When patients miss appointments, practices lose money. One of the reasons Zocdoc was founded was to help fill the sizable percentage of appointments that are cancelled, often within a day or two of the scheduled visit.
That was in 2007, six years ago. Since then, researchers have begun to wonder how services such as Zocdoc affect cancellation frequency. Last week, a new peer-reviewed University of Texas study was published that used Zocdoc to explore that very question. (Please note that the study was fully independent. Zocdoc had no previous knowledge of the study, involvement in its funding, how it was conducted, or the outcomes prior to its publication.)
Published electronically in the MEDLINE-indexed Dermatology Online Journal, authors Zuhair Siddiqui, MPH, and Rashid Rashid, MD, PhD, looked at online appointment-making data from three dermatology clinics in Southeast Texas – one urban and two rural – over a six month period between 2011 and 2012. In total, this added up to 130 appointments. As the researchers themselves noted, that’s a small sample size – and the findings are bound to in some degree reflect patient behaviors unique to dermatology.
Grow your practice with our weekly newsletter.
But if larger studies can yield similar results, it’s important information, both for Zocdoc and Zocdoc’s physician users. Here’s why: Non-attendance (both cancellations and no-shows) was at 6.9 percent among patients that booked online. By contrast, non-attendance rates for dermatology appointments made offline can range from 17 to 31 percent, according to research cited in the paper.
We have received permission to reprint the study here, and there are plenty of other useful observations, like the typical age of patients who cancel versus those who simply don’t show up. Take a look at all of it, below.
Cancellations and patient access to physicians: Zocdoc and the evolution of e-medicine
Zuhair Siddiqui MPH, Rashid Rashid MD PhD
Dermatology Online Journal 19 (4): 14
BACKGROUND: Appointment attendance has always been a concern for physicians and the landscape is changing now that patients can book appointments online in many practices. OBJECTIVE: This manuscript examined attendance rates of appointments made on the internet for rural and urban dermatology clinics. METHODS: The study analyzed appointment records made over a 6-month period on Zocdoc.com for 3 dermatology clinics located outside Houston, Texas. RESULTS: Non-attendance rates for online appointments were much lower (6.9%) than non-attendance rates at dermatology clinics through traditional means. The average age of patients who missed their appointments was lower than the average age of those who made their appointments. In addition, the average age of those who cancelled their appointments was higher than those who made their appointments. Also, urban non-attendance rates were higher than rural rates. LIMITATIONS: This study has a small sample size because online appointment scheduling is not a common practice. CONCLUSION: The early returns of online appointment scheduling indicate that appointments made online are more likely to have lower non-attendance rates than appointments made through traditional means.
Accessibility is now one of the most important components to medicine in the 21st century. Patients and providers alike prefer a streamlined system where appointments can be attained easily . Zocdoc is an online medical scheduling service that gives patients the option to schedule same-day appointments online. Likewise, this site gives practices a simple way to track confirmed appointments, cancellations, and missed appointments. One major issue for physicians is the threat of a missed appointment. When a patient does not show up for an appointment, valuable clinic time goes unused and clinic revenue is lost . As a result, delays associated with missed appointments can cause dissatisfaction and worse clinical outcomes . Additionally, recent surveys indicate that patients who miss appointments are young .
This manuscript aims to gain a greater understanding of the relationship between age and non-attendance of appointments made online. It will focus on rural and urban dermatology clinics in Southeast Texas. These clinics will be used because they are enrolled in the Zocdoc appointment service. Nonattendance of appointments made through traditional means (in person, by phone, etc.) in dermatology clinics is a major problem, with rates ranging from 17 percent to 31 percent .
This paper examined two rural dermatology clinics and one urban clinic for a demographic breakdown of confirmed appointments, cancellations, and missed appointments. Records from 2 rural clinics and 1 urban clinic near Houston, Texas were examined for the study. These clinics are part of a newly established practice with a total of 2,340 active charts in the patient population. This was a retrospective cross-sectional study that looked at appointment records made on zocdoc.com from October 1, 2011, to March 31, 2012. MedLine (1966-2012) and EBSCOhost (1980-2012) were searched in August 2012. All data entry and subsequent analysis was completed on Microsoft Excel. A total of 130 appointments were examined.
In all, 130 appointments were made over the course of the 6 months, with 13.8 percent cancellations, and 6.9 percent missed appointments. Overall, the average age of all participants in the study was 35.0 and the average of patients who made their appointments was 34.7. The average age of cancellation patients was 40.2 and the average age of those who missed their appointments was 27.7. Furthermore, 21.3 percent of the patients who made their appointments were under 18. In addition, 5.6 percent of the cancellations were under 18 years of age and none of the missed appointments were under 18 years of age.
