随机森林与Logistic回归在预约挂号失约影响因素预测中的应用

目的探讨和评价随机森林法与Logistic回归用于预测预约挂号失约影响因素的可行性与准确性。方法以新疆某三甲医院的预约挂号患者为研究对象,随机抽取预约挂号患者400份,回顾性分析预约患者的特性及失约行为,利用随机森林法与Logistic回归分别建立预约挂号失约影响因素的模型。结果对于预约患者失约影响因素预测分析,随机森林回归明显优于Logistic回归方法,随机森林回归对失约因素误判率(20.5%)明显低于Logistic回归(22%);用随机森林方法显示失约的影响因素的顺序是:年龄、具体时间、短信提醒、工作状况。结论完善短信提醒功能,降低失约率;预测易失约人群,合理分配号源,避免医疗资源的浪费。     

某三甲医院普通门诊人流分布与分时段预约的应用

目的探讨普通门诊人流分布与分时段预约的应用效果,分析提高预约服务的手段。方法以2015年1月至2017年12月上海交通大学医学院附属新华医院儿内科、皮肤科、神经内科3个科室普通门诊的相关就诊数据,回顾分析不同门诊的预约情况、预约患者与非预约患者就诊时间流量分布、非医疗候诊时间、实际就诊时间等情况的差异。结果试点科室普通门诊预约率11. 34%,失约率30. 99%。预约服务缩短患者候诊时间、增加实际就诊时间,实现削峰分流,不同科室预约率、预约途径、预约效果存在差异。结论普通门诊分时段预约推行需要根据科室的不同属性,以人流分布情况作为参考依据,利用信息化手段有效降低失约可能;结合分级诊疗推动医疗服务体系建设。     

预约挂号失约相关因素调查分析

失约是病人在预约过程中最常见的问题。如果失约率太高，将使得预约失去原有意义，病人就诊可能恢复原来的随意性，候诊时间得不到缩短，医疗资源不可按计划均匀分配，就诊时间及人数得不到控制，使预约挂号事倍功半；失约率高，将给医院、门诊、医务人员造成一定的经济损失及资源浪费。预约了医生，占用了号源，又不来就诊，真正需预约者却约不到，耽误了他人，浪费了资源。在国外，失约率颇高，在Canigares和Penneys的调查中，他们发现有23．9％的失约率；在Sharp和Hamillon的调查中，他们发现约5％～34％的失约率，更甚者，失约率在新就诊者中达48％。在香港参观学习时，被告知香港地区的失约率约15％，这些人大多因急性发作看了急诊或住院或死亡。国外的失约率与预约期限和年龄等有关。在我们的预调查中，失约率是17．60％。但国内外的预约方法不同（表1）。     

口腔门诊预约挂号失约的原因及对策

目的分析口腔门诊预约挂号失约的原因,探讨有效的对策.方法采用问卷回访的形式对口腔门诊预约挂号失约的患者进行调查.结果 50%的失约患者因工作忙而失约,是失约的主要原因,10%左右的失约患者分别因忘记时间和天气不好而失约.结论通过加大社会宣传力度,增设退号专线方便退号,采取对预约挂号患者建立诚信档案,限制预约时间,网上预...     

某妇产科医院患者预约失约行为研究

目的分析门诊预约患者的个体特征对失约行为发生的效应。方法根据Logit模型的相关理论,以患者失约与否作为被解释变量,个体特征作为解释变量,以医院信息系统中的有效样本进行建模。结果模型显示,患者的年龄、地区、预约时段、是否预约专家号、预约提前天数、预约院区等特征对失约行为发生的效应显著。结论应通过健全预约管理制度,有针对性地实施人性化管理,对失约率较高的门诊实施超订等措施,应对失约造成的资源浪费。     

预约挂号实施中的问题与对策

为改进医院门诊服务流程,提高预约诊疗服务质量,对医院预约挂号实施过程中存在的问题进行分析并采取相应的对策.认为通过加大宣传力度、加强号源及就诊管理、完善预约平台、降低失约率、重视停替诊管理及预约护士的作用,是提高预约诊疗服务质量的关键.     

