Modified open-access scheduling for new patient evaluations at an academic chronic pain clinic increased patient access to care, but did not materially reduce their mean cancellation rate

A retrospective, observational study

Eellan Sivanesan, David Lubarsky, Chaturani Ranasinghe, Konstantinos D. Sarantopoulos, Richard H. Epstein

Research output: Contribution to journalArticle

Abstract

Study objective To determine if open-access scheduling would reduce the cancellation rate for new patient evaluations in a chronic pain clinic by at least 50%. Design Retrospective, observational study using electronic health records. Setting Chronic pain clinic of an academic anesthesia department. Patients All patients scheduled for evaluation or follow-up appointments in the chronic pain clinic between April 1, 2014, and December 31, 2015. Interventions Open-access scheduling was instituted in April 2015 with appointments offered on a date of the patient's choosing ≥ 1 business day after calling, with no limit on the daily number of new patients. Measurements Mean cancellation rates for new patients were compared between the 12-month baseline period prior to and for 7 months after the change, following an intervening 2-month washout period. The method of batch means (by month) and the 2-sided Student t-test were used; P < 0.01 required for significance. Main results The new patient mean cancellation rate decreased from a baseline of 35.7% by 4.2% (95% confidence interval [CI] 1.4% to 6.9%; P = 0.005); however, this failed to reach the 50% reduction target of 17.8%. Appointment lag time decreased by 4.7 days (95% CI 2.3 to 7.0 days, P < 0.001) from 14.1 days to 9.4 days in the new patient group. More new patients were seen within 1 week compared to baseline (50.6% versus 19.1%; P < 0.0001). The mean number of new patient visits per month increased from 158.5 to 225.0 (P = 0.0004). The cancellation rate and appointment lag times did not decrease for established patient visits, as expected because open-access scheduling was not implemented for this group. Conclusions Access to care for new chronic pain patients improved with modified open-access scheduling. However, their mean cancellation rate only decreased from 35.7% to 31.5%, making this a marginally effective strategy to reduce cancellations.

Original languageEnglish (US)
Pages (from-to)92-96
Number of pages5
JournalJournal of Clinical Anesthesia
Volume41
DOIs
StatePublished - Sep 1 2017

Fingerprint

Pain Clinics
Chronic Pain
Observational Studies
Retrospective Studies
Appointments and Schedules
Hospital Anesthesia Department
Confidence Intervals
Electronic Health Records

Keywords

  • Appointments and schedules
  • Health services accessibility
  • Pain clinics

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Cite this

@article{708b8a23ee6943419dd0bbbbec59a2d7,
title = "Modified open-access scheduling for new patient evaluations at an academic chronic pain clinic increased patient access to care, but did not materially reduce their mean cancellation rate: A retrospective, observational study",
abstract = "Study objective To determine if open-access scheduling would reduce the cancellation rate for new patient evaluations in a chronic pain clinic by at least 50{\%}. Design Retrospective, observational study using electronic health records. Setting Chronic pain clinic of an academic anesthesia department. Patients All patients scheduled for evaluation or follow-up appointments in the chronic pain clinic between April 1, 2014, and December 31, 2015. Interventions Open-access scheduling was instituted in April 2015 with appointments offered on a date of the patient's choosing ≥ 1 business day after calling, with no limit on the daily number of new patients. Measurements Mean cancellation rates for new patients were compared between the 12-month baseline period prior to and for 7 months after the change, following an intervening 2-month washout period. The method of batch means (by month) and the 2-sided Student t-test were used; P < 0.01 required for significance. Main results The new patient mean cancellation rate decreased from a baseline of 35.7{\%} by 4.2{\%} (95{\%} confidence interval [CI] 1.4{\%} to 6.9{\%}; P = 0.005); however, this failed to reach the 50{\%} reduction target of 17.8{\%}. Appointment lag time decreased by 4.7 days (95{\%} CI 2.3 to 7.0 days, P < 0.001) from 14.1 days to 9.4 days in the new patient group. More new patients were seen within 1 week compared to baseline (50.6{\%} versus 19.1{\%}; P < 0.0001). The mean number of new patient visits per month increased from 158.5 to 225.0 (P = 0.0004). The cancellation rate and appointment lag times did not decrease for established patient visits, as expected because open-access scheduling was not implemented for this group. Conclusions Access to care for new chronic pain patients improved with modified open-access scheduling. However, their mean cancellation rate only decreased from 35.7{\%} to 31.5{\%}, making this a marginally effective strategy to reduce cancellations.",
keywords = "Appointments and schedules, Health services accessibility, Pain clinics",
author = "Eellan Sivanesan and David Lubarsky and Chaturani Ranasinghe and Sarantopoulos, {Konstantinos D.} and Epstein, {Richard H.}",
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T1 - Modified open-access scheduling for new patient evaluations at an academic chronic pain clinic increased patient access to care, but did not materially reduce their mean cancellation rate

