• Yasir Tarabichi, Jessica Higginbotham, Nicholas Riley, David C Kaelber, and Brook Watts.
• Center for Clinical Informatics Research and Education, MetroHealth, Cleveland, OH, USA. yxt277@case.edu.
• J Gen Intern Med. 2023 Oct 1; 38 (13): 292129272921-2927.

BackgroundAppointment no shows are prevalent in safety-net healthcare systems. The efficacy and equitability of using predictive algorithms to selectively add resource-intensive live telephone outreach to standard automated reminders in such a setting is not known.ObjectiveTo determine if adding risk-driven telephone outreach to standard automated reminders can improve in-person primary care internal medicine clinic no show rates without worsening racial and ethnic show-rate disparities.DesignRandomized controlled quality improvement initiative.ParticipantsAdult patients with an in-person appointment at a primary care internal medicine clinic in a safety-net healthcare system from 1/1/2022 to 8/24/2022.InterventionsA random forest model that leveraged electronic health record data to predict appointment no show risk was internally trained and validated to ensure fair performance. Schedulers leveraged the model to place reminder calls to patients in the augmented care arm who had a predicted no show rate of 15% or higher.Maine MeasuresThe primary outcome was no show rate stratified by race and ethnicity.Key ResultsThere were 5840 appointments with a predicted no show rate of 15% or higher. A total of 2858 had been randomized to the augmented care group and 2982 randomized to standard care. The augmented care group had a significantly lower no show rate than the standard care group (33% vs 36%, p < 0.01). There was a significant reduction in no show rates for Black patients (36% vs 42% respectively, p < 0.001) not reflected in white, non-Hispanic patients.ConclusionsIn this randomized controlled quality improvement initiative, adding model-driven telephone outreach to standard automated reminders was associated with a significant reduction of in-person no show rates in a diverse primary care clinic. The initiative reduced no show disparities by predominantly improving access for Black patients.© 2023. The Author(s), under exclusive licence to Society of General Internal Medicine.

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