Health Services Research & Development

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2007 HSR&D National Meeting Abstract

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National Meeting 2007

3102 — Relationship of Scheduling Interval to Missed and Cancelled Clinic Appointments

Whittle J (Clement J. Zablocki VA Medical Center) , Schectman G (Clement J. Zablocki VA Medical Center), Bair B (VSSC), Lu N (Medical College of Wisconsin), Mayo-Smith MF (VISN 1)

Objectives:
Longer intervals between the date an appointment is scheduled and the date it occurs may increase missed and cancelled appointments, reducing efficiency and access to providers. We examined VHA scheduling data to test this hypothesis.

Methods:
We examined scheduled visits to all VHA clinics that transmitted data monthly to a central VA database. We included appointments scheduled to occur between July 2004 and June 2005 to clinics that provide individual care by a physician, nurse practitioner, physician’s assistant, or psychologist. At the time of the visit, clerks classify appointments as kept, missed, or cancelled (by patient or clinic). We defined scheduling interval as the difference in days between appointment creation and actual appointment. Clinics were classified as Primary Care (PC), Mental Health (MH), Medical Specialty (MS), or Surgical Specialty (SS). We used weighted Pearson correlation coefficients to assess the degree of association between daily and monthly scheduling intervals and cancelled and missed appointment rates. Because we observed an apparent plateau in missed appointment rates, we used weighted piece-wise linear models to fit the percent missed and percent cancelled vs. interval in days. By maximizing R-squares or minimizing mean square errors, we estimate the day at which there was a plateau in the missed appointment rate, overall and for each clinic type.

Results:
Cancellations increased steadily as scheduling intervals increased up to one year, from a mean of 19% during month one to 50% by month 12. In contrast, as the interval increased, the missed appointment rate increased from 12.0% at day one to 20.3% at day 13, but was stable thereafter. These patterns were similar across clinic types; the missed visit rate plateaued at 7, 9, 11, and 13 days for PC, MH, MS, and SS, respectively. Missed appointment rates were lowest in PC, but similar for other clinic types. Cancellation rates were similar for all clinic types.

Implications:
Unless scheduling intervals become quite short, missed visits may not be reduced by relying on patients to self schedule near the time of the appointment.

Impacts:
Efforts to enhance access using creative scheduling approaches to decrease missed appointments must consider these findings.