The Effect of Automated Mammogram Orders Paired With Electronic Invitations to Self-schedule on Mammogram Scheduling Outcomes: Observational Cohort Comparison

Background

Screening mammography is recommended for the early detection of breast cancer. The processes for ordering screening mammography often rely on a health care provider order and a scheduler to arrange the time and location of breast imaging. Self-scheduling after automated ordering of screening mammograms may offer a more efficient and convenient way to schedule screening mammograms.

Objective

The aim of this study was to determine the use, outcomes, and efficiency of an automated mammogram ordering and invitation process paired with self-scheduling.

Methods

We examined appointment data from 12 months of scheduled mammogram appointments, starting in September 2019 when a web and mobile app self-scheduling process for screening mammograms was made available for the Mayo Clinic primary care practice. Patients registered to the Mayo Clinic Patient Online Services could view the schedules and book their mammogram appointment via the web or a mobile app. Self-scheduling required no telephone calls or staff appointment schedulers. We examined uptake (count and percentage of patients utilizing self-scheduling), number of appointment actions taken by self-schedulers and by those using staff schedulers, no-show outcomes, scheduling efficiency, and weekend and after-hours use of self-scheduling.

Results

For patients who were registered to patient online services and had screening mammogram appointment activity, 15.3% (14,387/93,901) used the web or mobile app to do either some mammogram self-scheduling or self-cancelling appointment actions. Approximately 24.4% (3285/13,454) of self-scheduling occurred after normal business hours/on weekends. Approximately 9.3% (8736/93,901) of the patients used self-scheduling/cancelling exclusively. For self-scheduled mammograms, there were 5.7% (536/9433) no-shows compared to 4.6% (3590/77,531) no-shows in staff-scheduled mammograms (unadjusted odds ratio 1.24, 95% CI 1.13-1.36; P<.001). The odds ratio of no-shows for self-scheduled mammograms to staff-scheduled mammograms decreased to 1.12 (95% CI 1.02-1.23; P=.02) when adjusted for age, race, and ethnicity. On average, since there were only 0.197 staff-scheduler actions for each finalized self-scheduled appointment, staff schedulers were rarely used to redo or “clean up” self-scheduled appointments. Exclusively self-scheduled appointments were significantly more efficient than staff-scheduled appointments. Self-schedulers experienced a single appointment step process (one and done) for 93.5% (7553/8079) of their finalized appointments; only 74.5% (52,804/70,839) of staff-scheduled finalized appointments had a similar one-step appointment process (P<.001). For staff-scheduled appointments, 25.5% (18,035/70,839) of the finalized appointments took multiple appointment steps. For finalized appointments that were exclusively self-scheduled, only 6.5% (526/8079) took multiple appointment steps. The staff-scheduled to self-scheduled odds ratio of taking multiple steps for a finalized screening mammogram appointment was 4.9 (95% CI 4.48-5.37; P<.001).

Conclusions

Screening mammograms can be efficiently self-scheduled but may be associated with a slight increase in no-shows. Self-scheduling can decrease staff scheduler work and can be convenient for patients who want to manage their appointment scheduling activity after business hours or on weekends.

Appointment Adherence to a City-Wide Cardiovascular Disease Prevention Program: Its Predictors and Outcomes

This study identified predictors of appointment adherence and examined its impacts on improvements in metabolic risk factors in a free city-wide cardiovascular disease prevention program in Seoul, South Korea. Data of 8251 citizens with metabolic syndrome were used. Appointment adherers were defined as having 70% or higher adherence rates, that is, 3 or more visits. Of the 8251 citizens, 17.6% were appointment adherers. Appointment adherers were significantly more likely to be older, low-income earners, nonsmokers, and nonobese than appointment nonadherers. Moreover, appointment adherers, compared with nonadherers, showed significant improvements in waist circumference, systolic blood pressure, and high-density lipoprotein cholesterol, but not in fasting glucose and triglycerides. Designing strategies for increasing appointment adherence to a free city-wide cardiovascular disease prevention program is essential to improve health outcomes, especially targeting population groups with young age, high-income, current smoking, or obesity.

Impact of Web-Based Self-Scheduling on Finalization of Well-Child Appointments in a Primary Care Setting: Retrospective Comparison Study

Background

Web-booking of flights, hotels, and sports events has become commonplace in the travel and entertainment industry, but self-scheduling of health care appointments on the web is not yet widely used. An electronic health record that integrates appointment scheduling and patient web-based access to medical records creates an opportunity for patient self-scheduling. The Mayo Clinic developed and implemented a feature in its Patient Online Services (POS) web and mobile platform that allows software-managed self-scheduling of well-child visits.

Objective

This study aims to examine the use of a new self-scheduling appointment feature within POS in both web and mobile formats and determine the use characteristics, outcomes, and efficiency of self-scheduling compared with staff scheduling.

