PREDICTION AND FACTORS RELATED TO NO-SHOW: A STUDY IN A CARDIOLOGY AND NEUROLOGY CLINIC

Peres, Igor Tona; Dantas, Leila Figueiredo; Gouveia, Davi Melhoranse; Schneider, Fabio

doi:10.1590/0101-7438.2023.043.00275795

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ARTICLES • Pesqui. Oper. 43 • 2023 • https://doi.org/10.1590/0101-7438.2023.043.00275795 copy

PREDICTION AND FACTORS RELATED TO NO-SHOW: A STUDY IN A CARDIOLOGY AND NEUROLOGY CLINIC

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Background:

The no-show of patients to their scheduled appointments has caused a large increase in healthcare costs, worsening service quality and clinical efficiency.

Objectives:

This case study aims to identify the factors associated with patient no-shows in cardiology and neurology clinics, and develop a prediction model to estimate the no-show probability.

Methods:

We developed a retrospective analysis of 32,573 appointments from January 2019 to June 2022 in a Rio de Janeiro clinic. Logistic regressions were performed to analyze and model the influence of patient and appointment variables on no-show rates.

Results:

The factors most related to no-shows were the patient’s sex, age, medical specialty, month of the year, and type of insurance. Female patients have an increase of approximately 17% chance of no-shows compared to males. The age group with the highest no-show rates is between 21 and 30. Clinic consultations have higher no-shows when compared to medical procedures. Appointments in December tend to have higher non-attendance than in January, and patients with insurance from the five major companies presents greater no-show than those with smaller insurance. The prediction model presented the following performance indicators: AUC = 0.65, Sensitivity = 0.64, Specificity = 0.58, PPV = 0.11, and NPV = 0.95.

Conclusions:

This work contributes to understanding the factors related to non-attendance, assisting optimized management of appointment schedules.

Keywords:
no-show; appointments; clinical services; logistic regression; prediction model

Independent Variables	No-show N (%)	Show N (%)	Total
Total	1,300 (7.5%)	15,918 (92.5%)	17,218
Age Group
0 to 10 years	92 (5.4%)	1,627 (94.6%)	1,719
11 to 20 years	118 (7.7%)	1,414 (92.3%)	1,532
21 to 30 years	161 (9.7%)	1,505 (90.3%)	1,666
31 to 40 years	316 (10%)	2,722 (90%)	3,038
41 to 50 years	312 (9.2%)	3,071 (90.8%)	3,383
51 to 60 years	132 (5.8%)	2,130 (94.2%)	2,262
61 to 70 years	84 (5.0%)	1,608 (95%)	1,692
Over 70 years	85 (4.4%)	1,841 (95.6%)	1,926
Insurance company
5 Major	1,011 (8.3%)	11,179 (91.7%)	12,190
Minors	135 (5.1%)	2,509 (94.9%)	2,644
Particular (no insurance)	154 (6.5%)	2,230 (93.5%)	2,384
Month
January	117 (7.8%)	1,382 (92.2%)	1,499
February	119 (6.9%)	1,602 (93.1%)	1,721
March	129 (8.4%)	1,402 (91.6%)	1,531
April	100 (7.1%)	1,307 (92.9%)	1,407
May	106 (6.9%)	1,432 (93.1%)	1,538
June	112 (7.9%)	1,306 (92.1%)	1,418
July	81 (5.5%)	1,389 (94.5%)	1,470
August	125 (8.4%)	1,365 (91.6%)	1,490
September	82 (6.4%)	1,193 (93.6%)	1,275
October	107 (6.9%)	1,434 (93.1%)	1,541
November	93 (7.3%)	1,173 (92.7%)	1,266
December	129 (12%)	933 (88%)	1,062
Time of the Day
Before 9 am	131 (6.7%)	1,830 (93.3%)	1,961
From 9 am to 12 pm	372 (7.0%)	4,924 (93%)	5,296
From 12 pm to 3 pm	278 (7.2%)	3,593 (92.8%)	3,871
From 3 pm to 6 pm	471 (9.2%)	4,662 (90.8%)	5,133
After 6 pm	48 (5.0%)	909 (95%)	957
Day of the Week
Monday	418 (8.0%)	4,790 (92%)	5,208
Tuesday	229 (9.2%)	2,269 (90.8%)	2,498
Wednesday	218 (6.8%)	2,980 (93.2%)	3,198
Thursday	269 (6.8%)	3,665 (93.2%)	3,934
Friday	166 (7.0%)	2,214 (93%)	2,380
Sex
Female	799 (8.4%)	8,726 (91.6%)	9,525
Male	501 (6.5%)	7,192 (93.5%)	7,693
Scheduling Status
Confirmed	942 (8.7%)	9,873 (91.3%)	10,815
Unconfirmed	358 (5.6%)	6,045 (94.4%)	6,403
Patient Type
First Time	1,206 (7.7%)	14,449 (92.3%)	15,655
Return	94 (6.0%)	1,469 (94%)	1,563
Specialty
Consultation - Cardiologist	447 (7.6%)	5,468 (92.4%)	5,915
Consultation - Neurologist	611 (9.8%)	5,597 (90.2%)	6,208
Procedure Echocardiogram/Carotid	64 (3.8%)	1,622 (96.2%)	1,686
Procedure -	138 (4.8%)	2,749 (95.2%)	2,887
Electroencephalogram/Polysomnography
Procedure Map/Holter	40 (7.7%)	482 (92.3%)	522