精益管理有效降低预约挂号的取消率、失约率和迟到率

在推广门诊预约挂号就诊的实施过程中,不可避免的存在预约挂号后失约率高,取消率高,不按预约时间就诊的迟到率高,从而导致医生工作效率低,我们简称"三高一低"现象。在一定程度上造成老百姓挂号难,老百姓挂不到号不满意;其次是病人迟到就诊,不同程度上影响医生工作效率,医生也不满意。这些现象直接而且严重影响到预约就诊做法的推广。为扭转该现象,我们制定"预约就诊信誉度综合管理办法",对预约诊疗实施精益化管理,实施一年后,预约挂号的取消率、失约率和迟到率分别从原来的23.2%、15.6%和4.09%下降至15.2%、8.7%和1.28%,分别下降8个百分点、7个百分点和2.8个百分点,效果显著,大大提高病人和医生的满意度。     

“医信通”对降低门诊预约挂号失约率的效果评价

目的 探讨“医信通”信息平台对提升门诊预约挂号服务质量的促进作用.方法 比较“医信通”信息平台使用前后对门诊预约失约率、违约率、门诊停/改诊的通知及时率的影响.结果 “医信通”信息平台使用后明显降低了门诊患者预约挂号失约率,降低了临时停诊造成的就诊失误率,有效控制了停/改诊率.同时,医院客服中心医务人员处理门诊停/改诊服务人均工作时长由2 312±268（min）降至467±211 （min）,工作效率明显提高.患者门诊预约类投诉事件下降,医院服务质量满意度明显提升.结论 开展“医信通”信息平台对提升门诊服务质量有积极作用,值得推广.     

预约挂号失约的控制

预约门诊,也称预约挂号,是指门诊病人提前一段时间预约某日、某时到某医生处看病。预约门诊不但可缩短候诊就诊时间,还能改善门诊秩序,充分发挥现有医疗资源的最大效应〔1〕。对象与方法1.研究对象本研究的对象是门诊预约病人、失约病人。预约及失约资料来源于我院门诊2003年11     

专家门诊预约挂号的实践效果及体会

目的通过调查某大型三甲综合性医院专家门诊预约挂号推进情况,分析实施过程中的不足,为完善专家门诊预约挂号管理与全面推进门诊实名制预约挂号提供一些可行性的建议。方法采用回顾性调查方法,对医院2011—2013年的专家门诊预约挂号情况及影响因素进行总结分析。结果门急诊部采取加大医患双方的宣传力度、整合预约平台、健全服务措施后,专家门诊预约挂号比例明显上升,优化了患者的就医体验,但仍需完善后续服务,控制失约率。结论预约挂号的完善和发展需要医患双方的共同努力,医院应进一步细化分时段预约,改变传统的就医习惯,引导患者合理就诊,使有限的医疗资源最大限度地发挥。     

Reducing non-attendance at outpatient clinics.

Outpatient non-attendance is a common source of inefficiency in a health service, wasting time and resources and potentially lengthening waiting lists. A prospective audit of plastic surgery outpatient clinics was conducted during the six months from January to June 1997, to determine the clinical and demographic profile of non-attenders. Of 6095 appointments 16% were not kept. Using the demographic information, we changed our follow-up guidelines to reflect risk factors for multiple non-attendances, and a self-referral clinic was introduced to replace routine follow-up for high risk non-attenders. After these changes, a second audit in the same six months of 1998 revealed a non-attendance rate of 11%--i.e. 30% lower than before. Many follow-up appointments are sent inappropriately to patients who do not want further attention. This study, indicating how risk factor analysis can identify a group of patients who are unlikely to attend again after one missed appointment, may be a useful model for the reduction of outpatient non-attendance in other specialties.     

Factors affecting non-attendance in an ophthalmic outpatient department.

