVID-19: 3/15/2020-9/14/2020 (predominately telemedicine), and (3) “Later” COVID-19: 9/15/2020-3/14/2021 (mixed in-person/telemedicine). Multivariable logistic regression models evaluated the two study hypotheses: (i) equivalence of Period 2 with Period 1 and of Period 3 with Period 1 and (ii) improved outcomes with telemedicine over in-person visits. No-show rates were 1% in Period 1, 4% in Period 2, and 18% in Period 3. Compared to the pre-pandemic period, individuals had a higher rate of appointment no-shows during Period 2 [OR (90% CI): 7.67 (2.68, 21.93)] and 3 [OR (90% CI): 30.91 (12.83 to 75.06). During the total study period, those with telemedicine appointments were less likely to no-show than those with in-person appointments [OR (95% CI): 0.36 (0.16–0.80), p = 0.012]. There was no statistical difference between telemedicine and in-person appointments for laboratory completion rates. Our study failed to prove that no-show rates before and during the pandemic were similar; in fact, no-show rates were higher during both the early and later pandemic. Overall, telemedicine was associated with lower no-show rates compared to in-person appointments. In future pandemics, telemedicine may be a valuable component to maintain care in PLWH.

Reducing No-Show Appointments in Preanesthesia Screening

PurposePreanesthesia screening is critical to evaluate the patient’s medical and surgical history prior to any procedure or surgery to assess for risks and to optimize outcomes during the perioperative period. Missed appointments impede the ability to identify comorbidities, perform cardiac testing, review laboratory results and current medications. No-shows also result in a waste of clinical resources and impacts the schedules of Advance Practice Providers (APPs). The purpose of this quality improvement project was to decrease the number of missed appointments in the outpatient preanesthesia and surgical screening clinic and the impact on provider satisfaction. DesignThe design of this quality improvement project was pre and post design. Automated and live phone calls reminders were provided for patients scheduled in the outpatient preanesthesia. Data was collected to compare missed appointment rates from a 3-month period prior to the project implementation and a 3-month period afterwards. MethodsPre-data collection included the number of no-shows in the EHR system from the previous 3 months. Participants included all adult patients who are scheduled for a pre-anesthesia surgical screening appointment. Provider satisfaction was assessed using a 5-question survey, pre and post innovation. FindingsReminder systems had a statistically significant impact on reducing the number of no-shows in the preanesthesia and surgical screening clinic (PASS). No significant impact was shown in provider satisfaction. ConclusionImplementation of a reminder system can help to reduce no show rates in clinics. Patient no-shows overload the health system by reducing the productivity of providers and waste resources including use of clinic staff, longer wait times for other patients, and the timing providers put into chart preparation.

Design and implementation of automated notification systems and an electronic whiteboard for radiation therapy planning monitoring.

Radiotherapy (RT) treatment and treatment planning is a complex process prepared and delivered by a multidisciplinary team of specialists. Efficient communication and notification systems among different team members are therefore essential to ensure the safe, timely delivery of treatments to patients. To address this issue, we developed and implemented automated notification systems and an electronic whiteboard to track every CT simulation, contouring task, the new-start schedule, and physician's appointments and tasks, and notify team members of overdue and missing tasks and appointments. The electronic whiteboard was developed to have a straightforward view of current patients' planning workflow and to help different team members coordinate with each other. The systems were implemented and have been used at our center to monitor the progress of treatment-planning tasks for over 2 years. The last-minute plans were relatively reduced by about 40% in 2023 compared to 2021 and 2022 with a p-value<0.05. The overdue contouring tasks of more than 1 day decreased from 46.8% in 2019 and 33.6% in 2020 to 20%-26.4% in 2021-2023 with a p-value<0.05 after the implementation of the notification system. The rate of plans with 1-3 day planning time decreased by 20.31%, 39.32%, and 24.08% with a p-value<0.05 and the rate of plans with 1-3 day planning time due to the contouring task overdue more than 1 day decreased by 49.49%, 56.89%, and 46.52% with a p-value<0.05 after the implementation. The rate of outstanding appointments that are overdue by more than 7 days decreased by more than 5% with a p-value<0.05 following the implementation of the system. Our experience shows that this system requires minimal human intervention, improves the treatment planning workflow and process by reducing errors and delays in the treatment planning process, positively impacts on-time treatment plan completion, and reduces the need for compressed or rushed treatment planning timelines.

