Missed Appointments in an Outpatient Clinic for Adolescents, an Approach to Predict the Risk of Missing

Chariatte, Vincent; Berchtold, André; Akré, Christina; Michaud, Pierre‐André; Surı́s, Joan-Carles

doi:10.1016/j.jadohealth.2007.12.017

Cited by 64 publications

(67 citation statements)

References 28 publications

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“…We are not aware of any studies investigating a role for NLP in measuring appointment adherence. [19][20][21][32][33][34][35][36][37][38][39][40] Thus, our work highlights a novel method using NLP for this purpose.…”

Section: Discussionmentioning

confidence: 99%

Predicting Non-Adherence with Outpatient Colonoscopy Using a Novel Electronic Tool that Measures Prior Non-Adherence

et al. 2015

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BACKGROUND: Accurately predicting the risk of no-show for a scheduled colonoscopy can help target interventions to improve compliance with colonoscopy, and thereby reduce the disease burden of colorectal cancer and enhance the utilization of resources within endoscopy units. OBJECTIVES: We aimed to utilize information available in an electronic medical record (EMR) and endoscopy scheduling system to create a predictive model for no-show risk, and to simultaneously evaluate the role for natural language processing (NLP) in developing such a model. DESIGN: This was a retrospective observational study using discovery and validation phases to design a colonoscopy non-adherence prediction model. An NLPderived variable called the Non-Adherence Ratio ("NAR") was developed, validated, and included in the model. PARTICIPANTS: Patients scheduled for outpatient colonoscopy at an Academic Medical Center (AMC) that is part of a multi-hospital health system, 2009 to 2011, were included in the study. MAIN MEASURES: Odds ratios for non-adherence were calculated for all variables in the discovery cohort, and an Area Under the Receiver Operating Curve (AUC) was calculated for the final non-adherence prediction model. KEY RESULTS: The non-adherence model included six variables: 1) gender; 2) history of psychiatric illness, 3) NAR; 4) wait time in months; 5) number of prior missed endoscopies; and 6) education level. The model achieved discrimination in the validation cohort (AUC= =70.2 %). At a threshold non-adherence score of 0.46, the model's sensitivity and specificity were 33 % and 92 %, respectively. Removing the NAR from the model significantly reduced its predictive power (AUC = 64.3 %, difference = 5.9 %, p<0.001). CONCLUSIONS: A six-variable model using readily available clinical and demographic information demonstrated accuracy for predicting colonoscopy non-adherence. The NAR, a novel variable developed using NLP technology, significantly strengthened this model's predictive power.

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Section: Discussionmentioning

confidence: 99%

Predicting Non-Adherence with Outpatient Colonoscopy Using a Novel Electronic Tool that Measures Prior Non-Adherence

et al. 2015

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“…For instance, in a study of adolescent outpatients in Switzerland, 135 the authors reported that forgetting the appointment was a common cause and suggested that the higher non-attendance for appointments with a long delay probably reflects the greater risk of forgetting the appointment. Similarly, a study in a 136 concluded that as long delays to appointments were common; this explains why the most frequent reason given for non-attendance is forgetting the appointment.…”

Section: Explanations and Implications For Remindersmentioning

confidence: 99%

“…First, it has been suggested that other issues are more likely to arise that mean the appointment timing becomes incompatible. 135 It has also been suggested that when appointments are scheduled a long time in advance, patient symptoms may be resolved, either because they resolve themselves or because the patient (or referring health-care professional) opts to seek alternative care. For instance, an Irish study that examined appointments in a general surgical outpatients department 20 revealed that resolution of symptoms accounted for almost one-third of missed appointments.…”

Section: Explanations and Implications For Remindersmentioning

confidence: 99%

Targeting the Use of Reminders and Notifications for Uptake by Populations (TURNUP): a systematic review and evidence synthesis

