• John F Steiner, Michael R Shainline, Jennifer Z Dahlgren, Alan Kroll, and Stan Xu.
• Institute for Health Research, 10065 E Harvard Ave, Ste 300, Denver, CO 80231. Email: john.f.steiner@kp.org.
• Am J Manag Care. 2018 Aug 1; 24 (8): 377-384.

ObjectivesTo compare missed appointment rates for patients receiving a single reminder either 3 days prior to a primary care visit, 1 day prior to the visit, or both 3 days and 1 day prior to the visit.Study DesignThree-armed randomized controlled trial.MethodsText messages or interactive voice response calls were sent to patients with appointments at 25 primary care clinics in an integrated delivery system. A multivariable prediction model was developed to identify patients at high risk of missing appointments, based on prior appointment-keeping history and other variables from electronic health records.ResultsAmong 54,066 randomized patients, those who received reminders both 3 days and 1 day prior to the visit were less likely to miss their appointment than those who received only a 3-day or 1-day reminder (4.4% vs 5.8% vs 5.3%, respectively; P <.001). In patients at high risk, 20.5% of those who received 2 reminders missed their visit, compared with 25.0% and 24.2% of those with only 3-day or 1-day reminders, respectively (P <.001). Visit satisfaction was unaffected by providing an additional reminder.ConclusionsTwo automated reminders were more effective than 1 in reducing missed appointments and did not reduce visit satisfaction. A predictive model based on clinical characteristics and prior appointment history can accurately identify patients who are at highest risk of missing appointments. These individuals may benefit more from multiple reminders, but additional strategies are necessary to further reduce their rates of missed appointments.

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