Predictors of "no shows" at Omaha Veterans Administration primary care clinics 公开

Abstract

Background: Missed medical appointments ("no shows") affect both staff and other patients who are unable to make timely appointments. No shows can be prevented through interventions that target those most at risk to make appointments. Young age, low socioeconomic status, a history of missed appointments, psychosocial problems, and longer wait times are some predictors that have been previously found to be associated with higher no show rates.

Objective: This study aimed to determine the potential risk factors for no shows in primary care clinics of the Veterans Affairs Nebraska-Western Iowa Health Care System (VA NWI HCS). Design: Age, sex, race, presence of a mental health diagnosis, previous no show rate in past two years, wait time, distance to clinic, and neighborhood deprivation index were obtained for 69,908 primary care visits at the Omaha, Nebraska VA NWI HCS between January 1, 2012 and December 31, 2013. Inclusion criteria were visits for patients whose zip code was within the VA NWI HCS Service Area and non-cancelled appointments at the Omaha primary care clinics.

Results: In log-binomial models accounting for clustering by zip code, the strongest predictors of no shows were age between 20 and 39 (OR=3.86, 95% CI=3.46, 4.29) or between 40 and 59 (OR=2.22, 95% CI= 2.04, 2.42), black (OR=2.14, 95% CI=1.99, 2.31) or other non-white race (OR=1.35, 95% CI=1.17, 1.56), male sex (OR=1.29, 95% CI=1.15, 1.44), and presence of mental health diagnosis (OR=1.16, 95% CI=1.15, 1.44).

Conclusion: These results show that individuals who are younger, non-white, male or have been diagnosed with mental health issues are more likely to no show. Interventions to improve compliance could be targeted at these individuals in order to decrease the burden of no shows on healthcare systems, such as the Veterans Health Administration.

Table of Contents

Chapter 1. Background/Literature Review. 1

Chapter 2. Manuscript. 8

Abstract. 8

Introduction. 9

Methods. 10

Results. 13

Discussion. 15

References. 19

Tables. 22

Figures. 28

Chapter 3. Conclusion. 29

About this Master's Thesis

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• Permission granted by the author to include this thesis or dissertation in this repository. All rights reserved by the author. Please contact the author for information regarding the reproduction and use of this thesis or dissertation.

School	Rollins School of Public Health
Department	Epidemiology
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health Health Sciences, Epidemiology
关键词	Veterans neighborhood deprivation appointments and schedules multilevel primary care nonattendance
Committee Chair / Thesis Advisor	Kramer, Michael R, Emory University
Committee Members	Bittner, Marvin, Veterans Affairs Nebraska-Western Iowa Health Care System
Partnering Agencies	US (Federal) agency other than CDC Hospital or other health care provider

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