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Tavish Nanda, Jason Horowitz; Follow Up Trends in a Resident Clinic: A Medicare/Medicaid Population Analysis. Invest. Ophthalmol. Vis. Sci. 2019;60(9):5495.
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© ARVO (1962-2015); The Authors (2016-present)
In resident family medicine practices, >20% no show rate is common, particularly amongst Medicaid patients. The lack of compliance often results in sub-par care and lost educational opportunities. The objective of this study was to determine the no show rate in a primarily resident-based ophthalmology clinic serving Medicare/Medicaid patients.
As part of a quality improvement project, data on 18,917 adult appointments made through a computer-based scheduling system between 07/2017 and 05/2018 were analyzed to determine overall follow-up adherence. Only patients who required follow up within 130 days were included. ‘Show’ and ‘No Show’ was filtered for all visits, by sub-specialty clinic, new patients, and follow-up appointments. Scheduled follow ups were categorized into consecutive ten day (d) follow up times [Table 1]. A simpler division of 4 quartiles, each separated by 30 days, was also counted. Post-surgical follow ups, walk-ins, and rescheduled appointments were excluded.
In the period observed, 27.8% of all scheduled appointments were no shows. 43.2% of new patients did not show (Show: 52.9d, No Show: 63.0d, p=<0.001) and 23.9% of follow-ups did not show (Show: 43.72d, No Show: 54.44d, p=<0.001). No show percentages by sub-specialty can be seen in Table 2. On average, every ten additional days in follow up time resulted in a 3.0% increase in no show rate. When divided into quartiles, there was a 10.8% increase in overall no show rate from 30 days to 30-60 days, and an additional 4.8% from 30-60d to 60-90d.
Approximately a quarter of all scheduled patients were no shows. In Medicare/Medicaid patients who require acute/sub-acute follow up (<130 days), there were also notable differences in follow up compliance even within a ten-day timeframe. In both the new patients and follow-up groups, an average addition of ten days resulted in significant differences in attendance (Show vs. No Show). Residents should remain cognizant of the high no show rate in this population when assigning broad follow up ranges (i.e. 3-4months). A reduction in no show rate will improve predictability and accuracy of clinic scheduling, improve patient satisfaction and subsequently patient compliance; an important component for the optimal care of sight threatening disease. In addition, a more robust reminder program may benefit resident clinics in ophthalmology.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.
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