The object of the study was to establish the non-attendance rates in an ophthalmic outpatient department and any non-attendance patterns that may be useful in managing future outpatient resources. A detailed retrospective survey of monthly non-attendance rates was carried out in the outpatient department of a dedicated eye hospital over a 1 year period looking at differences in non-attendance between morning and afternoon clinics and new and review patients. A total of 43,004 scheduled outpatient appointments predominantly from the suburban population of the Merseyside region were made at St Paul's Eye Hospital from the 1 February 1990 to 31 January 1991. Five thousand four hundred and twenty-four appointments were missed giving an overall non-attendance rate of 12.6%. Non-attendance rates for morning and afternoon appointments were 12.0% and 13.0%, respectively: and for new and review patients, 11.9% and 12.8%, respectively. Logistic regression analysis showed that patients with afternoon appointments were on average 1.10 times more likely to non-attend than morning patients (P = 0.002), and that review patients were 1.09 times more likely to non-attend than new patients (P = 0.04). In order to maximize outpatient department efficiency, a reduction in non-attendance is essential. Establishing patterns for non-attendance provides us with a framework around which we can plan measures to compensate for outpatient non-attendance.     

Non-attendance at outpatient clinics at the Regional Hospital, Galway, Ireland

This paper examines the issue of non-attendance at outpatient clinics at the Regional Hospital, Galway, from the viewpoint of the patients who include both urban and rural residents. The results of a questionnaire survey of outpatients attending general and specialist medical and surgical clinics illustrate that very substantial costs are incurred and long periods of time are spent travelling by many patients. Females, and married females in particular, experience special difficulty in keeping appointments. Non-attendance increases as the cost of transport increases but many patients seriously underestimate the real cost of travel. Patients who have been attending over long periods of time have the worst record of non-attendance. It is recommended that any reorganisation of hospital outpatient systems in rural areas such as Western Ireland should take account of the particular needs of widely dispersed populations.     

Why do patients not keep their appointments? Prospective study in a gastroenterology outpatient clinic

Unkept outpatient appointments are a drain on resources. In a prospective study we asked non-attenders at a gastroenterology clinic why they had missed their appointment. 103 patients missed their appointment (14% of the total invited); 3 had died. The remaining 100 were asked to complete questionnaires, 68 by mail (43 returned) and 32 by telephone (30 successful); the response rate was thus 73%. 49 of the respondents were new patients, 6 of them with urgent referrals. The explanations for non-attendance by the 73 patients were: forgot to attend or to cancel (30%); no reason (26%); clerical errors (10%); felt better (8%), fearful of being seen by junior doctor (3%); inpatient in another hospital (3%); miscellaneous other (20%). 13 (27%) of the review patients had not kept one or more previous appointments. The non-attendance rates for different clinics ranged from 10% to 25% (average 14%). A substantial number of non-attenders claimed to have forgotten their appointment or to cancel it. If, as we surmise, this reflects apathy, no strategy to improve attendance is likely to have great impact. Since the non-attendance rate is reasonably constant, it can be taken into account when patients are booked.     

Non-compliance with Occupational Therapy Outpatient Attendance: A Quality Assurance Study

Therapists working in the outpatients service of a general hospital observed a problem regarding patient attendance at agreed appointment times. Valuable staff time was “lost” waiting for patients who failed to keep appointments. To develop policies and procedures about management of patient non-attendance a quality assurance study was conducted. This identified the extent of non-attendance, the reasons for this and the impact on the department. Of 192 appointments, 25 were non-attendances. Non-attendance was found to be a problem which occurred regularly, had an effect on staff job satisfaction and was a considerable financial cost to the department in terms of direct patient service delivery time lost. A number of methodological problems in the study are identified which limit the conclusions which can be drawn. These relate to data collection regarding the total outpatient service population which meant comparisons between attenders and non-attenders could not be made. On the basis of the information gained from the literature and the study a number of recommendations were made to decrease non-attendance. These include environmental changes to department waiting areas, the introduction of appointment reminder systems, waiting time policies, appointment negotiation procedures and a new protocol for dealing with non-attendance in the department.     

