Trends in patient no-shows

Will Kinsman
May 4, 2021
Two papers analyzed the attributes of thousands of appointments and the features of the patients associated with each when patient no-shows occur [1][2]. Attributes of appointments that are missed the most across both papers thematically have similar trends.

Temporally, appointments with higher no-show rates are scheduled for half an hour, in the winter season. While the time of day does not noticeably correlate with no-shows, Mondays have the highest proportion of no-shows when than any other day of the week. The further out an appointment is scheduled, the more likely it is to be missed. Patient demographic attributes most correlated with no-show appointments are older, lower income, unemployed, black, single women without communication technology (cell phone, email, or patient portal access) that live far away from the facility. Frequent smokers have a very high correlation with missed appointments.

Patients that have a history of no-shows are also highly likely to be a no-show patient in the future. A small-scale set of interviews of patients who had chosen not to attend appointments showed that in a group of 32 patients interviewed, 65% expressed fear of the results of an appointment, 44% of the patients felt perceived disrespect from the provider that nudged them into not attending their appointment, and 21% said that logistics of getting to the providers office on-time resulted in them not showing up to their appointment [3]. Overall no-show rates have noticeably declined in the past decade, likely driven in part by technological augmentation with tools such as calendar reminders and a rise in direct patient engagement [4]. 

Figure 1. Box Chart of no-show rates over the years, as presented by Dantas, Leila F., et al., 2018 [4].

No-show rates also very with the clinic specialty, with physiotherapy by and far leading, also with the most variation by clinic. Exams, pediatric care, and primary care have the lowest no-show rates by comparison. Surgical procedures for the head and neck (Otorhinolaryngology), while high in no-show rates, has the least variation among facilities.

Figure 2. Box Chart of no-show rates as a function of specialty, as presented by Dantas, Leila F., et al., 2018 [4]

[1] Mohammadi, Iman, et al. Data analytics and modeling for appointment no-show in community health centers. Journal of primary care community health 9 (2018): 2150132718811692.

[2] Daggy, Joanne, et al. ”Using no-show modeling to improve clinic performance. Health informatics journal 16.4 (2010): 246-259.

[3] Lacy, Naomi L., et al. Why we don’t come: patient perceptions on noshows. The Annals of Family Medicine 2.6 (2004): 541-545.

[4] Dantas, Leila F., et al. No-shows in appointment scheduling–a systematic literature review. Health Policy 122.4 (2018): 412-421.

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