title: Preventing Endoscopy Clinic No-Shows: Prospective Validation of a Predictive Overbooking Model.
abstract: Patient absenteeism for scheduled visits and procedures ("no-show") occurs frequently in healthcare systems worldwide, resulting in treatment delays and financial loss. To address this problem, we validated a predictive overbooking system that identifies patients at high risk for missing scheduled gastrointestinal endoscopy procedures ("no-shows" and cancellations), and offers their appointments to other patients on short notice.
  
  
  
  We prospectively tested a predictive overbooking system at a Veterans Administration outpatient endoscopy clinic over a 34-week period, alternating between traditional booking and predictive overbooking methods. For the latter, we assigned a no-show risk score to each scheduled patient, utilizing a previously developed logistic regression model built with electronic health record data. To compare booking methods, we measured service utilization-defined as the percentage of daily total clinic capacity occupied by patients-and length of clinic workday.
  
  
  
  Compared to typical booking, predictive overbooking resulted in nearly all appointment slots being filled-2.5 slots available during control weeks vs. 0.35 slots during intervention weeks, t(161)=4.10, P=0.0001. Service utilization increased from 86% during control weeks to 100% during intervention weeks, allowing 111 additional patients to undergo procedures. Physician and staff overages were more common during intervention weeks, but less than anticipated (workday length of 7.84 h (control) vs. 8.31 h (intervention), t(161)=2.28, P=0.02).
  
  
  
  Predictive overbooking may be used to maximize endoscopy scheduling. Future research should focus on adapting the model for use in primary care and specialty clinics.
authors.affiliation: Department of Gastroenterology, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA.|Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, California, USA.
authors.forename: Mark W
authors.initials: MW
authors.lastname: Reid
authors.affiliation: Department of Gastroenterology, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA.|Division of Digestive Diseases, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.
authors.forename: Folasade P
authors.initials: FP
authors.lastname: May
authors.affiliation: Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, California, USA.
authors.forename: Bibiana
authors.initials: B
authors.lastname: Martinez
authors.affiliation: Department of Gastroenterology, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA.
authors.forename: Samuel
authors.initials: S
authors.lastname: Cohen
authors.affiliation: Kaiser Permanente Northern California, Oakland, California, USA.
authors.forename: Hank
authors.initials: H
authors.lastname: Wang
authors.affiliation: Department of Gastroenterology, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA.|Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, California, USA.
authors.forename: Demetrius L
authors.initials: DL
authors.lastname: Williams
authors.affiliation: Department of Gastroenterology, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA.|Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, California, USA.|Department of Health Policy and Management, UCLA Fielding School of Public Health, UCLA, Los Angeles, California, USA.|Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA.
authors.forename: Brennan M R
authors.initials: BM
authors.lastname: Spiegel
mesh_terms: D000368:Aged; D000554:Ambulatory Care Facilities; D001071:Appointments and Schedules; D015897:Comorbidity; D016145:Endoscopy, Digestive System; D005260:Female; D005762:Gastroenterology; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D019964:Mood Disorders / Q000453:epidemiology; D015999:Multivariate Analysis; D000067455:No-Show Patients / Q000706:statistics & numerical data*; D016017:Odds Ratio; D011446:Prospective Studies; D018570:Risk Assessment; D019966:Substance-Related Disorders / Q000453:epidemiology; D014481:United States; D014493:United States Department of Veterans Affairs