title: Targeted Reminder Phone Calls to Patients at High Risk of No-Show for Primary Care Appointment: A Randomized Trial.
abstract: No-shows, or missed appointments, are a problem for many medical practices. They result in fragmented care and reduce access for all patients.
  
  
  
  To determine whether telephone reminder calls targeted to patients at high risk of no-show can reduce no-show rates.
  
  
  
  Single-center randomized controlled trial.
  
  
  
  A total of 2247 primary care patients in a hospital-based primary care clinic at high risk of no-show (>15 % risk) for their appointment in 7 days.
  
  
  
  Seven days prior to their appointment, intervention arm patients were placed in a calling queue to receive a reminder phone call from a patient service coordinator. Coordinators were trained to engage patients in concrete planning. All patients received an automated phone call (usual care).
  
  
  
  Primary outcome was no-show rate. Secondary outcomes included arrival rate, cancellation rate, reschedule rate, time to cancellation, and change in revenue.
  
  
  
  The no-show rate in the intervention arm (22.8 %) was significantly lower (absolute risk difference -6.4 %, p < 0.01, 95 % CI [-9.8 to -3.0 %]) than that in the control arm (29.2 %). Arrival, cancellation, and reschedule rates did not differ significantly. In the intervention arm, rescheduling and cancellations occurred further in advance of the appointment (mean difference, 0.35 days; 95 % CI [0.07-0.64]; p = 0.01). Reimbursement did not differ significantly.
  
  
  
  A phone call 7 days prior to an appointment led to a significant reduction in no-shows and increased reimbursement among patients at high risk of no-show. The use of targeted interventions may be of interest to practices taking on increased accountability for population health.
authors: Department of Medicine, Division of General Internal Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA. sshah@mgh.harvard.edu.|Massachusetts General Physicians Organization, Massachusetts General Hospital, 50 Staniford Street (940-J), Boston, MA, 02114, USA. sshah@mgh.harvard.edu.
authors: Sachin J
authors: SJ
authors: Shah
authors: Department of Medicine, Lab of Computer Science, Massachusetts General Hospital, Boston, MA, USA.
authors: Patrick
authors: P
authors: Cronin
authors: Los Angeles County Department of Health Services, Los Angeles, CA, USA.
authors: Clemens S
authors: CS
authors: Hong
authors: Department of Medicine, Division of General Internal Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
authors: Andrew S
authors: AS
authors: Hwang
authors: Department of Medicine, Division of General Internal Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
authors: Jeffrey M
authors: JM
authors: Ashburner
authors: Department of Medicine, Division of General Internal Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
authors: Benjamin I
authors: BI
authors: Bearnot
authors: Massachusetts General Physicians Organization, Massachusetts General Hospital, 50 Staniford Street (940-J), Boston, MA, 02114, USA.
authors: Calvin A
authors: CA
authors: Richardson
authors: Department of Medicine, Division of General Internal Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
authors: Blair W
authors: BW
authors: Fosburgh
authors: Massachusetts General Physicians Organization, Massachusetts General Hospital, 50 Staniford Street (940-J), Boston, MA, 02114, USA.|Department of Dermatology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
authors: Alexandra B
authors: AB
authors: Kimball
mesh_terms: D000046:Academic Medical Centers / Q000379:methods / Q000639:trends; D000328:Adult; D000368:Aged; D001071:Appointments and Schedules; D040421:Cell Phone / Q000639:trends; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D000067455:No-Show Patients / Q000523:psychology* / Q000639:trends; D010044:Outpatient Clinics, Hospital / Q000639:trends; D010349:Patient Compliance / Q000523:psychology*; D011320:Primary Health Care / Q000379:methods* / Q000639:trends; D017010:Reminder Systems / Q000639:trends; D012307:Risk Factors; D060145:Text Messaging / Q000639:trends
keywords: access to care; applied informatics; behavior change; population health; primary care redesign