Independent variable (reference level)	Univariable			Multivariable I			Multivariable II
Independent variable (reference level)	OR	IC-95%	p-value	OR	IC-95%	p-value	β	OR	IC-95%	p-value
Intercept					-3.664
Scheduling status (not confirmed)	1.04	0.94-1.15	0.4
Confirmed			0.4
Month (January)			<0.001			<0.001			<0.001
February	0.88	0.70-1.11	0.30	0.86	0.66-1.13	0.3	-0.186	0.83	0.61-1.12	0.20
March	1.04	0.83-1.31	0.70	1.04	0.80-1.36	0.70	0.015	1.01	0.76-1.36	>0.90
April	0.91	0.72-1.16	0.50	0.88	0.67-1.17	0.40	-0.123	0.88	0.65-1.21	0.40
May	0.96	0.76-1.22	0.80	0.84	0.64-1.11	0.20	-0.168	0.85	0.62-1.14	0.30
June	0.88	0.69-1.13	0.40	1.02	0.78-1.34	0.90	0.018	1.02	0.75-1.38	>0.90
July	0.81	0.63-1.03	0.084	0.70	0.52-0.94	0.02	-0.425	0.65	0.47-0.91	0.013
August	1.11	0.89-1.40	0.40	1.04	0.80-1.35	0.80	0.013	1.01	0.75-1.36	>0.90
September	0.86	0.67-1.11	0.20	0.81	0.60-1.09	0.20	-0.171	0.84	0.61-1.16	0.30
October	0.97	0.77-1.22	0.80	0.90	0.68-1.19	0.50	-0.159	0.85	0.63-1.16	0.30
November	0.97	0.76-1.23	0.80	0.92	0.69-1.22	0.60	-0.112	0.89	0.65-1.23	0.50
December	1.61	1.28-2.03	<0.001	1.60	1.23-2.10	<0.001	0.426	1.53	1.14-2.07	0.005
Sex (Male)			<0.001			0.018			0.023
Female	1.27	1.14-1.40	<0.001	1.17	1.03-1.34	0.018	0.153	1.17	1.02-1.33	0.023
Patient Type (Return)			<0.001			0.40
First Time	1.69	1.38-2.09	<0.001	1.11	0.86-1.44	0.40
Day of the Week (Monday)			<0.001			0.10
Tuesday	0.95	0.82-1.10	0.50	1.16	0.95-1.43	0.14
Wednesday	0.73	0.63-0.85	<0.001	1.23	0.99-1.53	0.059
Thursday	0.78	0.68-0.89	<0.001	0.98	0.81-1.18	0.80
Friday	0.76	0.65-0.89	<0.001	0.92	0.72-1.17	0.50
Age (0 to 10 years)			<0.001			<0.001			<0.001
11 to 20 years	1.44	1.09-1.91	0.009	1.31	0.98-1.75	0.071	0.270	1.31	0.96-1.79	0.091
21 to 30 years	1.84	1.42-2.40	<0.001	1.62	1.23-2.14	<0.001	0.418	1.52	1.13-2.05	0.006
31 to 40 years	2.03	1.61-2.58	<0.001	1.75	1.36-2.26	<0.001	0.457	1.58	1.21-2.08	<0.001
41 to 50 years	1.75	1.39-2.23	<0.001	1.60	1.25-2.07	<0.001	0.375	1.46	1.12-1.92	0.006
