New England Section of the American Urological Association

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Factors associated with Patient No-show Appointments in Community Urology Practice
Ian T. Clark, MPH, CSPPM, Joseph Renzulli, MD, FACS, Lisa Rameaka, MD, FACOG
South County Health, Wakefield, RI

Background:
Patient no-show appointments may contribute to suboptimal health outcomes, limited access, and contribute to a loss of budgeted revenue in physician practices. In employed models, patient no-shows may also adversely affect physician productivity and incentive compensation.
Identifying and understanding factors associated with patient no-shows is an important first-step process of informing the development of interventions designed to optimize patient health outcomes, improve access, and maximize provider productivity and revenue.
The purpose of this evaluation is to describe factors associated with patient no-shows in a large community urology practice in Southern New England.
Methods:
A review of this evaluation by an institutional review board determined that it entailed an analysis of de-identified data for performance improvement, and human subject research was not indicated.
This evaluation analyzed patient demographic, payor, provider, and scheduling data reported through Greenway Prime Suite practice management software for office-based appointments scheduled to occur during May 2018-January 2019 among 5 physicians and 1 nurse practitioner.
Appointment outcomes were categorized as complete or patient no-show. Patient no-shows were defined as scheduled appointments the patient did not attend without prior notification of the practice. All other appointment statuses were excluded from analysis. Additional factors included in analysis were categorized according to variables and outcomes of interest.
Cohort means were compared using independent two-sample, two-sided t-tests. A p-value of .05 was considered statistically significant. Associations were measured using risk ratios (RRs) that were evaluated for significance using 95% confidence intervals (CIs). All data were analyzed using Microsoft Office-based software.
Results:
894 (11.4%) of 7,836 scheduled appointments resulted in patient no-shows. Patients generating no-shows were younger (64.7 vs. 68.1 years; p<.001) and more likely to identify no primary care provider (PCP) (RR: 3.31; 95% CI: 2.91-3.76) or secondary insurance coverage (RR: 1.18; 95% CI: 1.03-1.35) at the time of registration. Ninety-four (71.8%) of 131 appointments scheduled for self-paying patients resulted in patient no-shows. Self-paying patients were at highest risk of generating a no-show compared to all other patient-payor arrangements (RR: 6.91; 95% CI 6.09-7.84).
Provider-specific no-show rates ranged from 2.3% to 16.1%. General urology physicians were more likely to experience patient no-shows compared to physicians with urologic oncology subspecialty training (RR: 5.53; 95% CI: 3.67-8.32).
Patients generating no-shows were scheduled further in advance compared to patients generating complete appointments (54.7 vs. 38.4 days; p<.001), and were more likely to be scheduled at the main hospital-based office location compared to satellite office locations (RR: 1.40; 95% CI: 1.23-1.60). Appointments scheduled for less than 30 minutes were also more likely to generate no-shows when compared to appointments scheduled for 30 minutes or more (RR: 1.40; 95% CI: 1.15-1.71). Routine 3-
6-month follow-up appointments were most likely to generate no-shows compared to all other appointment types (RR: 1.84; 95% CI: 1.61-2.10).
Conclusions:
Interventions for reducing patient no-shows should focus on younger patients, uninsured and underinsured patients, patients without PCPs, patients seeking care from general urologists, and patients scheduled for routine 3-6 month follow-up appointments.


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