Home Visits for Patients at Risk for Appointment No-shows

NCT04376736 | Withdrawn

• 1 other identifier: IRB00196142
• Study Type: interventional
• Target: N/A
• Locations: 1 country
• Sites: 1

Brief Summary

Unused clinic visits due to patient no-shows continue to plague American healthcare as a large source of waste and avoidable constraint on access. The average no-show rate across 105 studies was 23% though with wide variation (4% to 79%). No-show behavior has adverse effects on patients, providers, and healthcare organizations' operational and financial outcomes. Patients that miss clinic visits are more likely to need acute care and suffer poor health outcomes. There have been increasingly sophisticated efforts focused on predicting which patients are likely to no-show. This can allow for tactful over-booking and/or patient outreach. At Hopkins, investigators have implemented a novel machine learning based approach for identifying those patients at high-risk for no-show. Offering home visits for patients who are most likely to no-show is an appealing strategy to connect medical providers with patients who need care but are otherwise unlikely to receive it. Yet, it is unclear if this would be helpful to engage patients in their care, and encourage subsequent attendance, or if it would encourage future missed appointments, fostering a reliance on possible ongoing home visits. This study would link existing efforts with no-show prediction to home visits by internal medicine residents and evaluate its clinical impact. Patients at high-risk for no-show will be randomized into the control arm where patients will be called to remind patients of their visits. Those randomized into the intervention arm will be offered a one time home visit in lieu of their in-person visit to help understand barriers to in-person care and build rapport. Outcomes evaluated include future in-person show rates and healthcare cost/utilization

Conditions

Utilization, Health Care; Engagement, Patient; No-Show Patients

Outcome Measures

Primary Outcomes (1)

• Engagement

  Subsequent show up rate for medical clinic appointments, that is, number of actual visits per total number of expected visits

  1 year post enrollment

Secondary Outcomes (1)

• Healthcare utilization as assessed by number of hospitalizations

  1 year post enrollment

Study Arms (2)

Control arm

NO INTERVENTION

Patients are reminded about their appointments

Intervention arm

EXPERIMENTAL

Patients are offered a one-time home visit by providers in lieu of their upcoming in-person visit

Other: Home visit

Interventions

Home visit OTHER

Home visit by medical provider

Intervention arm

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• One or more poorly controlled chronic medical illness
• More than one chronic illness, regardless of its level of control
• Acute illness

You may not qualify if:

• No documented medical illnesses (acute or chronic)
• Single well controlled chronic illness

Sponsors & Collaborators

• Johns Hopkins University: lead

Study Sites (1)

Johns Hopkins Outpatient Center

Baltimore, Maryland, 21287, United States

Location

MeSH Terms

Conditions

Patient Acceptance of Health Care; Patient Participation; No-Show Patients

Interventions

House Calls

Condition Hierarchy (Ancestors)

Treatment Adherence and Compliance; Health Behavior; Behavior; Patient Compliance

Intervention Hierarchy (Ancestors)

Professional Practice; Organization and Administration; Health Services Administration

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: PARTICIPANT
• Purpose: OTHER
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: May 1, 2020
• First Posted: May 6, 2020
• Study Start: September 1, 2019
• Primary Completion: July 1, 2023
• Study Completion: July 1, 2023
• Last Updated: July 7, 2023

Record last verified: 2023-07

Data Sharing

• IPD Sharing: Will not share

Locations

US (1)