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Improving Missed Opportunity and No Shows
Background£ºMissed opportunities are major problems in most of VA medical centers and they affect resource utilization, efficiency, cost and patient access significantly.
When an appointment is scheduled in VA system and is canceled after appointment time, then this appointment is called missed opportunity. There are 3 major categories of missed opportunities:
1. No show (The patient fails to show up in the appointment)
2. Cancelled by patient ( The patient cancelled the appointment after appointment time)
3. Cancelled by clinic ( The cancellation done by VA clinics)
In VA system, the missed opportunity rate is calculated by the following formula:
Where the term ¡° ¡± include all three categories of missed opportunities.
Clearly, the key to reduce missed opportunities is to reduce the occurrences of all these 3 categories of missed opportunities.
The first two categories of missed opportunities (no show and cancelled by patient) are caused by patients, the third category of missed opportunity is caused by VA health service providers.
Summary of Works done by Our Group in This Area£º
1. A Hybrid Probabilistic No Show Prediction Model
The number of no-shows has a significant impact on the revenue, cost and resource utilization for almost all healthcare systems.
In this study we develop a hybrid probabilistic model based on logistic regression and empirical Bayesian inference to predict the probability of no-shows in real time using both general patient social and demographic information and their individual clinical appointments attendance records.
The model also considers the effect of appointment date, and clinic type.
The effectiveness of the proposed approach is validated based on a patient dataset from a VA medical center.
Such an accurate prediction model can be used to enable a precise selective overbooking strategy to reduce the negative effect of no-shows and fill appointment slots while maintaining short wait times.
2. A Targeted Reminder Call Strategy to Reduce No Shows
Reminder call is a telephone call based appointment reminder to patients who have upcoming appointments. In this project, our group analyzed the data from a healthcare call center and had the following findings:
a. For patients who received reminder calls and confirmed appointment, the show up rate for their appointment is 93.5%, for general patient population, the show up rate is about 85%. So reminder call is effective to reduce no shows if it is received.
b. We also find that for patients who have low no show probability (<20%, either by no show prediction model prediction, or based on historical data),
reminder calls do not make much difference in actual appointments showing up versus no reminder calls; for patients who have medium no show probabilities (20% - 60%),
reminder calls make significant differences in actual appointment showing up rate versus no reminder calls, for patients with high probability of no shows (>60%), reminder calls make little difference in actual showing up rate.
Because reminder calls are most effective in reducing no shows for patients who have medium no show probability, we developed a targeted reminder call system that direct aggressive reminder calls to patients who have medium no show probability.
We are also developing a workflow management system that links the automated machine reminder call system to person to person call system to maximize the effectiveness of reminder calls.
3. A Scheduling System to Maximize the Clinical Provider Utilization and Reduce the effects of No Shows
This scheduling system is under development which can fill in appointment slots in healthcare system with the presence of no shows. This system will use selective over booking to reduce the effect of no shows.
Related funded projects
Improving Missed Opportunity and No Shows
US Department of Veteran Affairs, (PI 100%) $600,000, 10/10-9/13
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