Telemedicine Reduces Missed Appointments but Disparities Persist

IntroductionMissed appointments also known as “no-shows” adversely affect clinical outcomes, clinic efficiency, and quality of care and have been attributed to barriers such as work schedule conflicts and lack of transportation. The widespread telemedicine implementation and adoption that has occurred as a consequence of the COVID-19 pandemic has the potential to address these barriers and improve missed appointment rates. This study aims to analyze the relationship between telemedicine and missed appointments. MethodsThis retrospective cohort study used electronic health records data from a safety-net academic health center with federally qualified clinics (March 2020 to December 2022). Bivariate and multivariable generalized estimating equations were used to analyze the relationship between no-show and appointment type (in-person versus telemedicine appointment). Stratified adjusted regression analyses were used to calculate the average change in the marginal effect of telemedicine appointments on no-shows across covariates. The data was analyzed from 09/2023-10/2023. ResultsHispanic patients accounted for 60% of the 474,212 appointments, followed by non-Hispanic White (22.5%), Non-Hispanic Black (13.3%), Asian (2.7%), Native American (1%) and “other race/ethnicity” patients (0.6%). The no-show rate for telemedicine appointments was 12% compared to 25% for in-person appointments. Multivariable analysis showed that telemedicine appointment was associated with a decreased likelihood of no-show compared to in-person appointments (OR:0.40; 95% CI:0.40, 0.41). The average change in the marginal effect of telemedicine appointments on the reduction of no-shows across race/ethnicity was greatest for Native American and non-Hispanic Black patients. ConclusionsTelemedicine appointments were associated with decreased likelihood of no-shows and the protective effect of telemedicine appointments on missed appointments was greatest for underserved groups. Strategies to increase telemedicine uptake especially for underserved groups are critical.

Examining differences in time to appointment and no-show rates between rural telehealth users and non-users.

Telehealth has undergone widespread implementation since 2020 and is considered an invaluable tool to improve access to healthcare, particularly in rural areas. However, telehealth's applicability may be limited for certain populations including those who live in rural, medically underserved communities. While broadband access is a recognized barrier, other important factors including age and education influence a person's ability or preference to engage with telehealth via video telehealth or a patient portal. It remains unclear the degree to which these digital technologies lead to disparities in access to care. The purpose of this analysis is to determine if access to healthcare differs for telehealth users compared with non-users. Using electronic health record data, we evaluated differences in "time to appointment" and "no-show rates" between telehealth users and non-users within an integrated healthcare network between August 2021 and January 2022. We limited analysis to patient visits in endocrinology or outpatient behavioral health departments. We analyzed new patients and established patients separately. Telehealth visits were associated with shorter time to appointment for new and established patients in endocrinology and established patients in behavioral health, as well as with lower no-show rates for established patients in both departments. The findings suggest that those who are unwilling or unable to engage with telehealth may have more difficulty accessing timely care.

Estimating productivity levels in primary medical services across clinical commissioning groups in England and the impact of the COVID-19 pandemic: a data envelopment analysis

ObjectivesTo assess the relative productivity of primary medical services in England and the impact of the COVID-19 pandemic on productivity levels.SettingPrimary medical services for 59 million patients (98% of the population in England), in 101 clinical commissioning groups (CCGs), across two time periods: period 1, pre-pandemic, April to December 2019 and period 2, pandemic, April to December 2020.MethodsWe use data envelopment analysis (DEA) to assess relative productivity with four input measures (the number of full-time equivalent general practitioners, nurses, other direct patient contact staff and administrators), and five output measures (face-to-face appointments, remote consultations, home visits, referrals to secondary care and prescriptions). Our units of analysis were CCGs. DEA assigns an efficiency score to a CCG, taking a value between 0 and 100%, by benchmarking it against the most productive CCGs. We use Tobit regression to examine the association between productivity and other factors.ResultsThe mean bias-corrected efficiency score of primary medical services in CCGs was 92.9% (interquartile range 92.0% to 95.7%) in period 1, falling to 90.6% (interquartile range 86.8% to 95.2%) in period 2. In period 1, CCGs with a higher proportion of registered patients aged over 65 years, higher levels of deprivation, lower levels of disease prevalence, higher nurse to GP ratios and higher GP to other direct patient contact staff ratios, achieved statistically significantly higher general practice efficiency scores (p < 0.05). In period 2, only the ratio of GP to other direct patient contact staff was associated with efficiency scores (p > 0.05).ConclusionsOur analysis indicates only modest geographic variation in productivity of primary medical services when measured at the level of clinical commissioning groups and a small reduction in productivity during the pandemic. Further work to establish relative productivity of individual GP practices is warranted once sufficient data on appointment rates by GP practice is available.

Understanding radiation treatment terminations as an element of quality.

