The Effect of Computer Generated Appointment Reminders On Compliance With Clinic Appointments

摘要

Introduction Missed medical appointments are an important obstacle to the provision of effective health care. By failing to keep their appointments, patients disrupt the doctor-patient relationship, adversely affect clinic efficiency, and erode continuity of care. The benefits of continuity of care include a decrease in emergency department visits 1234 , a decrease in the likelihood of future hospitalizations 56 , an increase in patient satisfaction 78 and the use of preventive health services 9 , and ultimately a decrease the cost of health care 10 . Moreover, there is decreased use of diagnostic tests and more reliance on judicious expectant management when as the result of the provision of continuity of care practitioners have a high level of accumulated knowledge regarding their patients 11 . Decreasing the missed appointment rate can therefore be expected to improve continuity of care and the provision of effective health care.Failure to keep appointments leads to increased administrative complexity and decreased revenues. Missed appointments also decrease access to care for other patients needing health care. Practitioners and administrators struggle with the resultant unpredictable patient volume, and often resort to overbooking patients in an attempt to maintain productivity. This in turn can lead to patient and staff dissatisfaction. All of these factors indirectly increase the cost of care. Unfortunately, missed appointments are common in many different health care settings; a review by Oppenheim et al found missed appointment rates ranged from 19% to 52% in a large variety of health care settings 12 . Increased missed appointments were noted in young adults, adults with young children, and low socioeconomic groups.Several interventions, with varying degrees of success, have been designed and described in the medical literature in order to improve compliance with appointment keeping and decrease clinic no-show rates. Computer generated telephone messages may provide an inexpensive and effective means to improve clinic attendance. Evaluation of these systems has shown that they can improve immunization rates 1314 and increase attendance in some public health clinics 15 . We decided to evaluate the effectiveness of a computer generated reminder system on kept appointment rates in an inner city public hospital system. Our hypothesis was that such a system would positively impact the kept appointment rates in primary care clinics in our integrated public health system. Methods Equipment: Computer Telephony Integration (CTI) is a computer-based application that automatically calls patients to remind them of their upcoming appointments. This program (BRITE) is interfaced with a computerized scheduling system to automatically download patient and appointment information. It uses an interactive voice response technology to call patients 24 to 72 hours before their appointment. The message delivers the appointment time and instructs the patient to call the clinic and cancel their appointment if necessary. Messages are given to the answering person in either English or Spanish. If there is no answer, the patient will be called back up to 5 times.(Note: BRITE is manufactured by InterVoice of Dallas, Tx. The scheduling system used was INVISION Resource Scheduling from Seimens Medical Solutions Corporation, Malvern, PA. Denver Health and Hospital Authority has purchased both of these systems. No financial support was provided to the authors.)Patient Population: Patients in this study receive their health care through Denver Health, a vertically integrated public health care system that includes Denver Health Medical Center, an urban hospital and ambulatory care center, and 11 community health centers, serving primarily minority, low income patients. Approximately 49% of the patients are Hispanic, 27% White, and 17% African-American. Nearly half of the patients lack any form of medical insurance, and the majority of the remainder