Improving Rates of Cardiac Stress Test Completion through Scheduling Interventions

Many patients with cardiac stress tests ordered in primary care settings fail to complete them due to scheduling delays. Prior research has shown that such delays can affect diagnostic accuracy and patient outcomes. However, the specific barriers to scheduling and completion remain unclear. No prior work had resolved how to systematically reduce these delays. Existing knowledge highlights the importance of timely cardiac diagnostics, but practical methods for improving scheduling rates are limited. This gap motivated the development of a multi-layered intervention. That uncertainty drove the need to test outreach strategies. The study aimed to address this by evaluating a novel approach. The goal was to determine if proactive outreach could improve both scheduling and completion rates.

The aim of this study was to assess whether a two-part outreach intervention could improve the rates of cardiac stress test scheduling and completion in primary care. The specific problem addressed was the high rate of unscheduled tests despite physician orders. The motivation was to reduce delays that may impact patient care. The study sought to identify practical solutions for workflow inefficiencies. It also aimed to understand patient-reported barriers to scheduling. The intervention was designed to address both logistical and informational gaps. The study focused on a pilot implementation to test feasibility. The ultimate goal was to inform future system-wide improvements.

The study used a nonrandomized mixed-methods pre-post design to evaluate the intervention. Patients with ordered but unscheduled stress tests were identified for inclusion. The first intervention involved proactive outreach phone calls by a primary care patient service representative. The second intervention consisted of priming phone calls to remind patients to schedule their tests. These calls also invited participation in a semi-structured interview. Scheduling and completion rates were compared between baseline and intervention groups. Statistical analysis included hypothesis tests and X-bar/S charts for time to completion. Qualitative data from interviews were used to explore patient-reported barriers.

The intervention cohort (n = 548) had a significantly higher completion rate of 81.0% (444 patients) compared to the baseline cohort (n = 157) at 66.2% (104 patients). Scheduling rates also improved, from 70.1% (110) in the baseline group to 91.2% (500) in the intervention group. Time to completion was reduced from 44.70 days (σ = 72.93) to 33.6 days (σ = 26.67). These findings suggest the intervention effectively reduced delays. The statistical significance of these results was confirmed with hypothesis tests. Qualitative interviews revealed that patients cited time constraints and confusing processes as barriers. The intervention demonstrated a practical solution to these challenges. The pilot was found to be cost-effective, though it may increase staff workload.

The multi-layered outreach intervention successfully improved both scheduling and completion rates for cardiac stress tests. The intervention also reduced the time to completion, as reported by the study authors. These findings suggest that proactive outreach can address workflow inefficiencies in primary care. The authors propose that such an approach could be a quality-improving strategy. The study highlights the importance of patient-reported barriers in shaping interventions. The pilot demonstrated cost-effectiveness, though it may increase staff workload. The authors suggest that future studies should explore automation to reduce system burden. The intervention is not the current standard of care, as stated by the authors.