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Shang Y, Chen M, Wang T, Xia T. Baseline 25(OH)D level is a prognostic indicator for bariatric surgery readmission: a matched retrospective cohort study. Front Nutr 2024; 11:1362258. [PMID: 38803446 PMCID: PMC11128655 DOI: 10.3389/fnut.2024.1362258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 04/22/2024] [Indexed: 05/29/2024] Open
Abstract
Introduction Managing postsurgical complications is crucial in optimizing the outcomes of bariatric surgery, for which preoperative nutritional assessment is essential. In this study, we aimed to evaluate and validate the efficacy of vitamin D levels as an immunonutritional biomarker for bariatric surgery prognosis. Methods This matched retrospective cohort study included adult patients who underwent bariatric surgery at a tertiary medical center in China between July 2021 and June 2022. Patients with insufficient and sufficient 25(OH)D (< 30 ng/mL) were matched in a 1:1 ratio. Follow-up records of readmission at 3 months, 6 months, and 1 year were obtained to identify prognostic indicators. Results A matched cohort of 452 patients with a mean age of 37.14 ± 9.25 years and involving 69.47% females was enrolled. Among them, 94.25 and 5.75% underwent sleeve gastrectomy and gastric bypass, respectively. Overall, 25 patients (5.54%) were readmitted during the 1-year follow-up. The prognostic nutritional index and controlling nutritional status scores calculated from inflammatory factors did not efficiently detect malnourishment. A low 25(OH)D level (3.58 [95% CI, 1.16-11.03]) and surgery season in summer or autumn (2.68 [95% CI, 1.05-6.83]) increased the risk of 1-year readmission in both the training and validation cohorts. The area under the receiver operating characteristic curve was 0.747 (95% CI, 0.640-0.855), with a positive clinical benefit in the decision curve analyses. The relationship between 25(OH)D and 6-month readmission was U-shaped. Conclusion Serum 25(OH)D levels have prognostic significance in bariatric surgery readmission. Hence, preferable 25(OH)D levels are recommended for patients undergoing bariatric surgery.
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Affiliation(s)
- Yongguang Shang
- Department of Pharmacy, China-Japan Friendship Hospital, Beijing, China
| | - Mengli Chen
- Department of Pharmacy, Chinese PLA General Hospital, Beijing, China
| | - Tianlin Wang
- Department of Pharmacy, Chinese PLA General Hospital, Beijing, China
| | - Tianyi Xia
- Department of Pharmacy, China-Japan Friendship Hospital, Beijing, China
- Department of Pharmacy, Chinese PLA General Hospital, Beijing, China
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Miranne JM, Courtepatte A, Schatzman-Bone S, Minassian VA. Risk Factors for Missed Appointments at a Multisite Academic Urban Urogynecology Practice. UROGYNECOLOGY (PHILADELPHIA, PA.) 2024; 30:406-412. [PMID: 37737743 DOI: 10.1097/spv.0000000000001406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/23/2023]
Abstract
IMPORTANCE Missed appointments lead to decreased clinical productivity and poor health outcomes. OBJECTIVES The objectives of this study were to describe sociodemographic and clinical characteristics of patients who miss urogynecology appointments and identify risk factors for missed appointments. STUDY DESIGN We conducted an institutional review board-approved case-control study of women 18 years or older scheduled for a urogynecology appointment at 1 of 4 sites associated with an urban academic tertiary care center over 4 months. Patients were included in the missed appointment group if they canceled their appointments the same day or did not show up for them. For comparison, we included a control group consisting of patients immediately preceding or following the ones who missed their appointments with the same visit type. Logistic regression was used to identify risk factors for missed appointments. RESULTS Four hundred twenty-six women were included: 213 in the missed appointment group and 213 in the control group. Women who missed appointments were younger (60 years [interquartile range (IQR), 47-72 years] vs 69 years [IQR, 59-78 years], P < 0.0001). More women in the missed appointment group were Hispanic (24.4% vs 13.1%) and non-Hispanic Black (7.5% vs 3.8%, P = 0.009), had Medicaid (17.4% vs 6.57%, P = 0.0006), missed previous appointments (24.9% vs 11.7% P = 0.0005), waited longer for appointments (39 days [IQR, 23.5-55.5 days] vs 30.5 days [IQR, 12.8-47.0 days], P = 0.002), and made appointments for urinary incontinence (44.1% vs 26.8%, P = 0.0002). On multivariate logistic regression, women with Medicaid had significantly higher odds of missing appointments (adjusted OR, 2.11 [1.04-4.48], P = 0.044). CONCLUSIONS Women with Medicaid were more likely to miss urogynecology appointments. Further research is needed to address barriers this group faces when accessing care.
