A Dedicated Outbound Scheduler Is Associated With Improved Clinic Utilization and Access to Care

Differential access to care for patients living in more disadvantaged areas has been well-documented, though the specific factors underlying these disparities have not been well-described. We undertook this study to describe how clinic utilization and patient demographics differed before and after the utilization of a dedicated scheduler making outbound calls for scheduling.

We identified all new patients seen in a single pediatric urology outreach clinic in March and April 2021 (before the scheduler being hired); July and October 2021; and April, July, and October 2022 (after the scheduler was hired). We recorded the overall clinic utilization for each fiscal year and also demographic data (including Area Deprivation Index) on the new patients seen in clinic. Data before and after the hiring of the dedicated scheduler were compared.

Scheduled clinic utilization increased from 93.6% in FY2021 to 95.2% in FY2022 and to 98.9% in early FY2023. Missed appointments were relatively stable at 7.4% in FY2021, 7.8% in FY2022, and 6.8% in early FY2023. There was a 39.1% increase in the number of new patients seen per clinic shortly after the addition of an outbound clinic-embedded scheduler (8.63 versus 12), which was sustained and slightly increased to 43.8% (8.63 versus 12.4) 1 y later. The proportion of new patients living in the most disadvantaged areas (Area Deprivation Index 8-10) rose 35.3% (from 49.3% to 66.7%; P = 0.04) shortly after the outbound clinic-embedded scheduler was hired and remained 27.7% higher (49.3% versus 62.9%; P = 0.07) 1 y later. The proportion of new patients speaking a language other than English increased from 8.7% before the outbound clinic-embedded scheduler to 13.9% (P = 0.48) shortly after the outbound clinic-embedded scheduler, and 21.0% (P = 0.03) 1 y later.

Addition of a dedicated clinic scheduler making outbound calls was associated with a durable increase in clinic utilization and improved access primarily for patients living in the most disadvantaged areas. Further research is needed to identify what aspects of outbound scheduling are most helpful to the most vulnerable patients.