Designing risk prediction models for hospital

outpatient visits

Introduction:
Healthcare systems consumes a significant part of the U.S. Gross Domestic Product (GDP).
To confront rising costs, limited resource capacities, and burgeoning demands facing U.S.
healthcare providers, efficiently using clinical resources is critical. A major obstacle in cost-
effective health care delivery and patient safety is no-show. Patient no-show is defined as a
patient who does not appear for the scheduled appointment.
This is a recurring problem in healthcare that a high percentage of patients who miss their
appointment, be it a consultation or a hospital test. The hospital outpatient non-attendance
imposes huge financial burden on hospitals every year. In USA, it is reported that an average
no-show rate of 62 appointments per day and an estimated annual cost of $3 million in a
community hospital setting.

Consequences of No Show:
1. Non attendance at clinic appointments (no-show) significantly affects delivery, cost of
care and resource planning
2. Huge financial burden on hospitals every year. Almost $156,340.80 per provider, per
year
3. Manually following up with every single patient who no-shows, you are looking at
about 31.9 minutes per provider, per day
4. Longer wait times at clinics
5. Dissatisfaction among the patients

Important Statistics related to No Show:

1. About 3.6 million U.S. patients miss their appointments due to transportation issues.
2. Patients point to transportation as the reason for missing an appointment 67 percent of
the time.
3. On average, no-shows cost a single-physician medical practice $150,000 annually.
4. Medical practices actively working to minimize no-shows can reduce no-shows by up to
70 percent.
5. One physician practice with multiple physicians can have 14,000 time slots go unfilled
each year.
How Machine Learning can help predict No Show
Based on previous data collected, we can build a predictive model assessing the risk of a
patient skipping his/her appointment. We can divide the risky patients in two categories – No
Show & Late cancellation.

Model Selection:
Since we want probability score i.e. a score associated with each member to being a No Show
or Late Cancellation, we can use Logistic Regression model for this analysis and more
importantly LASSO Logistic Regression to avoid over fitting while training.

Model Evaluation:
We can use different techniques to evaluate our model like concordance, KS test and Confusion
matrix. We should also look at the ROC AUC curve after training the model.

Conclusion:
Predicting No show or late cancellation can help us re-schedule the appointments thus better
resource management and patient satisfaction.
Patients with a flag of no show can be given alternate appointment schedule or an option for
virtual appointment.