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Affiliation(s)
- Jeannine M Miranne
- From the Division of Urogynecology, Department of OB/GYN, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Alexa Courtepatte
- Division of Urogynecology, Department of OB/GYN, Brigham and Women's Hospital, Boston, MA
| | | | - Vatche A Minassian
- From the Division of Urogynecology, Department of OB/GYN, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
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Deina C, Fogliatto FS, da Silveira GJC, Anzanello MJ. Decision analysis framework for predicting no-shows to appointments using machine learning algorithms. BMC Health Serv Res 2024; 24:37. [PMID: 38183029 PMCID: PMC10770919 DOI: 10.1186/s12913-023-10418-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 11/30/2023] [Indexed: 01/07/2024] Open
Abstract
BACKGROUND No-show to medical appointments has significant adverse effects on healthcare systems and their clients. Using machine learning to predict no-shows allows managers to implement strategies such as overbooking and reminders targeting patients most likely to miss appointments, optimizing the use of resources. METHODS In this study, we proposed a detailed analytical framework for predicting no-shows while addressing imbalanced datasets. The framework includes a novel use of z-fold cross-validation performed twice during the modeling process to improve model robustness and generalization. We also introduce Symbolic Regression (SR) as a classification algorithm and Instance Hardness Threshold (IHT) as a resampling technique and compared their performance with that of other classification algorithms, such as K-Nearest Neighbors (KNN) and Support Vector Machine (SVM), and resampling techniques, such as Random under Sampling (RUS), Synthetic Minority Oversampling Technique (SMOTE) and NearMiss-1. We validated the framework using two attendance datasets from Brazilian hospitals with no-show rates of 6.65% and 19.03%. RESULTS From the academic perspective, our study is the first to propose using SR and IHT to predict the no-show of patients. Our findings indicate that SR and IHT presented superior performances compared to other techniques, particularly IHT, which excelled when combined with all classification algorithms and led to low variability in performance metrics results. Our results also outperformed sensitivity outcomes reported in the literature, with values above 0.94 for both datasets. CONCLUSION This is the first study to use SR and IHT methods to predict patient no-shows and the first to propose performing z-fold cross-validation twice. Our study highlights the importance of avoiding relying on few validation runs for imbalanced datasets as it may lead to biased results and inadequate analysis of the generalization and stability of the models obtained during the training stage.
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Affiliation(s)
- Carolina Deina
- Department of Industrial Engineering, Federal University of Rio Grande do Sul, Av. Osvaldo Aranha, 99, 5° Andar, Porto Alegre, 90035-190, Brazil.
| | - Flavio S Fogliatto
- Department of Industrial Engineering, Federal University of Rio Grande do Sul, Av. Osvaldo Aranha, 99, 5° Andar, Porto Alegre, 90035-190, Brazil
| | - Giovani J C da Silveira
- Haskayne School of Business, University of Calgary, 2500 University Dr NW, Calgary, AB, T2N 1N4, Canada
| | - Michel J Anzanello
- Department of Industrial Engineering, Federal University of Rio Grande do Sul, Av. Osvaldo Aranha, 99, 5° Andar, Porto Alegre, 90035-190, Brazil
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Ahmad Hamdan AF, Abu Bakar A. Machine Learning Predictions on Outpatient No-Show Appointments in a Malaysia Major Tertiary Hospital. Malays J Med Sci 2023; 30:169-180. [PMID: 37928795 PMCID: PMC10624443 DOI: 10.21315/mjms2023.30.5.14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 11/12/2022] [Indexed: 11/07/2023] Open
Abstract
Introduction A no-show appointment occurs when a patient does not attend a previously booked appointment. This situation can cause other problems, such as discontinuity of patient treatments as well as a waste of both human and financial resources. One of the latest approaches to address this issue is predicting no-shows using machine learning techniques. This study aims to propose a predictive analytical approach for developing a patient no-show appointment model in Hospital Kuala Lumpur (HKL) using machine learning algorithms. Methods This study uses outpatient data from the HKL's Patient Management System (SPP) throughout 2019. The final data set has 246,943 appointment records with 13 attributes used for both descriptive and predictive analyses. The predictive analysis was carried out using seven machine learning algorithms, namely, logistic regression (LR), decision tree (DT), k-near neighbours (k-NN), Naïve Bayes (NB), random forest (RF), gradient boosting (GB) and multilayer perceptron (MLP). Results The descriptive analysis showed that the no-show rate was 28%, and attributes such as the month of the appointment and the gender of the patient seem to influence the possibility of a patient not showing up. Evaluation of the predictive model found that the GB model had the highest accuracy of 78%, F1 score of 0.76 and area under the curve (AUC) value of 0.65. Conclusion The predictive model could be used to formulate intervention steps to reduce no-shows, improving patient care quality.
