A groundbreaking study examining appointment data from the Veterans Affairs Health Care System (VA) has revealed significant insights into primary care appointment utilization and cancellation patterns. The research, analyzing over 90 million in-person and nearly 24 million virtual appointments between October 2018 and April 2024, found that 11.9 million appointments (10.87%) were canceled on the same day they were scheduled.
Breakdown of Cancellation Patterns
For in-person appointments, the study identified three main categories of same-day cancellations:
- Patient cancellations: 3.92% (3,531,016 appointments)
- No-shows: 3.87% (3,487,944 appointments)
- Clinic cancellations: 3.08% (2,780,259 appointments)
Virtual appointments showed a different distribution:
- Clinic cancellations: 3.40% (827,535 appointments)
- Patient cancellations: 2.09% (500,645 appointments)
- No-shows: 3.29% (785,993 appointments)
Impact of COVID-19
The pandemic significantly influenced cancellation patterns. In-person appointment cancellations increased by 13.5% in 2020 compared to 2019 (12.07% vs. 10.63%). However, by 2023, rates had stabilized to near pre-pandemic levels at 10.76%. The initial COVID-19 wave saw a notable spike in clinic-initiated cancellations for in-person appointments.
System Performance and Patient Care
Despite these challenges, the VA system's performance compares favorably to other healthcare providers. The study found that patients experiencing no-shows faced longer wait times for their next visit (40.8 days) compared to those with clinic cancellations (23.2 days) or patient cancellations (25.3 days).
Facility Variations and Management
The research revealed significant variations in cancellation rates across VA medical centers, particularly for no-shows. While the VA maintains quality measures to monitor appointment adherence, there are currently no national protocols specifically designed to reduce missed and canceled appointments.
Future Implications
The findings highlight the need for improved appointment management strategies, particularly for same-day cancellations. The study suggests that while the VA system performs relatively well compared to other healthcare settings, there remains room for optimization in appointment utilization and reducing cancellation rates.
The research team emphasizes that these results represent a lower bound of unused appointments, as cancellations occurring days before scheduled appointments were not included in the analysis. This suggests that the actual impact of cancelled appointments on healthcare delivery may be even more significant than reported.
