Currently submitted to: Journal of Medical Internet Research
Date Submitted: Sep 30, 2019
Open Peer Review Period: Sep 30, 2019 - Nov 25, 2019
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Patient-Centric Scheduling Practices: Implementation of Health Information Technology to Improve the Patient Experience and Access to Care
Cancellations and rescheduling of doctor’s appointments are common. An automated rescheduling system has the potential to facilitate rescheduling process so that newly opened slots are promptly filled by patients who need and can take the slot. Building on an existing online patient portal, a large healthcare system adopted an automated rescheduling system, called Fast Pass, that sends out an earlier appointment offer via email or text alert to patients and allows patients to reschedule their appointment through the online portal.
We examined the uptake of Fast Pass at its early stage of implementation. We assessed program features and patient and visit characteristics associated with higher levels of Fast Pass utilization and association between Fast Pass use and no-show and cancellation rates.
This study was a retrospective analysis of Fast Pass offers sent between July and December 2018. Multivariable logistic regression was used to assess the independent contribution of program, patient, and visit characteristics on the likelihood of accepting the offer. We then assessed appointment outcome (completion, cancellation, or no-show) of Fast Pass offered appointments compared to appointments with the same patient and visit characteristics but without an offer.
Of 177,311 Fast Pass offers sent, 8.3% were accepted. Overall, there were 1.3 percentage points (or 38%) reduction in no-show rates among Fast Pass accepted appointments than other appointments with matching characteristics (P < .001). The offers were more likely to be accepted if they were sent in the evening (vs. early morning), the first (vs. repeated) offer for the same appointment, for a slot 1-31 days ahead (vs. same-day), for later in a day (vs. before 10am), for primary care (vs. specialty) visit, sent via text message (vs. email only), for an appointment made through patient online portal (vs. via phone call or in-person), or for younger adults aged 18-49 (vs. ≥65) (all at P < .001). Factors negatively associated with offer acceptance were increasing number of comorbidities (P = .02) and visits scheduled for chronic conditions (vs. acute conditions only) (P = .002).
An automated rescheduling system can improve patient’s access by reducing wait time for an appointment, with an added benefit of preventing no-shows by serving as a reminder of an upcoming appointment. Future modifications, such as increasing adoption of text-based offers and targeting older adults or patients with complex conditions, may help promote wider utilization and patient-centeredness of the system. Clinical Trial: N/A
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