title: Prevalence, predictors and economic consequences of no-shows.
abstract: BACKGROUND
  Patients not attending to clinic appointments (no-show) significantly affects delivery, cost of care and resource planning. We aimed to evaluate the prevalence, predictors and economic consequences of patient no-shows.
  
  
  METHODS
  This is a retrospective cohort study using administrative databases for fiscal years 1997-2008. We searched administrative databases for no-show frequency and cost at a large medical center. In addition, we estimated no-show rates and costs in another 10 regional hospitals. We studied no-show rates in primary care and various subspecialty settings over a 12-year period, the monthly and seasonal trends of no-shows, the effects of implementing a reminder system and the economic effects of missed appointments.
  
  
  RESULTS
  The mean no-show rate was 18.8% (2.4%) in 10 main clinics with highest occurring in subspecialist clinics. No-show rate in the women clinic was higher and the no-show rate in geriatric clinic was lower compared to general primary care clinic (PCP). The no-show rate remained at a high level despite its reduction by a centralized phone reminder (from 16.3% down to 15.8%). The average cost of no-show per patient was $196 in 2008.
  
  
  CONCLUSIONS
  Our data indicates that no-show imposed a major burden on this health care system. Further, implementation of a reminder system only modestly reduced the no-show rate.
authors.affiliation: Office of Performance Improvement, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Parviz
authors.initials: P
authors.lastname: Kheirkhah
authors.affiliation: Industrial Engineering Department, University of Houston, Houston, TX, USA.
authors.forename: Qianmei
authors.initials: Q
authors.lastname: Feng
authors.affiliation: Audie L. Murphy VA Medical Center, San Antonio, TX, USA.
authors.forename: Lauren M
authors.initials: LM
authors.lastname: Travis
authors.affiliation: Baylor College of Medicine, 2002 Holcombe Blvd., Houston, TX, 77030, USA.|Michael E. DeBakey VA Medical Center, 2002 Holcombe Blvd., Houston, TX, 77030, USA.
authors.forename: Shahriar
authors.initials: S
authors.lastname: Tavakoli-Tabasi
authors.affiliation: Baylor College of Medicine, 2002 Holcombe Blvd., Houston, TX, 77030, USA. amirs@bcm.edu.|Michael E. DeBakey VA Medical Center, 2002 Holcombe Blvd., Houston, TX, 77030, USA. amirs@bcm.edu.
authors.forename: Amir
authors.initials: A
authors.lastname: Sharafkhaneh
mesh_terms: D000368:Aged; D000554:Ambulatory Care Facilities / Q000191:economics / Q000706:statistics & numerical data*; D001071:Appointments and Schedules; D003365:Costs and Cost Analysis; D003695:Delivery of Health Care / Q000191:economics; D005260:Female; D006295:Health Resources / Q000191:economics; D006767:Hospitals, District / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D000067455:No-Show Patients / Q000191:economics / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000191:economics; D017010:Reminder Systems / Q000191:economics / Q000706:statistics & numerical data; D012189:Retrospective Studies; D013781:Texas