Preventing No-shows With Pre-appointment "Reserved for You" Nudges

No-shows are a problem for health systems because they prevent appointment slots from being used by other patients waiting to be seen. Canceling at least 48 hours in advance of the appointment time helps ensure improved access for those patients who are waiting, as well as potentially improving the chances that the canceling patients will eventually be seen (by encouraging rescheduling). An algorithm in Epic attempts to predict which patients are at high risk for no-showing to their appointments. In the present initiative, Geisinger will send pre-appointment text messages and/or MyChart messages to patients predicted to be at high risk for no-showing to their appointment (>50% likely to no-show according to the algorithm).

Prior research suggests that telling patients a vaccine is "reserved for you" increases vaccine update (e.g., Milkman et al., 2021). However, it is unclear whether "reserved for you" language also motivates other health behaviors, like attending appointments.

The study team will run an A/B test to assess whether pre-appointment messages can reduce appointment no-shows. One message version will indicate the appointment is "reserved" for the patient; another version will be nearly identical but will not include the "reserved" language. A passive control group will not be sent messages.

Messages will be sent 10 days pre-appointment via MyChart or text message based on patient communication preferences.

For the primary analysis, we will include only the first appointment for every unique patient.