Original article
Environmental Factors Predictive of No-Show Visits in Radiology: Observations of Three Million Outpatient Imaging Visits Over 16 Years

https://doi.org/10.1016/j.jacr.2018.12.046Get rights and content

Abstract

Purpose

To evaluate the impact of environmental and socioeconomic factors on outpatient cancellations and “no-show visits” (NSVs) in radiology.

Materials and Methods

We conducted a retrospective analysis by collecting environmental factor data related to outpatient radiology visits occurring between 2000 and 2015 at our multihospital academic institution. Appointment attendance records were joined with daily weather observations from the National Oceanic and Atmospheric Administration and estimated median income from the US Census American Community Survey. A multivariate logistic regression model was built to examine relationships between NSV rate and median income, commute distance, maximum daily temperature, and daily snowfall.

Results

There were 270,574 (8.0%) cancellations and 87,407 (2.6%) NSVs among 3,379,947 scheduled outpatient radiology appointments and 575,206 unique patients from 2000 to 2015. Overall cancellation rates decreased from 14% to 8%, and NSV rates decreased from 6% to 1% as median income increased from $20,000 to $120,000 per year. In a multivariate model, the odds of NSV decreased 10.7% per $10,000 increase in median income (95% confidence interval [CI]: 10.3%-11.1%) and 2.0% per 10°F increase in maximum daily temperature (95% CI: 1.3%-1.6%). The odds of NSV increased 1.4% per 10-mile increase in commute distance (95% CI: 1.3%-1.6%) and 4.5% per 1-inch increase in daily snowfall (95% CI: 3.6%-5.3%). Commute distance was more strongly associated with NSV for those in the two lower tertiles of income than the highest tertile (P < .001).

Conclusion

Environmental factors are strongly associated with patients’ attendance at scheduled outpatient radiology examinations. Modeling of appointment failure risk based on environmental features can help increase the attendance of outpatient radiology appointments.

Key Words

Environmental factors
informatics
missed appointment
no-show visit (NSV)
population health
quality improvement
scheduling

Cited by (0)

Rebecca Mieloszyk, PhD, is an employee of Microsoft Healthcare. Christopher S. Hall, PhD, is an employee of Philips Healthcare Bothell Campus. Martin Gunn, MBChB, receives grant funding from Philips Healthcare and is a consultant for Elsevier Inc. Puneet Bhargava, MD is editor-in-chief of Current Problems in Diagnostic Radiology, Elsevier Inc. Daniel Hippe, MS, receives grant funding from Philips Healthcare, GE Healthcare, Toshiba America Medical Systems, and Siemens Medical Solutions. Joshua I. Rosenbaum, MD states that he has no conflict of interest related to the material discussed in this article.

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