Factors Affecting Clinic Visit No-Shows at an Academic Medical Center in the American Southwest.

Abstract

No-show visits at hand surgery clinics are costly to the health care system and negatively affect clinic efficiency. Elucidating factors associated with increased likelihood of a no-show could facilitate interventions to minimize time and money lost. A 2015 study at an academic institution in Boston, Massachusetts, showed that younger age, Hispanic/Black race, unmarried status, Monday/Tuesday appointments, and residence near the office are risk factors for hand clinic no-shows. No similar studies have been done in a rural setting. We hypothesized that similar factors would play a role at a southwestern safety-net hospital with a majority rural catchment area. A retrospective cross-sectional study was performed looking at all patient visits in our southwestern academic orthopedic hand surgery practice from January 1, 2022, to December 31, 2023. Demographic, temporal, environmental, and clinical factors and their relationships to the likelihood of a no-show were analyzed using pairwise comparisons and a multivariable logistic generalized linear mixed-effects model. A total of 3586 patients were seen during 6539 office visits in the 2-year study period. The no-show rate was 25.8%. Independent risk factors for no-shows in the multivariable model were age <55 years old, male sex, Black race, return visit, fall/summer appointment, high Social Deprivation Index, self-pay and Medicaid insurance, and attending surgeon. The American Southwest and New England differ considerably, yet many factors that contribute to clinic no-shows in both locations are consistent. Identifying at-risk populations and allocating resources appropriately may decrease the rate of clinic no-shows.