Of the 29 appointments in the first rural location over the time period of the study, there were 2 cancellations and no missed appointments. The average age of all patients in this location was 35.8 and the average age of patients who made their appointment was 35.1. The average age of cancelling patients was 44.5. There were 9 appointments in second rural location during the study, with 2 cancellations (22%) and no missed appointments. The average age of all patients in this location was 30.8; the average age of patients who made their appointment was 33.3 with the average cancellation age was 22.0. The average age of all rural patients in both locations was 34.6, with the average age of cancellation at 33.3. In the urban clinic, there were 92 appointments made on Zocdoc during the course of the study, with 14 cancellations (15.2%) and 9 missed appointments (9.8%). The average age of all patients in this location was 35.3 and the average age of those who made the appointment was 34.7. The average age of cancelling patients was 42.2 and the average age of patients who missed their appointment was 27.7. This was the only location with missed appointments.
|Figure 1. Average age of all patients at all locations using Zocdoc to schedule appointments. Number over the bar indicates specific averages for each location.|
Technology has made it easier to see a physician, but the problem of non-attendance remains. In this study, we were able to take a look at the evolving relationship of internet appointment and subsequent attendance. Whereas our sample size was limited, we were able to glean information about age and attendance. Fewer appointments were made on Zocdoc in the 2 rural clinics in comparison to the urban clinic. However, the average age of patients at all locations was similar, as shown in Figure 1. There were 38 appointments made in the rural clinics. These figures are dwarfed by the 92 appointments made in the urban location over the same 6-month period. This discrepancy may be caused by the lower population and patient density, potential lower internet usage in the area, or lack of awareness about the online appointment service. In addition, because the clinic was not a primary care clinic, but rather a dermatology clinic, fewer patients might be likely to seek this care in rural areas.
According to clinic records, 1 out of every 5 visits in the urban locations was booked through Zocdoc whereas 1 out of 30 appointments were booked through Zocdoc in the rural areas. Because demand for these services exists in rural areas, this might further prove that Zocdoc has not penetrated the rural market as successfully as the urban one. Whereas dermatology clinic nonattendance rates have been reported to be between 17 percent and 31 percent , only 6.9 percent of patients who made their appointments on Zocdoc.com failed to show up. This could also relate to differences in the ability to make a same-day or soon appointment. Figure 2 shows the average age of missed appointments in all locations. This may indicate that those who made their appointments online are less likely to miss their appointments than those who made appointments through more traditional routes. Furthermore, 13.8 percent of the appointments made online were cancelled ahead of time. Whereas not as favorable as showing up to an appointment, cancellation is a better alternative to non-attendance. This allows the clinic staff the opportunity to fill the slot with another appointment, rather than letting the allotted time go to waste. It is difficult to make accurate statistical conclusions about the rural clinic appointments, because there were no missed appointments. However, the lack of missed appointments indicates that rural patients are more likely to show up to their appointments. This may show that rural residents are more concerned about making appointments because they are not as readily available as in urban areas. The average age of patients who made their appointment is shown in Figure 3. As online appointment services become more available, better statistical analysis can be made.
The average age of all appointments made was 35.0, but the age of cancellation was higher at 40.2. In addition, as shown in Figure 4, the missed appointments average age was lower, at 27.7. Previous studies  have suggested a relationship between youth and nonattendance and these numbers suggest a similar finding. Similarly, patients who cancelled were older than the overall average, suggesting that older patients are more likely to notify the clinic ahead of time of their inability to make the appointment.
The studies referenced in this paper analyze clinics with established patient populations and traditional clinic setups in which appointments are scheduled in advance and reminders are send to patients. The records used in this study were taken from a new practice with a growing patient population. As a result, same-day appointments are more common than in most practices and phone scheduling is less common. However, these clinics send email reminders to patients, much like older practices. Whereas the clinics used in this manuscript are not completely congruent to ones from previous studies, they still provide a comparison for the possibilities of online appointment scheduling in the future. This manuscript did not analyze phone-scheduled appointments at the clinics in the study because the aim was to understand the impact of internet scheduling. The internet is more accessible than ever and it is imperative to gain a greater understand of how the it will impact practices in the future.
Online integration of the medical field is somewhat gradual. Zocdoc was founded in 2007, and more clinics are signing up to be a part of the service. Similarly, more patients are turning to the internet as a part of their medical care experience. This emerging area has few articles on the subject and will certainly become more relevant to an increasing number of patients and physicians alike. Future research can expand upon this field as more records become available.
1. Cao W, Wan Y, Tu H, Shang F, Liu D, Tan Z, Sun C, Ye Q, Xu Y. A web-based appointment system to reduce waiting for outpatients: a retrospective study. BMC Health Serv Res. 2011;11:318. [PubMed]
2. Woodcock EW. Managing your appointment “no-shows.” J Med Pract Manag 2000; 15: 284-288.
3. Murray M. Modernising the NHS. Patient care: access. Br Med J 2000; 320: 1594-1596.
4. Neal RD, Lawlor DA, Allgar V et al. Missed appointments in general practice: retrospective data analysis from four practices. Br J Gen Pract 2001; 51: 830-832. [PubMed]
5. Pehr K. No show: incidence of nonattendance at a dermatology practice in a single universal payer model.J Cutan Med Surg 2007;11: 53-56. [PubMed]
6. Cohen AD, Vardy DA. Non-attendance in adult dermatological patients. Acta Derm Venerol 2006;86 377-378.
© 2013 Dermatology Online Journal