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AU - Sivanesan, Eellan

AU - Lubarsky, David

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AU - Sarantopoulos, Konstantinos D.

AU - Epstein, Richard H.

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N2 - Study objective To determine if open-access scheduling would reduce the cancellation rate for new patient evaluations in a chronic pain clinic by at least 50%. Design Retrospective, observational study using electronic health records. Setting Chronic pain clinic of an academic anesthesia department. Patients All patients scheduled for evaluation or follow-up appointments in the chronic pain clinic between April 1, 2014, and December 31, 2015. Interventions Open-access scheduling was instituted in April 2015 with appointments offered on a date of the patient's choosing ≥ 1 business day after calling, with no limit on the daily number of new patients. Measurements Mean cancellation rates for new patients were compared between the 12-month baseline period prior to and for 7 months after the change, following an intervening 2-month washout period. The method of batch means (by month) and the 2-sided Student t-test were used; P < 0.01 required for significance. Main results The new patient mean cancellation rate decreased from a baseline of 35.7% by 4.2% (95% confidence interval [CI] 1.4% to 6.9%; P = 0.005); however, this failed to reach the 50% reduction target of 17.8%. Appointment lag time decreased by 4.7 days (95% CI 2.3 to 7.0 days, P < 0.001) from 14.1 days to 9.4 days in the new patient group. More new patients were seen within 1 week compared to baseline (50.6% versus 19.1%; P < 0.0001). The mean number of new patient visits per month increased from 158.5 to 225.0 (P = 0.0004). The cancellation rate and appointment lag times did not decrease for established patient visits, as expected because open-access scheduling was not implemented for this group. Conclusions Access to care for new chronic pain patients improved with modified open-access scheduling. However, their mean cancellation rate only decreased from 35.7% to 31.5%, making this a marginally effective strategy to reduce cancellations.

AB - Study objective To determine if open-access scheduling would reduce the cancellation rate for new patient evaluations in a chronic pain clinic by at least 50%. Design Retrospective, observational study using electronic health records. Setting Chronic pain clinic of an academic anesthesia department. Patients All patients scheduled for evaluation or follow-up appointments in the chronic pain clinic between April 1, 2014, and December 31, 2015. Interventions Open-access scheduling was instituted in April 2015 with appointments offered on a date of the patient's choosing ≥ 1 business day after calling, with no limit on the daily number of new patients. Measurements Mean cancellation rates for new patients were compared between the 12-month baseline period prior to and for 7 months after the change, following an intervening 2-month washout period. The method of batch means (by month) and the 2-sided Student t-test were used; P < 0.01 required for significance. Main results The new patient mean cancellation rate decreased from a baseline of 35.7% by 4.2% (95% confidence interval [CI] 1.4% to 6.9%; P = 0.005); however, this failed to reach the 50% reduction target of 17.8%. Appointment lag time decreased by 4.7 days (95% CI 2.3 to 7.0 days, P < 0.001) from 14.1 days to 9.4 days in the new patient group. More new patients were seen within 1 week compared to baseline (50.6% versus 19.1%; P < 0.0001). The mean number of new patient visits per month increased from 158.5 to 225.0 (P = 0.0004). The cancellation rate and appointment lag times did not decrease for established patient visits, as expected because open-access scheduling was not implemented for this group. Conclusions Access to care for new chronic pain patients improved with modified open-access scheduling. However, their mean cancellation rate only decreased from 35.7% to 31.5%, making this a marginally effective strategy to reduce cancellations.

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