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Volunteer Outreach and Predictive Modeling: Rapid Randomized Quality Improvement Project for New Patient Attendance
Kevin Chen1,2, Khera Bailey1, Simon Nemytov3
1Office of Ambulatory Care and Population Health, New York City Health + Hospitals, New York, New York, USA.
Background:
Nonattendance at new patient appointments leads to missed opportunities for engagement in care, lost revenue, and suboptimal resource utilization.
Objective:
To assess the effectiveness of outreach calls to new patients, prioritized by a no-show predictive algorithm and conducted by volunteers, on visit attendance.
Design:
Rapid randomized quality improvement project.
Participants:
Patients with new patient appointments at an urban safety-net adult primary care clinic scheduled to occur between August 1, 2024 and September 30, 2024.
Intervention:
Estimated probability of visit no-show for patients was calculated using a predictive algorithm embedded in the electronic health record and used to sort lists of patients with upcoming appointments. Every other patient received an outreach call from a trained volunteer within 3 business days of their appointment plus usual automated reminder messages versus usual automated reminder messages alone.
Main Measures:
New patient visit attendance compared between intervention and control groups. We conducted subgroup analyses of attendance by visit modality (in-person vs. telehealth), preferred language, and quartile of predicted no-show probability.
Key Results:
Patients in the intervention group (n = 281) had higher visit attendance than those in the control group (n = 280): 68.0% versus 54.1% (p < 0.01). There was a significant difference in attendance for in-person (70.7% vs. 51.7%; p < 0.01) but not telehealth (60.6% vs. 61.2%; p = 0.94) visits. Patients who preferred English had the biggest increase in attendance (17.2%; p < 0.01). Patients in the second and third quartiles of predicted no-show probability (31%-38% and 39%-45% predicted probability) had the biggest increases in attendance (22.2% [p = 0.01] and 15.4% [p = 0.05]).
Conclusions:
Outreach calls for new patients, prioritized by a no-show predictive algorithm and conducted by volunteers, can be a feasible and effective approach to improving visit attendance in a targeted fashion. Further investigation is needed to understand how to better support non-English preferring patients and patients with telehealth appointments.
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