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Affiliation(s)
| | - Azuraliza Abu Bakar
- Faculty of Information Science and Technology, Universiti Kebangsaan Malaysia, Selangor, Malaysia
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Coppa K, Kim EJ, Oppenheim MI, Bock KR, Zanos TP, Hirsch JS. Application of a Machine Learning Algorithm to Develop and Validate a Prediction Model for Ambulatory Non-Arrivals. J Gen Intern Med 2023; 38:2298-2307. [PMID: 36757667 PMCID: PMC9910253 DOI: 10.1007/s11606-023-08065-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 01/27/2023] [Indexed: 02/10/2023]
Abstract
BACKGROUND Non-arrivals to scheduled ambulatory visits are common and lead to a discontinuity of care, poor health outcomes, and increased subsequent healthcare utilization. Reducing non-arrivals is important given their association with poorer health outcomes and cost to health systems. OBJECTIVE To develop and validate a prediction model for ambulatory non-arrivals. DESIGN Retrospective cohort study. PATIENTS OR SUBJECTS Patients at an integrated health system who had an outpatient visit scheduled from January 1, 2020, to February 28, 2022. MAIN MEASURES Non-arrivals to scheduled appointments. KEY RESULTS There were over 4.3 million ambulatory appointments from 1.2 million adult patients. Patients with appointment non-arrivals were more likely to be single, racial/ethnic minorities, and not having an established primary care provider compared to those who arrived at their appointments. A prediction model using the XGBoost machine learning algorithm had the highest AUC value (0.768 [0.767-0.770]). Using SHAP values, the most impactful features in the model include rescheduled appointments, lead time (number of days from scheduled to appointment date), appointment provider, number of days since last appointment with the same department, and a patient's prior appointment status within the same department. Scheduling visits close to an appointment date is predicted to be less likely to result in a non-arrival. Overall, the prediction model calibrated well for each department, especially over the operationally relevant probability range of 0 to 40%. Departments with fewer observations and lower non-arrival rates generally had a worse calibration. CONCLUSIONS Using a machine learning algorithm, we developed a prediction model for non-arrivals to scheduled ambulatory appointments usable for all medical specialties. The proposed prediction model can be deployed within an electronic health system or integrated into other dashboards to reduce non-arrivals. Future work will focus on the implementation and application of the model to reduce non-arrivals.
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Affiliation(s)
- Kevin Coppa
- Clinical Digital Solutions, Northwell Health, New Hyde Park, NY, USA
| | - Eun Ji Kim
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
- Institute of Health System Science, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA
| | - Michael I Oppenheim
- Clinical Digital Solutions, Northwell Health, New Hyde Park, NY, USA
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Kevin R Bock
- Clinical Digital Solutions, Northwell Health, New Hyde Park, NY, USA
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Theodoros P Zanos
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
- Institute of Health System Science, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA
| | - Jamie S Hirsch
- Clinical Digital Solutions, Northwell Health, New Hyde Park, NY, USA.
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA.
- Institute of Health System Science, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA.
- Division of Kidney Diseases and Hypertension, and Barbara Zucker School of Medicine at Hofstra/Northwell, 100 Community Drive, 2nd Floor, Great Neck, Donald, NY, 11021, USA.
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Almaktoom AT. Health care overbooking cost minimization model. Heliyon 2023; 9:e18753. [PMID: 37560686 PMCID: PMC10407751 DOI: 10.1016/j.heliyon.2023.e18753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 07/21/2023] [Accepted: 07/26/2023] [Indexed: 08/11/2023] Open
Abstract
Challenges in the health care industry have confounded the provision of quality services for patients. Among many relevant concerns, the drive for cost-effectiveness and efficient care have placed considerable pressure on public health care systems and insurance coverage, amid existing barriers to restructuring entrenched systems. This study closely examines the factors impacting disruptions in health care scheduling systems using a structured case study in the health care industry. The study introduces a novel model to identify optimal overbooking capacity and minimize no-show costs. To address the complexity of this issue on a smaller scale, the model is implemented using a private hospital clinical platform in Jeddah, Saudi Arabia, instituting an overbooking reservation and queuing system in 14 departments to investigate the factors that influence disruptions and inefficacy of service provision, while also introducing a strategy for covering costs. The results identify the maximum amount of overbooking that can be made for each clinic. The cost-saving plan developed is expected to save each clinic a considerable sum, as opposed to randomly overbooking without any cost assumptions. Overall, if the clinics studied implemented this strategy, a total loss of no more than SAR. 2, 408 would be incurred from overbooking, in contrast to the exponentially growing amount of SAR. 10,000 that is currently lost on scheduling errors per year. The loss model developed has practical application as a tool for decision-making that includes no-show cost minimization variables.
