Behavioral factors associated with patients’ non-attendance: A retrospective study in an outpatient specialty clinic at a women’s and children’s hospital in Singapore

ABSTRACT

Background

This study aimed to identify behavioral factors that affect patient attendance in outpatient clinics, especially those related to rescheduling.

Methods

A retrospective study was conducted on 20,386 appointment records for 6,252 patients in an outpatient specialty clinic at a women’s and children’s hospital in Singapore over 34 months (January 2012–October 2014). Multivariate logistic regression was used to analyze the influence of independent variables on appointment no-shows.

Results

The average no-show rate of the study population was 28.87%. Patient historical behaviors were significantly associated with appointment attendance. In particular, a larger number of previous visits, more historical no-shows, more historical rescheduling events initiated by patients, and more reschedulings initiated by the clinic for the current appointment were positively associated with no-shows. Notably, the number of previous visits was found to exhibit a significantly diminishing marginal effect on no-show rates. Further analyses suggested that for appointments rescheduled by the clinic, subsequent rescheduling by patients was associated with a reduced risk of no-shows.

Conclusions

No-shows were more common in patients who missed more historical appointments or had their appointments rescheduled more frequently. Encouraging patients to reschedule their own appointments could be an effective measure to reduce no-shows. However, the benefit of patient-rescheduling decreased if patients rescheduled appointments repeatedly.

KEYWORDS:

• Appointments
• no-shows
• patient attendance
• patient adherence
• patient preference
• rescheduling
• outpatient clinics

Data availability statement

Due to the nature of this research, participants of this study did not agree for their data to be shared publicly, so supporting data is unavailable.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.

Notes on contributors

Yue Tang

Yue Tang, currently a PhD student at Emory University, was a Research Assistant at Lee Kong Chian School of Business, Singapore Management University. He is interested in exploring healthcare data to identify solutions to improving healthcare delivery.

Houyuan Jiang

Houyuan Jiang is a Professor of Management Science at Cambridge Judge Business School, University of Cambridge. He is an expert in healthcare operations management, supply chain management, and revenue management. His research has been published in Operations Research, Management Science, Manufacturing & Service Operations Management, and Production and Operations Management, among others.

Jingui Xie

Jingui Xie is an Associate Professor at TUM School of Management, Technical University of Munich. He is interested in optimization and healthcare data analytics. His research has been published in Management Science, Operations Research, Manufacturing & Service Operations Management, and Production and Operations Management, among others.

Zhichao Zheng

Zhichao Zheng serves as an Associate Professor of Operations Management at the Lee Kong Chian School of Business, Singapore Management University. His work primarily employs data analytics and optimization methodologies to enhance the efficiency of healthcare operations, bolster medical decision-making processes, and influence public health policy. Moreover, Professor Zheng extends his research interests to encompass fields like the sharing economy and supply chain risk management. His research has been published in premier operations, medical, and public health journals.

Chui Yee Loke

Chui Yee Loke is the Chief Operating Officer (Crisis Planning & Operations) for Singapore Health Services and the Chief Operating Officer for SingHealth Polyclinics in Singapore.

Bee Keow Goh

Bee Keow Goh is an Assistant Director in Data Analytics Office at KK Women’s and Children’s Hospital in Singapore.