Automated Waitlists for Ambulatory Appointment Scheduling: A Multi-Site, Mixed-Methods Evaluation.

Area of Science:

• Health Services Research
• Health Informatics
• Healthcare Management

Background:

• Delays in ambulatory care access lead to negative health outcomes and system inefficiencies.
• Automated waitlists are technology-enabled tools designed to notify patients of earlier appointment availability.
• Limited evidence exists on the efficacy of adopting, implementing, and sustaining automated waitlists to improve access.

Purpose of the Study:

• To evaluate automated waitlists and identify determinants influencing their adoption and ongoing use.
• To inform healthcare organizations on improving ambulatory care appointment access.
• To understand the factors affecting the successful implementation and sustainability of automated waitlists.

Main Methods:

• A convergent, multi-site, mixed-methods study was conducted.
• Data collected via survey of 127 health systems and in-depth study of 10 participating systems.
• The Consolidated Framework for Implementation Research guided the analysis of determinants.

Main Results:

• Automated waitlists successfully filled 38.8% of offered appointments and reduced missed appointments to 3.1% compared to 6.6% overall.
• Flexible configuration, external pressures, and organizational context (governance, leadership, culture) facilitated adoption and sustained use.
• Barriers included insurance/records requirements, seasonality, digital inequities, specialty gatekeeping, and clinician capacity.

Conclusions:

• Automated waitlists can improve access to ambulatory care when effectively implemented.
• Implementation success hinges on organizational factors and integration into system-level scheduling.
• Automated waitlists are most impactful as a dynamic component of comprehensive scheduling infrastructure, not a standalone solution.