Methods

Within a primary care setting, we collected 13 months of all appointment activity for the well-child visit for children aged 2-12 years. As these specific appointment types are for minors, self-scheduling is performed by parents or other proxies. We compared the appointment actions of scheduling and cancelling for both self-scheduled and staff-scheduled appointments. The frequency in which patients were using self-scheduling outside of normal business hours was quantified, and we compared no-show outcomes of finalized appointments.

Results

Of the 1099 patients who performed any self-scheduling actions, 73.1% (803/1099) exclusively used self-scheduling and self-cancelling software. For those with access to self-scheduling (patients registered with the Mayo Clinic POS), 4.92% (1201/24,417) of all well-child appointment-scheduling actions were self-scheduled. Staff scheduling required more than a single appointment step (eg, schedule, cancel, reschedule) in 28.32% (3729/13,168) compared with only 6.93% (53/765) of self-scheduled appointments (P<.001). Self-scheduling appointment actions took place outside of regular business hours 29.5% (354/1201) of the time. No-shows accounted for 3.07% (28/912) of the self-scheduled finalized appointments compared with 4.12% (693/16,828) of staff-scheduled appointments, which is a nonsignificant difference (P=.12). Staff-scheduled finalized appointments (that allowed for scheduling appointments for more than 12 weeks in the future) revealed a potential demand of 11.15% (1876/16,828) for appointments with longer lead times.

Conclusions

Self-scheduling can generate a significant number of finalized appointments, decreasing the need for staff scheduler time. We found that 29.5% (354/1201) of the self-scheduling activity took place outside of the usual staff scheduler hours, adding convenience value to the scheduling process. For exclusive self-schedulers, 93.1% (712/765) finalized the appointment in a single step. The no-show rates were not adversely affected by the self-scheduling.

Evaluating the Impact of Patient No-Shows on Service Quality

Purpose

Patient no-shows are long-standing issues affecting resource utilization and posing risks to the quality of healthcare services. They also lead to loss of anticipated revenue, particularly in services where resources are expensive and in great demand.

Methods

In order to address common reasons why patients miss appointments, this study reviews the current literature and investigates various tools and methods that have been implemented to mitigate such issues. Further, a case study is conducted to identify the rate of no-shows and underlying causes at a radiology department in one of the leading hospitals in the MENA region.

Results

Our results show that the no-shows are high due to multiple factors, such as patient behavior, patients’ financial situation, environmental factors and scheduling policy.

Conclusion

In conclusion, we generate a list of recommendations that can help in reducing the rate of patient no-shows, such as patient education, application of dynamic scheduling policies and effective appointment reminder systems to patients.

Combined effect of pill refilling and self-medication reminder system on patients' adherence to tuberculosis treatment during continuation phase in Northwest Ethiopia: a study protocol for randomised controlled trial

Introduction

Patients’ failure to adhere on tuberculosis (TB) treatment leads to drug resistance, relapse and death. Non-adherence to TB treatment is higher during continuation treatment phase. The study aimed to evaluate effectiveness of combined pill refilling and medication reminders on adherence to TB treatment.

Methods and analysis

A two-arm randomised controlled trial on adult patients with TB was used during continuation treatment phase. In the first arm, in addition to usual care, participants will receive cellphone-based daily medication and weekly pill refilling reminders. In the control arm, participants will receive only usual care. The study will use a covariate adaptive randomisation technique to balance covariates during allocation. The primary outcome is patients’ adherence to TB treatment and secondary outcomes are attendance to clinic and treatment outcomes. We apply intention to treat with generalised linear mixed model.

Ethics and dissemination

Ethical approval was obtained from Institutional Review Board of University of Gondar. Written informed consent was applied during enrolment. We will publish findings in peer-reviewed, scientific journals and conferences.

Trial registration number

PACTR201901552202539.

Do Waiting Times in Dental Offices Affect Patient Satisfaction and Evaluations of Patient-Provider Relationships? A Quasi-experimental Study

PURPOSE

Spending time in waiting rooms prior to dental visits is not uncommon for dental hygiene patients. The objectives were to determine if the length of a patients' waiting time affected their satisfaction with the appointment and their evaluation of their provider. In addition, the patient's level of education and whether the dental visit is a first visit will be examined to determine if these affected the outcome.

METHODS

Survey data were collected from 399 adult patients who came for regularly scheduled visits to a dental school clinic. The patients ranged in age from 19 to 93 years (mean=52 years; SD=16.9). For 29% of the patients, this visit was the first visit with this provider.

RESULTS

The patients whose providers were early (n=65) were more satisfied, more likely to plan to follow their provider's recommendation and evaluated their relationship with their provider more positively than patients whose providers were on time (n=283), while the patients in the "late" group (n=32) showed the most negative responses to all questions. Patients from higher educational backgrounds were most negative in their responses when their providers were late. Patients with a first visit whose providers were late had the most negative evaluations of the patient-provider relationship.

CONCLUSION

Long waiting times prior to a scheduled dental appointment have a negative effect on patients' satisfaction with their visit, the evaluations of the patient-provider relationship and the patients' intentions to return.