McLean

Gee

Booth

et al. 2014

Health Services and Delivery Research

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BackgroundMissed appointments are an avoidable cost and a resource inefficiency that impact on the health of the patient and treatment outcomes. Health-care services are increasingly utilising reminder systems to counter these negative effects.ObjectivesThis project explores the differential effect of reminder systems for different segments of the population for improving attendance, cancellation and rescheduling of appointments.DesignThree inter-related reviews of quantitative and qualitative evidence relating to theoretical explanations for appointment behaviour (review 1), the effectiveness of different approaches to reminding patients to attend health service appointments (review 2) and factors likely to influence non-attendance (review 3).Data sourcesDatabase searches were conducted on Allied and Complementary Medicine, Cumulative Index to Nursing and Allied Health Literature Plus with Full Text, The Cochrane Library, EMBASE (via NHS Evidence from 1 January 2000 to January/February 2012), Health Management Information Consortium database, Institute of Electrical and Electronics EngineersXplore, The King’s Fund Library Catalogue, Maternity and Infant Care, MEDLINE, Physiotherapy Evidence Database, PsycINFO, SPORTDiscus and Web of Science from 1 January 2000 to January/February 2012. Supplementary screening of references of included studies was conducted to identify additional potentially relevant studies. Conceptual papers were identified for review 1, randomised controlled trials (RCTs) and systematic reviews for review 2 and a range of quantitative and qualitative research designs for review 3.MethodsWe conducted three inter-related reviews of quantitative and qualitative evidence, involving a review of conceptual frameworks of reminder systems and adherence behaviours, a review of the reminder effectiveness literature and a review informed by realist principles to explain the contexts and mechanisms that explain reminder effectiveness. A preliminary conceptual framework was developed to show how reminder systems work, for whom they work and in which circumstances. Six themes emerged that potentially influence the effectiveness of the reminder or whether or not patients would attend their appointment, namely the reminder–patient interaction, reminder accessibility, health-care settings, wider social issues, cancellation and rebookings, and distal/proxy attributes. Standardised review methods were used to investigate the effectiveness of reminders to promote attendance, cancellation or rebooking across all outpatient settings. Finally, a review informed by realist principles was undertaken, using the conceptual framework to explain the context and mechanisms that influence how reminders support attendance, cancellation and rebooking.ResultsA total of 466 papers relating to 463 studies were identified for reviews 2 and 3. Findings from 31 RCTs and 11 separate systematic reviews (review 2 only) revealed that reminder systems are consistently effective at reducing non-attendance at appointments, regardless of health-care setting or patient subgroups. Simple reminders that provide details of timing and location of appointments are effective for increasing attendance at appointments. Reminders that provide additional information over and above the date, time and location of the appointment (‘reminder plus’) may be more effective than simple reminders at reducing non-attendance and may be particularly useful for first appointments and screening appointments; simple reminders may be appropriate thereafter for most patients the majority of the time. There was strong evidence that the timing of reminders, between 1 and 7 days prior to the appointment, has no effect on attendance; substantial numbers of patients do not receive their reminder; reminders promote cancellation of appointments; inadequate structural factors prevent patients from cancelling appointments; and few studies investigated factors that influence the effectiveness of reminder systems for population subgroups.LimitationsGenerally speaking, the systematic review method seeks to provide a precise answer to a tightly focused question, for which there is a high degree of homogeneity within the studies. A wide range of population types, intervention, comparison and outcomes is included within the RCTs we identified. However, use of this wider approach offers greater analytical capability in terms of understanding contextual and mechanistic factors that would not have been evident in a more narrowly focused review and increases confidence that the findings will have relevance in a wide range of service settings.ConclusionsSimple reminders or ‘reminder plus’ should be sent to all patients in the absence of any clear contraindication. Other reminder alternatives may be relevant for key groups of patients: those from a deprived background, ethnic minorities, substance abusers and those with comorbidities and/or illnesses. We are developing a practice guideline that may help managers to further tailor their reminder systems for their service and client groups. We recommend future research activities in three main areas. First, more studies should routinely consider the potential for differential effects of reminder systems between patient groups in order to identify any inequalities and remedies. Second, ‘reminder plus’ systems appear promising, but there is a need for further research to understand how they influence attendance behaviour. Third, further research is required to identify strategies to ‘optimise’ reminder systems and compare performance with current approaches.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

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“…Consequences of patient dropout and non-attendance include poorer treatment outcomes, increased burden of disease, loss of income for services, inefficient use of staff time, and longer waiting lists [5].…”

Section: Introductionmentioning

confidence: 99%

The Therapy Attitudes and Process Questionnaire: A Brief Measure of Factors Related to Psychotherapy Appointment Attendance

Clough

Nazareth

Casey

2016

Patient

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Objectives: Patient non-attendance and dropout remains problematic in mental health settings [1,2]. The Theory of Planned Behaviour (TPB) has proved useful in understanding such challenges in a variety of healthcare settings, but the absence of an adequate measure has hampered research in mental health. The aim of the current study was to develop and conduct an initial psychometric investigation of a brief measure, the Therapy Attitudes and Process (TAP) Questionnaire, utilising the TPB to understand factors associated with attendance in mental health settings.Design: A quantitative survey based design was utilised. Methods:The TAP was administered to 178 adult participants, who were engaged in individual or group psychotherapy. A subsample also provided data to assess validity and reliability.Results: A four-factor solution was revealed through Exploratory Factor Analysis and accounted for approximately 75% of the variance in scores. Factors corresponded to those predicted by the TPB. Analyses supported the reliability, validity, and internal consistency of the measure. Conclusions:Results suggest that the TAP may provide a useful measure for examining patients' attitudes and beliefs about attending psychotherapy appointments. The TAP can be used to better understand patients' intentions, attitudes, perceptions of behavioural control, and subjective norms relating to psychotherapy attendance. This understanding may facilitate improved outcomes for patients and clinicians. Key Points for Decision Makers:DEVELOPMENT OF THE TAP 3  Non-attendance and dropout is a substantial problem in psychotherapy settings. There is a need to better understand and tailor interventions in accordance with the individual patient barriers. The TAP was developed based on the Theory of Planned Behaviour, and is designed to assess attitudes, subjective norms, perceived behavioural control, and behavioural intentions regarding appointment attendance. Initial investigation of the TAP indicates it has sound psychometric properties and can be used to increase the delivery of patient centered services

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Missed Appointments in an Outpatient Clinic for Adolescents, an Approach to Predict the Risk of Missing

Cited by 64 publications

References 28 publications

Predicting Non-Adherence with Outpatient Colonoscopy Using a Novel Electronic Tool that Measures Prior Non-Adherence

Predicting Non-Adherence with Outpatient Colonoscopy Using a Novel Electronic Tool that Measures Prior Non-Adherence

Targeting the Use of Reminders and Notifications for Uptake by Populations (TURNUP): a systematic review and evidence synthesis

The Therapy Attitudes and Process Questionnaire: A Brief Measure of Factors Related to Psychotherapy Appointment Attendance

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