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Affiliation(s)
- Abdulaziz T. Almaktoom
- Department of Operations and Supply Chain Management, Effat University, PO Box 34689, Jeddah, 21478, Kingdom of Saudi Arabia
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Borges A, Carvalho M, Maia M, Guimarães M, Carneiro D. Predicting and explaining absenteeism risk in hospital patients before and during COVID-19. SOCIO-ECONOMIC PLANNING SCIENCES 2023; 87:101549. [PMID: 37255583 PMCID: PMC9972778 DOI: 10.1016/j.seps.2023.101549] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 02/15/2023] [Accepted: 02/22/2023] [Indexed: 06/01/2023]
Abstract
In order to address one of the most challenging problems in hospital management - patients' absenteeism without prior notice - this study analyses the risk factors associated with this event. To this end, through real data from a hospital located in the North of Portugal, a prediction model previously validated in the literature is used to infer absenteeism risk factors, and an explainable model is proposed, based on a modified CART algorithm. The latter intends to generate a human-interpretable explanation for patient absenteeism, and its implementation is described in detail. Furthermore, given the significant impact, the COVID-19 pandemic had on hospital management, a comparison between patients' profiles upon absenteeism before and during the COVID-19 pandemic situation is performed. Results obtained differ between hospital specialities and time periods meaning that patient profiles on absenteeism change during pandemic periods and within specialities.
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Affiliation(s)
- Ana Borges
- CIICESI, ESTG, Politecnico do Porto, Rua do Curral, Casa do Curral, Margaride, Felgueiras, 4610-156, Portugal
| | - Mariana Carvalho
- CIICESI, ESTG, Politecnico do Porto, Rua do Curral, Casa do Curral, Margaride, Felgueiras, 4610-156, Portugal
| | - Miguel Maia
- CIICESI, ESTG, Politecnico do Porto, Rua do Curral, Casa do Curral, Margaride, Felgueiras, 4610-156, Portugal
| | - Miguel Guimarães
- CIICESI, ESTG, Politecnico do Porto, Rua do Curral, Casa do Curral, Margaride, Felgueiras, 4610-156, Portugal
| | - Davide Carneiro
- CIICESI, ESTG, Politecnico do Porto, Rua do Curral, Casa do Curral, Margaride, Felgueiras, 4610-156, Portugal
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Babayoff O, Shehory O, Geller S, Shitrit-Niselbaum C, Weiss-Meilik A, Sprecher E. Improving Hospital Outpatient Clinics Appointment Schedules by Prediction Models. J Med Syst 2022; 47:5. [PMID: 36585996 DOI: 10.1007/s10916-022-01902-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Accepted: 12/14/2022] [Indexed: 01/01/2023]
Abstract
Patient no-shows and suboptimal patient appointment length scheduling reduce clinical efficiency and impair the clinic's quality of service. The main objective of this study is to improve appointment scheduling in hospital outpatient clinics. We developed generic supervised machine learning models to predict patient no-shows and patient's length of appointment (LOA). We performed a retrospective study using more than 100,000 records of patient appointments in a hospital outpatient clinic. Several machine learning algorithms were used for the development of our prediction models. We trained our models on a dataset that contained patients', physicians', and appointments' characteristics. Our feature set combines both unstudied features and features adopted from previous studies. In addition, we identified the influential features for predicting LOA and no-show. Our LOA model's performance was 6.92 in terms of MAE, and our no-show model's performance was 92.1% in terms of F-score. We compared our models' performance to the performance of previous research models by applying their methods to our dataset; our models demonstrated better performance. We show that the major effector of such differences is the use of our novel features. To evaluate the effect of our prediction results on the quality of schedules produced by appointment systems (AS), we developed an interface layer between our prediction models and the AS, where prediction results comprise the AS input. Using our prediction models, there was an 80% improvement in the daily cumulative patient waiting time and a 33% reduction in the daily cumulative physician idle time.