51 to 60 years	1.07	0.82-1.40	0.60	0.99	0.75-1.32	>0.90	-0.129	0.88	0.65-1.20	0.40
61 to 70 years	0.92	0.69-1.24	0.60	0.85	0.62-1.16	0.30	-0.260	0.77	0.55-1.09	0.14
Over 70 years	0.80	0.60-1.07	0.14	0.74	0.54-1.02	0.065	-0.428	0.65	0.46-0.92	0.014
Time of the day (Before 9 am)			<0.001			0.40
From 9 am to 12 pm	1.17	0.98-1.40	0.09	1.09	0.84-1.44	0.50
From 12 pm to 3 pm	1.10	0.91-1.33	0.30	1.02	0.77-1.37	0.90
From 3 pm to 6 pm	1.37	1.15-1.64	<0.001	1.20	0.91-1.59	0.20
After 6 pm	0.75	0.56-1.0	0.049	0.99	0.65-1.48	>0.90
Insurance Company (Minor)			<0.001			<0.001			<0.001
Particular “no insurance”	1.35	1.12-1.63	0.002	1.36	1.07-1.74	0.014	0.239	1.27	0.97-1.67	0.086
5 Major	1.43	1.24-1.67	<0.001	1.46	1.22-1.77	<0.001	0.382	1.47	1.19-1.82	<0.001
Specialty (Procedure Echocardiogram/Carotid)			<0.001			<0.001			<0.001
Procedure Electroencephalogram/Polysomnography	1.46	1.12-1.94	0.007	1.35	0.97-1.88	0.075	0.135	1.14	0.82-1.62	0.40
Procedure Map/Holter	2.03	1.37-2.97	<0.001	2.25	1.41-3.57	<0.001	0.650	1.92	1.20-3.02	0.006
Appointment Cardiologist	2.36	1.85-3.05	<0.001	2.22	1.65-3.01	<0.001	0.729	2.07	1.55-2.82	<0.001
Appointment Neurologist	3.51	2.77-4.52	<0.001	2.50	1.90-3.34	<0.001	0.880	2.41	1.81-3.27	<0.001

Variable	Description	Type
Service Status	Show/No-Show	Categorical
Year	Year of patient scheduling	Categorical
Day of the Week	Patient scheduling day	Categorical
Specialty	Type of schedule offered by the clinic	Categorical
Timetable	Patient scheduling time	Categorical
Age	Patient age, divided into age ranges from 10 to 10 years	Categorical
Month	Patient scheduling month	Categorical
Insurance Company	Payment method chosen by the patient	Categorical
Sex	Classification of patients’ sex by name according to IBGE census 2010	Categorical
Scheduling Status	If the patient confirms the consultation	Categorical
Patient Type	Patient’s first time in the office or if he is returning	Categorical

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[1] *Corresponding author