Missed Appointment Rates in Primary Care: The Importance of Site of Care

Lasser, Karen E.; Mintzer, Ira L.; Lambert, Astrid; Cabral, Howard; Bor, David H.

doi:10.1353/hpu.2005.0054

Cited by 53 publications

(47 citation statements)

References 17 publications

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“…Patients also miss appointments according to the hour of the appointment, the source of referral, delays in the appointment date and if a doctor is more junior. 8, 14 Using a novel research data gathering approach, we found similarities within our paediatric patients and with previous adult and general clinic studies. We were also able to efficiently and effectively attach a cost estimate to the situation using the extracted data.…”

Section: Principal Findingssupporting

confidence: 58%

Can we predict a national profile of non-attendance paediatric urology patients: a multi-institutional electronic health record study

Bush¹,

Vemulakonda²,

Corbett³

et al. 2014

Journal of Innovation in Health Informatics

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Section: Principal Findingssupporting

confidence: 58%

Can we predict a national profile of non-attendance paediatric urology patients: a multi-institutional electronic health record study

Bush¹,

Vemulakonda²,

Corbett³

et al. 2014

Journal of Innovation in Health Informatics

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show abstract

“…Studies that used secondary analyses included data ranging from 1987 (Konrad et al 2005) to 2001 (Blanchard et al 2007). Four studies were qualitative (Garcia et al 2003, Zayas et al 2005, Gordon et al 2006, Brown et al 2007), three used cross-sectional surveys (Cooper-Patrick et al 1999, Stevens et al 2003, Lasser et al 2005) and one collected data from actual patient–provider interactions (Tai-Seale et al 2005). One was a prospective study (Cooper et al 2003) and three used an experimental design using hypothetical vignettes (McKinlay et al 2002, Bender 2007, Modi et al 2007).…”

Section: Resultsmentioning

confidence: 99%

Patient–provider race-concordance: does it matter in improving minority patients’ health outcomes?

et al. 2009

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Objective To understand if patient–provider race-concordance is associated with improved health outcomes for minorities. Design A comprehensive review of published research literature (1980–2008) using MEDLINE, HealthSTAR, and CINAHL databases were conducted. Studies were included if they had at least one research question examining the effect of patient–provider race-concordance on minority patients’ health outcomes and pertained to minorities in the USA. The database search and data analysis were each independently conducted by two authors. The review was limited to data analysis in tabular and text format. A meta-analysis was not possible due to the discrepancy in methods and outcomes across studies. Results Twenty-seven studies met the inclusion criteria. Combined, the studies were based on data from 56,276 patients and only 1756 providers. Whites/Caucasians (37.6%) and Blacks/African Americans (31.5%), followed by Hispanics/Latinos (13.3%), and Asians/Pacific Islanders (4.3%) comprised the majority of the patient sample. The median sample of providers was only 16 for African Americans, 10 for Asians and two for Hispanics. The review presented mixed results. Of the 27 studies, patient–provider race-concordance was associated with positive health outcomes for minorities in only nine studies (33%), while eight studies (30%) found no association of race-concordance with the outcomes studied and 10 (37%) presented mixed findings. Analysis suggested that having a provider of same race did not improve ‘receipt of services’ for minorities. No clear pattern of findings emerged in the domains of healthcare utilization, patient–provider communication, preference, satisfaction, or perception of respect. Conclusions There is inconclusive evidence to support that patient–provider race-concordance is associated with positive health outcomes for minorities. Studies were limited to four racial/ethnic groups and generally employed small samples of minorities. Further research is needed to understand what health outcomes may be more sensitive to cultural proximity between patients and providers, and what patient, provider and setting-level variables may moderate or mediate these outcomes.

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“…The most significant predictor of attendance at an initial appointment was time from referral until appointment, consistent with other studies in specialty mental health and other clinical settings. [6][7][8][9][10] The retrospective design of this study allows for unmeasured confounding. Primary care clinicians may preferentially perform warm handoffs for patients they perceive are the least likely to attend an appointment, such as patients who have severe mental health conditions or substance use disorders, low health literacy, reluctance to engage with behavioral health services, disorganization, social barriers, or other factors.…”

Section: Discussionmentioning

confidence: 99%

Warm Handoffs and Attendance at Initial Integrated Behavioral Health Appointments

Pace

Barnett

Veidis³

et al. 2018

Ann Fam Med

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Though integrated behavioral health programs often encourage primary care physicians to refer patients by means of a personal introduction (warm handoff), data are limited regarding the benefits of warm handoffs. We conducted a retrospective study of adult primary care patients referred to behavioral health clinicians in an urban, safety-net hospital to investigate the association between warm handoffs and attendance rates at subsequent initial behavioral health appointments. In multivariable analyses, patients referred via warm handoffs were not more likely to attend initial appointments (OR = 0.96; 95% CI, 0.79-1.18; P = .71). A prospective study is necessary to confirm the role of warm handoffs. 2018;16:346-348. https://doi.org/10.1370/afm.2263. Ann Fam Med INTRODUCTIONW arm handoffs are a common and often recommended feature of programs that integrate behavioral health services into primary care.1 In a typical warm handoff, primary care clinicians refer patients to an integrated behavioral health clinician by directly introducing the patient. Warm handoffs have theoretical benefits, including building patients' trust in behavioral health clinicians and reducing patients' stigma about behavioral health care, which could translate to improved attendance at subsequent behavioral health appointments. Attendance to mental health appointments is low and a barrier to broadening access to care.2 Yet, whether warm handoffs improve attendance is unclear. Two previous studies have addressed this question with conflicting results. 3,4 Because warm handoffs require investment of clinician time and physician training, more data regarding their benefit would be useful. Our objective was to determine whether warm handoffs are associated with improved attendance at subsequent initial integrated behavioral health appointments. METHODSBoston Medical Center is an urban safety-net hospital serving primarily minority and low-income patients. In 2014, the hospital-based general internal medicine and family medicine clinics began a program of integrated behavioral health in which mental health clinicians (primarily social workers) offer evaluation, short-course therapy, and substance use counseling to patients. Primary care clinicians can refer patients using either warm handoffs to the program clinicians, who meet with the patient and schedule an intake encounter, or by having front desk staff schedule an initial appointment. We conducted a retrospective analysis of clinical and scheduling data from new referrals to the integrated behavioral health program from July 1, 2015, to December 31, 2016. The primary independent variable was whether the patient had a warm handoff encounter with a mental health clinician before the initial appointment. The mental health clinicians noted a warm handoff in the electronic health record (EHR). The primary outcome was whether the patient attended their initial program appoint- ment. The institutional review board at Boston University Medical Center approved this study as exempt.We used m...

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Missed Appointment Rates in Primary Care: The Importance of Site of Care

Cited by 53 publications

References 17 publications

Can we predict a national profile of non-attendance paediatric urology patients: a multi-institutional electronic health record study

Can we predict a national profile of non-attendance paediatric urology patients: a multi-institutional electronic health record study

Patient–provider race-concordance: does it matter in improving minority patients’ health outcomes?

Warm Handoffs and Attendance at Initial Integrated Behavioral Health Appointments

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