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Affiliation(s)
| | - Onn Shehory
- Bar-Ilan University, 5290002, Ramat Gan, Israel
| | - Shamir Geller
- Division of Dermatology, Tel Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Chen Shitrit-Niselbaum
- I-Medata AI Center, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Ahuva Weiss-Meilik
- I-Medata AI Center, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Eli Sprecher
- Division of Dermatology, Tel Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Sotudian S, Afran A, LeBedis CA, Rives AF, Paschalidis IC, Fishman MDC. Social determinants of health and the prediction of missed breast imaging appointments. BMC Health Serv Res 2022; 22:1454. [PMID: 36451240 PMCID: PMC9714014 DOI: 10.1186/s12913-022-08784-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 11/03/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Predictive models utilizing social determinants of health (SDH), demographic data, and local weather data were trained to predict missed imaging appointments (MIA) among breast imaging patients at the Boston Medical Center (BMC). Patients were characterized by many different variables, including social needs, demographics, imaging utilization, appointment features, and weather conditions on the date of the appointment. METHODS This HIPAA compliant retrospective cohort study was IRB approved. Informed consent was waived. After data preprocessing steps, the dataset contained 9,970 patients and 36,606 appointments from 1/1/2015 to 12/31/2019. We identified 57 potentially impactful variables used in the initial prediction model and assessed each patient for MIA. We then developed a parsimonious model via recursive feature elimination, which identified the 25 most predictive variables. We utilized linear and non-linear models including support vector machines (SVM), logistic regression (LR), and random forest (RF) to predict MIA and compared their performance. RESULTS The highest-performing full model is the nonlinear RF, achieving the highest Area Under the ROC Curve (AUC) of 76% and average F1 score of 85%. Models limited to the most predictive variables were able to attain AUC and F1 scores comparable to models with all variables included. The variables most predictive of missed appointments included timing, prior appointment history, referral department of origin, and socioeconomic factors such as household income and access to caregiving services. CONCLUSIONS Prediction of MIA with the data available is inherently limited by the complex, multifactorial nature of MIA. However, the algorithms presented achieved acceptable performance and demonstrated that socioeconomic factors were useful predictors of MIA. In contrast with non-modifiable demographic factors, we can address SDH to decrease the incidence of MIA.
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Affiliation(s)
- Shahabeddin Sotudian
- grid.189504.10000 0004 1936 7558Department of Electrical and Computer Engineering, Division of Systems Engineering, Boston University, Boston, MA USA
| | - Aaron Afran
- grid.189504.10000 0004 1936 7558Department of Radiology, Boston University School of Medicine, Boston, MA USA
| | - Christina A. LeBedis
- grid.189504.10000 0004 1936 7558Department of Radiology, Boston University School of Medicine, Boston, MA USA ,grid.189504.10000 0004 1936 7558Department of Radiology, Boston Medical Center, Boston University School of Medicine, Boston, MA USA
| | - Anna F. Rives
- grid.189504.10000 0004 1936 7558Department of Radiology, Boston University School of Medicine, Boston, MA USA ,grid.189504.10000 0004 1936 7558Department of Radiology, Boston Medical Center, Boston University School of Medicine, Boston, MA USA
| | - Ioannis Ch. Paschalidis
- grid.189504.10000 0004 1936 7558Department of Electrical and Computer Engineering, Division of Systems Engineering, Boston University, Boston, MA USA ,grid.189504.10000 0004 1936 7558Department of Biomedical Engineering, and Faculty of Computing & Data Sciences, Boston University, Boston, MA USA ,Rafik B. Hariri Institute for Computing and Computational Science & Engineering, Boston, MA USA
| | - Michael D. C. Fishman
- grid.189504.10000 0004 1936 7558Department of Radiology, Boston University School of Medicine, Boston, MA USA ,grid.189504.10000 0004 1936 7558Department of Radiology, Boston Medical Center, Boston University School of Medicine, Boston, MA USA
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Trott S, Young R, Hayden C, Yessin O, Bush M, Gupta N. Risk Factors for Operating Room No-Show in an Academic Otolaryngology Practice. Laryngoscope 2022; 132:1738-1742. [PMID: 35122445 PMCID: PMC9352814 DOI: 10.1002/lary.30018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 12/20/2021] [Accepted: 12/29/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVES/HYPOTHESIS A no-show to the operating room date negatively impacts a hospital and can lead to increased costs for an institution in terms of time, materials, and manpower. Our objectives are to identify the factors associated with operating room no-shows in order to increase clinical efficiency, reduce hospital costs, and increase patient access to care. STUDY DESIGN Single institution retrospective chart review. METHODS A retrospective review was performed of all surgeries within the Otolaryngology department performed at a single tertiary academic center between 2006 and 2019. Demographic and surgical data were collected from the charts. Descriptive, univariate, and multivariate statistics were performed on the data. RESULTS There were a total of 1,752 no-shows and 46,440 patients who did show with an overall no-show rate of 3.63%. A multivariate logistic regression analysis was performed to compare patients who did not show for surgery to those who did. Analysis found multiple risk factors for not showing to surgery that were statistically significant (P < .05) and included decreasing age, planned outpatient case, head and neck oncology subspecialty, increasing distance from the facility, higher number of clinic no-shows, and not having private insurance. African-American race was more likely to show for surgery as scheduled. CONCLUSIONS Numerous factors may play a role on whether or not a patient attends a scheduled surgical date. Some of these factors may be preventable or modifiable to mitigate increased hospital costs associated with no-show to surgery and increase access to care. LEVEL OF EVIDENCE 3 Laryngoscope, 132:1738-1742, 2022.
