Health Services Research & Development

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2006 HSR&D National Meeting Abstract


1068 — No-Shows Among Patients with Serious Mental Illness: Transportation Matters

Author List:
McCarthy JF (VA Serious Mental Illness Treatment Research and Evaluation Center)
Piette JC (VA Center for Practice Management and Outcomes Research)
Valenstein M (VA Serious Mental Illness Treatment Research and Evaluation Center)
Craig T (VA Office of Quality and Performance)
Blow FC (VA Serious Mental Illness Treatment Research and Evaluation Center)

Objectives:
Geographic accessibility involves not only the proximity of providers, but also the availability of effective transportation. To reduce accessibility barriers, the VA has expanded its points of contact and arranges transportation services, such as volunteer service organization vans. Individuals with serious mental illnesses may be particularly vulnerable to travel barriers. We evaluated the influence of self-reported mode of transportation for scheduled appointments on patients’ likelihood of having “no-shows” for outpatient appointments over a three-year period.

Methods:
Using data from the VA’s National Psychosis Registry, we identified all individuals who received a diagnosis of schizophrenia, bipolar disorder, or other psychoses in fiscal year 2002 (FY2002) and who completed the social support module of the VA’s Large Health Survey of Veteran Enrollees (N=3238). Survey respondents reported how they traveled to scheduled doctor appointments. For each month in FY2002 through FY2004, we assessed both total scheduled outpatient visit days and the number of days with “no-shows”. Using a generalized linear model that adjusted for the nesting of observations by patient and facility, we assessed the likelihood of scheduled visit days being no-shows. Model covariates included patient travel distance to the facility; age that month; gender; and marital status, psychiatric diagnosis, substance abuse, homelessness, and service connection in FY2002.

Results:
Of the 108,975 patient months with scheduled outpatient visit days, 17% included days with no-shows. Patients who were younger, male, non-white, and living farther away were more likely to have no-shows. Risks did not vary by diagnosis. Compared to those who reported driving a car to appointments, no-shows were less likely among individuals who walk to appointments (OR=0.74) or who use a hospital or clinic arranged service (OR=0.82). Patients using public transportation (e.g., bus, taxi, or subway) were most likely to have no-shows (OR=1.32).

Implications:
Distance poses accessibility barriers that are compounded by limited access to personal transportation. Patients relying on public transportation were most likely to have no-shows. VA travel services may substantially improve accessibility.

Impacts:
VA travel services should be maintained and expanded in order to improve patient accessibility. In particular these services should be offered to individuals who would otherwise rely on public transportation.