三级护理儿科耳鼻喉科诊所的爽约情况：预测因素及对医疗服务提供者工作效率的影响
No-Shows in a Tertiary Care Pediatric Otolaryngology Clinic: Predictors and Impact on Provider Productivity.
作者信息
Sunkara Yukta, Ulualp Seckin O, Robinson Kimberly, Lenes-Voit Felicity, Liu Christopher C, Mitchell Ron B
机构信息
Department of Otolaryngology-Head and Neck Surgery University of Texas Southwestern Medical Center Dallas Texas USA.
Division of Pediatric Otolaryngology Children's Medical Center Dallas Texas USA.
出版信息
Laryngoscope Investig Otolaryngol. 2025 Feb 8;10(1):e70097. doi: 10.1002/lio2.70097. eCollection 2025 Feb.
OBJECTIVES
No-show appointments (NS) lead to a mismatch between supply and expected demand, operational inefficiency, decreased access to care, and economic deficit. We evaluated the predictors and impact of NS on provider productivity in a tertiary pediatric otolaryngology clinic.
METHODS
Patients who had a pediatric otolaryngology clinic appointment were identified. Demographics, type of appointment and clinic visit, provider, insurance, appointment lead time, time of the appointment, caregiver income, distance to the clinic, and season of the year were analyzed. Predictors of NS and loss of providers' work-RVUs and revenue were assessed. NS and non-NS populations were compared using test for categorical variables and Mann-Whitney test for continuous variables. Multivariable analysis was performed with a binary logistics regression model for the prediction of NS.
RESULTS
Of 24,593 appointments, 10,392 (42%) were female, (age median = 5 years) and of the 4627 NS 2016 (44%) were female, (age median = 5 years). Logistic regression identified male (OR: 0.093, 95% CI [0.88-0.99], = 0.04), Black/African American race (OR: 1.97, 95% CI [1.72-2.26], < 0.001), spring (OR: 0.88, 95% CI [0.80-0.97], = 0.007), summer (OR: 0.90, 95% CI [0.83-0.99], = 0.04), clinic focus-general clinic (OR: 1.32, 95% CI [1.20-1.45], < 0.001), and appointment lead times of 0-7 days (OR: 0.36, 95% CI [0.29-0.46], < 0.001), 8-14 days (OR: 0.49, 95% CI [0.39-0.63], < 0.001), 15-30 days (OR: 0.60, 95% CI [0.47-0.76], < 0.001) were predictive of NS. The estimated loss of work-RVU ranged from 3852 to 14,820, and the estimated loss of revenue ranged from $276,831 to $959,908 per year.
CONCLUSIONS
No-show appointments led to a substantial loss of provider productivity and revenue. Of the multiple demographic and clinic visit determinants associated with high NS rates, appointment lead time can be tested in future studies of strategies to reduce NS.
LEVEL OF EVIDENCE
目的
爽约预约会导致供应与预期需求不匹配、运营效率低下、医疗服务可及性降低以及经济亏损。我们评估了三级儿科耳鼻喉科诊所中爽约预约的预测因素及其对医疗服务提供者生产力的影响。
方法
确定有儿科耳鼻喉科诊所预约的患者。分析了人口统计学特征、预约类型和门诊就诊情况、医疗服务提供者、保险、预约提前期、预约时间、照顾者收入、到诊所的距离以及一年中的季节。评估了爽约预约以及医疗服务提供者工作相对价值单位（work-RVUs）和收入损失的预测因素。使用分类变量的卡方检验和连续变量的曼-惠特尼检验对爽约预约组和未爽约预约组进行比较。采用二元逻辑回归模型进行多变量分析以预测爽约预约情况。
结果
在24593次预约中，10392例（42%）为女性（年龄中位数 = 5岁），在4627次爽约预约中，2016例（44%）为女性（年龄中位数 = 5岁）。逻辑回归分析确定男性（比值比：0.093，95%置信区间[0.88 - 0.99]，P = 0.04）、黑人/非裔美国人种族（比值比：1.97，95%置信区间[1.72 - 2.26]，P < 0.001）、春季（比值比：0.88，95%置信区间[0.80 - 0.97]，P = 0.007）、夏季（比值比：0.90，95%置信区间[0.83 - 0.99]，P = 0.04）、诊所重点为普通诊所（比值比：1.32，95%置信区间[1.20 - 1.45]，P < 0.001）以及预约提前期为0 - 7天（比值比：0.36，95%置信区间[0.29 - 0.46]，P < 0.001）、8 - 14天（比值比：0.49，95%置信区间[0.39 - 0.63]，P < 0.001）、15 - 30天（比值比：0.60，95%置信区间[0.47 - 0.76]，P < 0.001）是爽约预约的预测因素。估计每年工作相对价值单位的损失范围为3852至14820，收入损失范围为276831美元至959908美元。
结论
爽约预约导致医疗服务提供者生产力和收入大幅损失。在与高爽约率相关的多种人口统计学和门诊就诊决定因素中，预约提前期可在未来减少爽约预约的策略研究中进行检验。
证据级别
4级。
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