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Affiliation(s)
- Skylar Trott
- Department of Otolaryngology, University of Kentucky Medical Center, Lexington, KY, USA
| | - Rory Young
- University of Kentucky School of Medicine, Lexington, KY, USA
| | - Chris Hayden
- University of Kentucky School of Medicine, Lexington, KY, USA
| | - Olivia Yessin
- University of Kentucky School of Medicine, Lexington, KY, USA
| | - Matthew Bush
- Department of Otolaryngology, University of Kentucky Medical Center, Lexington, KY, USA
| | - Nikita Gupta
- Department of Otolaryngology, University of Kentucky Medical Center, Lexington, KY, USA
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Barrera Ferro D, Bayer S, Bocanegra L, Brailsford S, Díaz A, Gutiérrez-Gutiérrez EV, Smith H. Understanding no-show behaviour for cervical cancer screening appointments among hard-to-reach women in Bogotá, Colombia: A mixed-methods approach. PLoS One 2022; 17:e0271874. [PMID: 35867727 PMCID: PMC9307170 DOI: 10.1371/journal.pone.0271874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 07/08/2022] [Indexed: 11/18/2022] Open
Abstract
The global burden of cervical cancer remains a concern and higher early mortality rates are associated with poverty and limited health education. However, screening programs continue to face implementation challenges, especially in developing country contexts. In this study, we use a mixed-methods approach to understand the reasons for no-show behaviour for cervical cancer screening appointments among hard-to-reach low-income women in Bogotá, Colombia. In the quantitative phase, individual attendance probabilities are predicted using administrative records from an outreach program (N = 23384) using both LASSO regression and Random Forest methods. In the qualitative phase, semi-structured interviews are analysed to understand patient perspectives (N = 60). Both inductive and deductive coding are used to identify first-order categories and content analysis is facilitated using the Framework method. Quantitative analysis shows that younger patients and those living in zones of poverty are more likely to miss their appointments. Likewise, appointments scheduled on Saturdays, during the school vacation periods or with lead times longer than 10 days have higher no-show risk. Qualitative data shows that patients find it hard to navigate the service delivery process, face barriers accessing the health system and hold negative beliefs about cervical cytology.
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Affiliation(s)
- David Barrera Ferro
- Southampton Business School, University of Southampton, Southampton, United Kingdom
- Departamento de Ingeniería Industrial, Pontificia Universidad Javeriana, Bogotá, Colombia
- * E-mail:
| | - Steffen Bayer
- Southampton Business School, University of Southampton, Southampton, United Kingdom
| | | | - Sally Brailsford
- Southampton Business School, University of Southampton, Southampton, United Kingdom
| | - Adriana Díaz
- Departamento de Ingeniería Industrial, Pontificia Universidad Javeriana, Bogotá, Colombia
| | | | - Honora Smith
- Mathematical Sciences, University of Southampton, Southampton, United Kingdom
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Benedito Zattar da Silva R, Fogliatto FS, Garcia TS, Faccin CS, Zavala AAZ. Modelling the no-show of patients to exam appointments of computed tomography. Int J Health Plann Manage 2022; 37:2889-2904. [PMID: 35648052 DOI: 10.1002/hpm.3527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 05/09/2022] [Accepted: 05/18/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Patients' no-shows negatively impact healthcare systems, leading to resources' underutilisation, efficiency loss, and cost increase. Predicting no-shows is key to developing strategies that counteract their effects. In this paper, we propose a model to predict the no-show of ambulatory patients to exam appointments of computed tomography at the Radiology department of a large Brazilian public hospital. METHODS We carried out a retrospective study on 8382 appointments to computed tomography (CT) exams between January and December 2017. Penalised logistic regression and multivariate logistic regression were used to model the influence of 15 candidate variables on patients' no-shows. The predictive capabilities of the models were evaluated by analysing the Area Under the Curve (AUC) of the Receiver Operating Characteristic (ROC). RESULTS The no-show rate in computerised tomography exams appointments was 6.65%. The two models performed similarly in terms of AUC. The penalised logistic regression model was selected using the parsimony criterion, with 8 of the 15 variables analysed appearing as significant. One of the variables included in the model (number of exams scheduled in the previous year) had not been previously reported in the related literature. CONCLUSIONS Our findings may be used to guide the development of strategies to reduce the no-show of patients to exam appointments.
