The effect of a carve-out advanced access scheduling system on no-show rates.

Delays are common for patients seeking primary care services, with wait times for appointments as high as 60 days.1,2 For academic practices, this delayed access is exacerbated by interrupted continuity clinic schedules, day-to-day variation in provider availability, and communication difficulties when residents are on hospital-based rotations that limit their ambulatory clinical time.3 Advanced access scheduling is recommended as a way for ambulatory practices to improve both access and continuity at the same time. Advanced access gives patients the ability to schedule an appointment with the provider of their choice, for virtually any service, within a day or two.4 Many non-academic practices have experienced success with this scheduling model by demonstrating increased appointment availability, reduced no-show rates, increased patient satisfaction, and increased revenues.2,5-9 Additionally, the Institute for Healthcare Improvement (IHI) has shown that advanced access scheduling increases the proportion of visits that are with a patient’s primary provider, which increases the likelihood of a patient arriving for a visit.11 Some academic practices have seen a decrease in no-show appointment rates with the introduction of advanced access and attributed subsequent increases in visit volumes to this reduction.10 Others, however, did not see an improvement in no-show rates.12 This discrepancy may be due to a myriad of factors that have been shown to influence no-show rates, such as insurance status, clinical characteristics of the patient, type of provider to be seen, and system characteristics.13-15 Since the relationship between advanced access scheduling and no-show rates in academic settings is unclear, further study is warranted. The purpose of this analysis is to assess the effect of moving to a form of advanced access scheduling system on no-show appointment frequency within an academic practice. Our no-show rate in the year before we implemented advanced access varied each month between 20%–25%. Unlike previous studies that only examined no-show rate as one of many outcomes of advanced access implementation, we will examine the factors associated with no-shows within this environment in more detail. The Effect of a Carve-out Advanced Access Scheduling System on No-show Rates