Automated Waitlists for Ambulatory Appointment Scheduling: Multisite, Mixed Methods Evaluation

Area of Science:

• Health Services Research
• Health Informatics
• Implementation Science

Background:

• Delayed ambulatory care access negatively impacts patient outcomes and system efficiency.
• Automated waitlists are emerging tools to notify patients of earlier appointment availability.
• Limited evidence exists on the efficacy of automated waitlists for improving access.

Purpose of the Study:

• To evaluate automated waitlists in US health systems.
• To identify determinants influencing the adoption and sustained use of automated waitlists.
• To inform healthcare organizations aiming to enhance ambulatory appointment access.

Main Methods:

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

Main Results:

• Automated waitlists filled 38.8% of offered appointments, with a lower missed appointment rate (3.1%) compared to all appointments (6.6%).
• Flexible configuration, external pressures (peer benchmarking, patient demand) facilitated adoption.
• Organizational factors like governance, leadership, and iterative culture enabled sustained use, while constraints included insurance, seasonality, and digital inequities.

Conclusions:

• Automated waitlists can improve access to ambulatory care.
• Effectiveness is primarily driven by implementation processes and organizational factors.
• Integration into system-level scheduling infrastructure is key for maximizing impact.