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Affiliation(s)
- Rodolfo Benedito Zattar da Silva
- Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil.,Universidade Federal de Mato Grosso, Varzea Grande, Mato Grosso, Brazil
| | | | - Tiago Severo Garcia
- Hospital de Clinicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - Carlo Sasso Faccin
- Hospital de Clinicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
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Agarwal P, Nathan AS, Jaleel Z, Levi JR. Factors Contributing to Missed Appointments in a Pediatric Otolaryngology Clinic. Laryngoscope 2021; 132:895-900. [PMID: 34427327 DOI: 10.1002/lary.29841] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 08/10/2021] [Accepted: 08/16/2021] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To understand why pediatric otolaryngology patients do not attend scheduled clinic appointments and identify factors correlated with no-show status. STUDY DESIGN Retrospective cohort study. METHODS This is a retrospective cohort study that uses medical record data extraction of patients that was scheduled to attend new patient appointments at a pediatric otolaryngology clinic in 2018. RESULTS Factors associated with no-shows included complex psychiatric history (OR (95% CI) 0.789 (0.71-0.88), P < .001), increased appointment lead time (OR (95% CI) 0.981 (0.976-0.987), P < .001), afternoon appointments (OR (95% CI) 0.783 (0.64-0.99), P = .038), and complex maternal medical history (OR (95% CI) 0.987 (0.979-0.996), P < .005). In contrast, factors associated with attendance included complex patients' medical history (OR (95% CI) 1.058 (0.98-1.02), P < .001), primary care physician at the same hospital (OR (95% CI) 2.766 (2.25-3.39), P < .001), and primary language being Spanish (OR (95% CI) 2.536 (1.75-3.67) P < .001). The factors of distance from the hospital (OR (95% CI) 1.001 (0.99-1.01), P = .868), season of appointment (P = .997), race (P = .623), and ethnicity (P = .804) were not associated with attendance or no-shows. CONCLUSION Patient and maternal medical problems, mental health history, primary care location, appointment lead time, hour of appointment, and primary language, all contribute to appointment attendance, while appointment timing, race, and ethnicity are not associated with attendance. Further work must be performed to overcome these barriers to minimize healthcare risks and improve patient outcomes. QUALITY OF EVIDENCE Level 3 Laryngoscope, 2021.
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Affiliation(s)
- Pratima Agarwal
- Department of Otolaryngology/Head and Neck Surgery, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, U.S.A
| | - Ajay S Nathan
- Boston University School of Medicine, Boston, Massachusetts, U.S.A
| | - Zaroug Jaleel
- Department of Otolaryngology/Head and Neck Surgery, University of Washington Medical Center, Seattle, Washington, U.S.A
| | - Jessica R Levi
- Department of Otolaryngology/Head and Neck Surgery, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, U.S.A
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Moawad GN, Klebanoff JS, Rahman S, Kazma J, Amdur R, Nishikawa MI, Maassen MS, Tyan P. Discrepancies in Access to Minimally Invasive Gynecologic Surgery Care Between Privately and Publicly Insured Patients. J Gynecol Surg 2021. [DOI: 10.1089/gyn.2020.0117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Gaby N. Moawad
- Department of Obstetrics and Gynecology and The George Washington University Hospital, Washington, District of Columbia, USA
| | - Jordan S. Klebanoff
- Department of Obstetrics and Gynecology and The George Washington University Hospital, Washington, District of Columbia, USA
| | - Sara Rahman
- Department of Obstetrics and Gynecology and The George Washington University Hospital, Washington, District of Columbia, USA
| | - Jamil Kazma
- Department of Obstetrics and Gynecology and The George Washington University Hospital, Washington, District of Columbia, USA
| | - Richard Amdur
- Department of Surgery, The George Washington University Hospital, Washington, District of Columbia, USA
| | - Moena I. Nishikawa
- The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | - Marloes S. Maassen
- Department of Obstetrics and Gynaecology, Medisch Spectrum Twente, Enschede, the Netherlands
| | - Paul Tyan
- Department of Obstetrics and Gynecology, Division of Minimally Invasive Gynecologic Surgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
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Carreras-García D, Delgado-Gómez D, Llorente-Fernández F, Arribas-Gil A. Patient No-Show Prediction: A Systematic Literature Review. ENTROPY 2020; 22:e22060675. [PMID: 33286447 PMCID: PMC7517206 DOI: 10.3390/e22060675] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 06/13/2020] [Accepted: 06/14/2020] [Indexed: 12/02/2022]
Abstract
Nowadays, across the most important problems faced by health centers are those caused by the existence of patients who do not attend their appointments. Among others, these patients cause loss of revenue to the health centers and increase the patients’ waiting list. In order to tackle these problems, several scheduling systems have been developed. Many of them require predicting whether a patient will show up for an appointment. However, obtaining these estimates accurately is currently a challenging problem. In this work, a systematic review of the literature on predicting patient no-shows is conducted aiming at establishing the current state-of-the-art. Based on a systematic review following the PRISMA methodology, 50 articles were found and analyzed. Of these articles, 82% were published in the last 10 years and the most used technique was logistic regression. In addition, there is significant growth in the size of the databases used to build the classifiers. An important finding is that only two studies achieved an accuracy higher than the show rate. Moreover, a single study attained an area under the curve greater than the 0.9 value. These facts indicate the difficulty of this problem and the need for further research.
