Targeted Reminder Phone Calls to Patients at High Risk of No-Show for Primary Care Appointment: A Randomized Trial.
BACKGROUND
No-shows, or missed appointments, are a problem for many medical practices. They result in fragmented care and reduce access for all patients.


OBJECTIVE
To determine whether telephone reminder calls targeted to patients at high risk of no-show can reduce no-show rates.


DESIGN
Single-center randomized controlled trial.


PARTICIPANTS
A total of 2247 primary care patients in a hospital-based primary care clinic at high risk of no-show (>15 % risk) for their appointment in 7 days.


INTERVENTION
Seven days prior to their appointment, intervention arm patients were placed in a calling queue to receive a reminder phone call from a patient service coordinator. Coordinators were trained to engage patients in concrete planning. All patients received an automated phone call (usual care).


MAIN MEASURES
Primary outcome was no-show rate. Secondary outcomes included arrival rate, cancellation rate, reschedule rate, time to cancellation, and change in revenue.


KEY RESULTS
The no-show rate in the intervention arm (22.8 %) was significantly lower (absolute risk difference -6.4 %, p < 0.01, 95 % CI [-9.8 to -3.0 %]) than that in the control arm (29.2 %). Arrival, cancellation, and reschedule rates did not differ significantly. In the intervention arm, rescheduling and cancellations occurred further in advance of the appointment (mean difference, 0.35 days; 95 % CI [0.07-0.64]; p = 0.01). Reimbursement did not differ significantly.


CONCLUSIONS
A phone call 7 days prior to an appointment led to a significant reduction in no-shows and increased reimbursement among patients at high risk of no-show. The use of targeted interventions may be of interest to practices taking on increased accountability for population health.
['Shah|Sachin J|SJ|', 'Cronin|Patrick|P|', 'Hong|Clemens S|CS|', 'Hwang|Andrew S|AS|', 'Ashburner|Jeffrey M|JM|', 'Bearnot|Benjamin I|BI|', 'Richardson|Calvin A|CA|', 'Fosburgh|Blair W|BW|', 'Kimball|Alexandra B|AB|']
D000046:Academic Medical Centers D000328:Adult D000368:Aged D001071:Appointments and Schedules D040421:Cell Phone D005260:Female D006801:Humans D008297:Male D008875:Middle Aged D000067455:No-Show Patients D010044:Outpatient Clinics, Hospital D010349:Patient Compliance D011320:Primary Health Care D017010:Reminder Systems D012307:Risk Factors D060145:Text Messaging
population health access to care applied informatics behavior change primary care redesign