No-Show Modeling for Adult Ambulatory Clinics

Patient no-show is a pervasive problem in outpatient clinics. This chapter provides a literature review and discussion on how to develop statistical no-show models. The literature review is a structured and representative selection of research studies from a variety of medical areas. The literature is grouped into four classes. The first class covers self-reported reasons for no-show. The most common self-reported reasons are forgetting, conflicts, transportation, scheduling system problems, and physical or mental illness. The second class discusses the effect of no-show interventions such as appointment reminders, patient education, and changes in scheduling systems on no-show behavior. The third class develops statistical models of no-show behavior in a variety of settings. Several patient, provider, and clinic characteristics are considered in developing these models. The last class of literature considers the impact of no-shows on health outcomes, which illustrates the importance of no-show modeling. The second part of the chapter explains how statistical no-show models can be developed. The data requirements, determination of significant factors, development of logistic regression models, and model validation are explained in detail. An example no-show model is provided to illustrate the modeling and validation process. The chapter concludes with summarizing thoughts and a discussion of future research opportunities.