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Affiliation(s)
- Danae Carreras-García
- Department of Statistics, University Carlos III of Madrid, 28911 Leganés, Spain; (D.C.-G.); (F.L.-F.)
| | - David Delgado-Gómez
- Department of Statistics, University Carlos III of Madrid, 28911 Leganés, Spain; (D.C.-G.); (F.L.-F.)
- UC3M-Santander Big Data Institute, University Carlos III of Madrid, 28903 Getafe, Spain;
- Correspondence:
| | | | - Ana Arribas-Gil
- UC3M-Santander Big Data Institute, University Carlos III of Madrid, 28903 Getafe, Spain;
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Marbouh D, Khaleel I, Al Shanqiti K, Al Tamimi M, Simsekler MCE, Ellahham S, Alibazoglu D, Alibazoglu H. Evaluating the Impact of Patient No-Shows on Service Quality. Risk Manag Healthc Policy 2020; 13:509-517. [PMID: 32581613 PMCID: PMC7280239 DOI: 10.2147/rmhp.s232114] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 03/23/2020] [Indexed: 11/23/2022] Open
Abstract
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.
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Affiliation(s)
- Dounia Marbouh
- Research Center of Digital Supply Chain and Operations, Department of Industrial and Systems Engineering, Khalifa University, Abu Dhabi, United Arab Emirates
| | - Iman Khaleel
- Research Center of Digital Supply Chain and Operations, Department of Industrial and Systems Engineering, Khalifa University, Abu Dhabi, United Arab Emirates
| | - Khawla Al Shanqiti
- Research Center of Digital Supply Chain and Operations, Department of Industrial and Systems Engineering, Khalifa University, Abu Dhabi, United Arab Emirates
| | - Maryam Al Tamimi
- Research Center of Digital Supply Chain and Operations, Department of Industrial and Systems Engineering, Khalifa University, Abu Dhabi, United Arab Emirates
| | - Mecit Can Emre Simsekler
- Research Center of Digital Supply Chain and Operations, Department of Industrial and Systems Engineering, Khalifa University, Abu Dhabi, United Arab Emirates.,School of Management, University College London, London, UK
| | - Samer Ellahham
- Heart and Vascular Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Deniz Alibazoglu
- Heart and Vascular Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Haluk Alibazoglu
- Imaging Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
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Abstract
PURPOSE Appointment scheduling systems traditionally book patients at fixed intervals, without taking into account the complexity factors of the health system. This paper analyzes several appointment scheduling policies of the literature and proposes the most suitable to a bariatric surgery clinic, considering the following complexity factors: (i) stochastic service times, (ii) patient unpunctuality, (iii) service interruptions, and (iv) patient no-shows. MATERIALS AND METHODS We conducted the study using data collected in a bariatric surgery clinic located in Rio de Janeiro, Brazil. The dataset presented 1468 appointments from June 29, 2015, to June 29, 2016. We comparatively evaluate the main literature policies through a discrete event simulation (DES). RESULTS The proposed policy (IICR) provides a 30% increase in attendance and allows a decrease in the total cost, maintaining the level of service in terms of average waiting time. CONCLUSION IICR was successfully implemented, and the practical results were very close to the simulated ones.
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Aladeemy M, Adwan L, Booth A, Khasawneh MT, Poranki S. New feature selection methods based on opposition-based learning and self-adaptive cohort intelligence for predicting patient no-shows. Appl Soft Comput 2020. [DOI: 10.1016/j.asoc.2019.105866] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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