Evaluation of Patient No-Shows in a Tertiary Hospital: Focusing on Modes of Appointment-Making and Type of Appointment.

No-show appointments waste resources and decrease the sustainability of care. This study is an attempt to evaluate patient no-shows based on modes of appointment-making and types of appointments. We collected hospital information system data and appointment data including characteristics of patients, service providers, and clinical visits over a three-month period (1 September 2018 to 30 November 2018), at a large tertiary hospital in Seoul, Korea. We used multivariate logistic regression analyses to identify the factors associated with no-shows (Model 1). We further assessed no-shows by including the interaction term ("modes of appointment-making" X "type of appointment") (Model 2). Among 1,252,127 appointments, the no-show rate was 6.12%. Among the modes of appointment-making, follow-up and online/telephone appointment were associated with higher odds of no-show compared to walk-in. Appointments for treatment and surgery had higher odds ratios of no-show compared to consultations. Tests for the interaction between the modes of appointment-making and type of appointment showed that follow-up for examination and online/telephone appointments for treatment and surgery had much higher odds ratios of no-shows. Other significant factors of no-shows include age, type of insurance, time of visit, lead time (time between scheduling and the appointment), type of visits, doctor's position, and major diagnosis. Our results suggest that future approaches for predicting and addressing no-show should also consider and analyze the impact of modes of appointment-making and type of appointment on the model of prediction.

Dosimetric parameters that predict late rectal complications after curative radiotherapy in patients with uterine cervical carcinoma.

BACKGROUND: Late rectal complication (LRC) was a major late complication in patients with uterine cervical carcinoma who were treated with a combination of external beam radiotherapy (EBRT) and high-dose-rate intracavitary irradiation (HDR-ICR). For the current study, the authors retrospectively evaluated dosimetric parameters that were correlated with LRC > or = Grade 2 in patients with uterine cervical carcinoma who were treated with curative radiotherapy, and they analyzed the appropriate dose estimates to the rectum that were predictive for LRC > or = Grade 2. METHODS: Between July 1994 and September 2002, 157 patients who were diagnosed with Stage IB-IIIB cervical carcinoma and were treated with definitive radiotherapy were included. EBRT (41.4-66 grays [Gy] in 23-33 fractions) to the whole pelvis was delivered to all patients, with midline shielding performed after a 36-50.4 Gy external dose. HDR-ICR (21-39 Gy in 6-13 fractions to Point A) was administered at a rate of 2 fractions weekly after midline shielding of EBRT. LRC was scored using Radiation Therapy Oncology Group criteria. The total biologically effective dose (BED) at specific points, such as Point A (BED(Point A)), rectal point (BED(RP)), and maximal rectal point (BED(MP)), was determined by a summation of the EBRT and HDR-ICR components, in which the alpha/beta ratio was set to 3. Analyzed parameters included patient age, tumor size, stage, concurrent chemotherapy, ICR fraction size, RP ratio (dose at the rectal point according to the Point A dose), MP ratio (dose at the maximal rectal point according to the Point A dose), EBRT dose, BED(Point A), BED(RP), and BED(MP). RESULTS: The 5-year actuarial overall rate of LRC > or = Grade 2 in all patients was 18.4%. Univariate analysis showed that the RP ratio, MP ratio, EBRT dose, BED(Point A), BED(RP), and BED(MP) were correlated with LRC > or = Grade 2 (P < 0.05). Multivariate analysis showed that, of all clinical and dosimetric parameters evaluated, only BED(RP) was correlated with LRC > or = Grade 2 (P = 0.009). The 5-year actuarial rate of LRC > or = Grade 2 was 5.4% in patients with a BED(RP) < 125 Gy(3) and 36.1% in patients with a BED(RP) > or = 125 Gy(3) (P < 0.001). CONCLUSIONS: BED(RP) was a useful dosimetric parameter for predicting the risk of LRC > or = Grade 2 and should be limited to < 125 Gy(3) whenever possible to minimize the risk of LRC > or = Grade 2 in patients with uterine cervical carcinoma who are treated with a combination of EBRT and HDR-ICR. Cancer 2005.