title: Patient no-show predictive model development using multiple data sources for an effective overbooking approach.
abstract: BACKGROUND
  Patient no-shows in outpatient delivery systems remain problematic. The negative impacts include underutilized medical resources, increased healthcare costs, decreased access to care, and reduced clinic efficiency and provider productivity.
  
  
  OBJECTIVE
  To develop an evidence-based predictive model for patient no-shows, and thus improve overbooking approaches in outpatient settings to reduce the negative impact of no-shows.
  
  
  METHODS
  Ten years of retrospective data were extracted from a scheduling system and an electronic health record system from a single general pediatrics clinic, consisting of 7,988 distinct patients and 104,799 visits along with variables regarding appointment characteristics, patient demographics, and insurance information. Descriptive statistics were used to explore the impact of variables on show or no-show status. Logistic regression was used to develop a no-show predictive model, which was then used to construct an algorithm to determine the no-show threshold that calculates a predicted show/no-show status. This approach aims to overbook an appointment where a scheduled patient is predicted to be a no-show. The approach was compared with two commonly-used overbooking approaches to demonstrate the effectiveness in terms of patient wait time, physician idle time, overtime and total cost.
  
  
  RESULTS
  From the training dataset, the optimal error rate is 10.6% with a no-show threshold being 0.74. This threshold successfully predicts the validation dataset with an error rate of 13.9%. The proposed overbooking approach demonstrated a significant reduction of at least 6% on patient waiting, 27% on overtime, and 3% on total costs compared to other common flat-overbooking methods.
  
  
  CONCLUSIONS
  This paper demonstrates an alternative way to accommodate overbooking, accounting for the prediction of an individual patient's show/no-show status. The predictive no-show model leads to a dynamic overbooking policy that could improve patient waiting, overtime, and total costs in a clinic day while maintaining a full scheduling capacity.
authors.affiliation: New Mexico State University , Industrial Engineering, Las Cruces, New Mexico, United States.
authors.forename: Y
authors.initials: Y
authors.lastname: Huang
authors.affiliation: Department of Pediatrics, University of Michigan Medical School , Ann Arbor, MI.
authors.forename: D A
authors.initials: DA
authors.lastname: Hanauer
mesh_terms: D000553:Ambulatory Care / Q000706:statistics & numerical data*; D001071:Appointments and Schedules; D003198:Computer Simulation; D003627:Data Interpretation, Statistical; D057286:Electronic Health Records / Q000706:statistics & numerical data*; D006801:Humans; D008824:Michigan; D015233:Models, Statistical; D010044:Outpatient Clinics, Hospital / Q000706:statistics & numerical data*; D010349:Patient Compliance / Q000706:statistics & numerical data*; D010352:Patient Dropouts / Q000706:statistics & numerical data*
keywords: No-shows; appointment scheduling; overbooking; predictive models