Home Visits for Patients at Risk for Appointment No-shows

Not Applicable

Withdrawn

• Conditions: Utilization, Health Care; No-Show Patients; Engagement, Patient
• Interventions: Other: Home visit

• Registration Number: NCT04376736
• Lead Sponsor: Johns Hopkins University

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

Detailed Description

Not available

Study Timeline

• Study Start: 2019-09-01
• Study First Submitted: 2020-05-01
• Study First Submitted QC: 2020-05-05
• Study First Posted: 2020-05-06
• Status Verified: 2023-07
• Primary Completion: 2023-07-01
• Study Completion: 2023-07-01
• Last Update Submitted: 2023-07-06
• Last Update Posted: 2023-07-07

Recruitment & Eligibility

• Status: WITHDRAWN
• Sex: All
• Target Recruitment: Not specified

Inclusion Criteria

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

Exclusion Criteria

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

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Intervention arm	Home visit	Patients are offered a one-time home visit by providers in lieu of their upcoming in-person visit

Primary Outcome Measures

Name	Time	Method
Engagement	1 year post enrollment	Subsequent show up rate for medical clinic appointments, that is, number of actual visits per total number of expected visits

Secondary Outcome Measures

Name	Time	Method
Healthcare utilization as assessed by number of hospitalizations	1 year post enrollment	This will be assessed based on the Number of ER visits and hospitalizations

Trial Locations

Locations (1)

Johns Hopkins Outpatient Center; 🇺🇸 Baltimore, Maryland, United States