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.