408 Background: Disruptions in cancer care adversely affect clinical outcomes. The effect is magnified when treatments are not just protracted, but discontinued prematurely. The incidence of such treatment termination (TT) during radiation therapy has not been well studied. We herein present a single-institution cohort of TT at a large multi-center radiation oncology department over 10 years. Methods: As part of our ongoing departmental quality and safety monitoring program, TTs were prospectively tracked and assessed. A TT was defined as the premature discontinuation of therapy at any point following the initiation of radiation planning. The rate of TT was calculated as a percentage of all new patients who start radiation planning. Each TT between 1/2013 and 1/2023 was analyzed for a root cause, reviewed among multi-disciplinary Quality committee members, and presented monthly to the radiation department. Selected cases sparked discussion and efforts to identify interventions that may decrease the likelihood of similar TTs. Incremental departmental policy and procedure changes to critical pre-treatment evaluation, prospective contouring rounds, on-treatment management, and scheduling processes were implemented, collectively referred to as the “No-Fly” policy. Results: A total of 1,467 TTs were identified and analyzed. 688 (46.9%) involved patients treated with curative intent, 770 (52.5%) with palliative intent, and 9 (0.6%) for benign disease. The most common cause of TT was hospice and/or death (36.5%), 69.1% of which were in patients receiving palliative treatments. Other common causes identified are shown in Table 1. The overall 10-year rate of TT was 5.1% (1,467 of 28,707 planned treatment courses). The rate of TT decreased from 9.3% to 3.3% (2013 and 2022, respectively), with rates decreasing at each iteration of No-Fly from 8.8% (No-Fly 1, 2013-2014) to 5.2% (No-Fly 2, 2015-2018) to 4.0% (No-Fly 3, 2019-2022) (ANOVA p&lt;0.001). Conclusions: Premature termination of radiation therapy can be deleterious for cancer patients. Determining the causes of TTs so that they may be mitigated is integral to effectively managing care and improving safety culture in radiation medicine departments. While some TTs may be unavoidable, open discourse and quality improvement changes are effective in reducing incidents over time. Understanding TTs is complimentary to other nationwide projects exploring how reducing missed radiation therapy appointment rates support access to high quality oncology care.[Table: see text]

A Novel Ophthalmic Telemedicine Program for Follow-Up of Minor Ophthalmic Emergencies.

Background: Near-term follow-up for minor ophthalmic emergencies is important to ensure positive patient outcomes but can impose logistical challenges for patients and ophthalmology practices. While ophthalmic telemedicine has been used for screening and triage, its feasibility and safety for follow-up care for minor ophthalmic emergencies have not been reported. The objective of this study was to report initial results of a novel virtual emergency department (ED) follow-up clinic. Methods: Retrospective cross-sectional study of patients discharged from the ophthalmic ED who required near-term follow-up and carried diagnoses suitable for virtual evaluation, between December 6, 2021, and June 26, 2022, at a single tertiary eye care center. Main outcome measures included missed appointment rate, time interval between ED encounter and virtual follow-up, clinical diagnoses, and referrals after telemedicine follow-up (including for urgent ambulatory and ED evaluation). Results: A total of 145 virtual visits were scheduled with 99 (68.3%) completed appointments, yielding a no-show rate of 31.7%. Of the completed visits, the mean time interval between ED evaluation and virtual follow-up was 8.3 days (standard deviation ±3.9). Eighty-four (84.9%) visits were video-based and 15 (15.1%) were audio-only. Seventy-nine (94%) had at least one aspect of the ophthalmic examination documented. The most common diagnoses were chalazion (18), conjunctivitis (13), corneal abrasion (12), and encounter after corneal foreign body removal (7). After virtual follow-up, 23 patients (23.2%) had subsequent referrals, and no patients re-presented to the ophthalmic ED. Conclusions: Ophthalmic telemedicine may be a safe and feasible modality for providing timely post-acute near-term follow-up care for patients with appropriate ophthalmic diagnoses.

Evaluation of Quality Indicators in Home Health Services Delivery.

We aimed to evaluate the quality indicators monitored within the scope of quality standards health. In this descriptive study, patients who visited the home health services unit in 2021, were included. Patient age and diagnostic data were obtained from the Basic Health Statistics Module. Other information such as the number of patient visits and nutritional status were obtained from the indicator data collection form followed by the quality management unit of our hospital and from the home health services unit. We included the data of Antalya Training and Research Hospital. Microsoft Excel and SPSS 25.0 program were used in the analysis of the data, and the data obtained were shown as numbers and ratios (%). When the quality indicators of home health services delivery were examined, the timely response rate of the application was 100%, the nutritional status of all patients was evaluated using the Nutritional Risk Score (NRS-2002) evaluation form at the first patient visit; the patients receiving health care from the home health unit of our hospital visited an average of three times in a year, and the health service from the home health unit was determined: the annual average rate of medical appointments kept with patients who receive medical care at the scheduled time is 83%. Quality indicators are being met well, and good-quality care services are being delivered in the home health service of the training and research hospitals.