儿科门诊候诊时间及其影响因素分析

目的深入挖掘影响儿科门诊候诊时间过长的影响因素,为改善门诊候诊状况提供方法学上的借鉴.方法收集某三级甲等医院2018年儿科门诊的就诊信息,采用方差分析及多元线性回归筛选候诊时间过长的影响因素.结果多元线性回归结果显示,年龄、病人来源、民族、医保类型、月份、星期、预约方式、挂号类别对候诊时间的影响有统计学意义.结论通过对影响候诊时间主要因素的分析,提示医院管理部门针对主要的影响因素实施弹性排班、分时段预约等措施,减少患者的候诊时间.     

Non-attendance at Outpatient Clinics: Is It Related to the Referral Process?

Non-attendance at outpatient clinics is a complex problem andprevious studies have concentrated on hospital-related factors.It has been suggested that non-attendance might be related tothe referral pro cess, including the selection of patients forreferral and the quality of communication between GP and patient.These issues are examined in a study of 1492 patients givenfirst-time appointments at ENT and gastroenterology clinics.Non-attendance rates were 26 and 20% respectively. Non-attendancewas not related to the nature, severity or duration of the patients'presenting problems at the time of referral or to their perceptionof the need for referral. Resolution of symptoms did not appearto be a major reason for non-attendance. Patients were significantlyless likely to attend if they had been unable or only partlyable to discuss their health problem with their general practitioner.Those who had requested referral were equally likely to default.     

Improving outpatient clinic efficiency using computer simulation

To assess and plan alterations in outpatient clinic structure, produces a computer simulation of an outpatient clinic based on detailed time and role measurements from the authors' clinic. The stimulation which used an object-oriented design method is able to indicate the impact of changes in clinic structure using patient and doctor waiting times in clinic as endpoint measures. The effects of changes in clinic size, consultation time, patient mix, appointment scheduling and non-attendance were examined. We found that patient waiting time could be shortened considerably by using an optimizing appointment scheduler to determine appointment intervals. Clinic mix influences patient waiting time, which was shorter with a 1 in 4 ratio of new to follow-up patients. In mixed clinics, new patients appointments are optimally spread throughout the clinic to reduce patient waiting time. In all new or all follow-up clinics, waiting time is improved if the appointment interval reflects the consultation time. Computer modelling can help in optimizing clinic management so improving the delivery of care in outpatient services.     

Non-attendance and effective equity of access at four public specialist outpatient centers in Hong Kong

This study tests whether socio-economic status (SES), at either the individual or ecologic levels, exerts a direct impact on non-attendance or an indirect impact on attendance through longer waiting time for appointments and/or doctor-shopping behavior at four public specialist outpatient centers in Hong Kong. We collected information through three main sources, namely patients' referral letters, telephone interviews with both open- and closed-ended questions (e.g. doctor-shopping data) and hospital administrative databases from a total of 6495 attenders and non-attenders enrolled from July 2000 through October 2001. Individual-level SES was measured by education, occupation and monthly household income. Tertiary planning unit (TPU)-level SES data consisted of proportion unemployed, proportion with tertiary education, median income and Gini coefficient. Direct effects of SES on non-attendance were examined by logistic regression. Indirect contributions mediated through waiting time and doctor-shopping were analyzed by structural equation modeling. We found that SES, at the individual or ecologic level, did not exert a direct effect on non-attendance. Instead, TPU-level SES contributed positively to waiting time (beta=0.06+/-0.03, p=0.048), i.e. worse-off neighborhoods (and those with greater income inequality) had a shorter waiting time. Individual-level SES was also directly associated with the likelihood of doctor-shopping (beta=0.16+/-0.02, p<0.001), i.e. the poor were less likely to doctor-shop. Both waiting time (beta=0.12+/-0.02, p<0.001) and doctor-shopping (beta=0.37+/-0.02, p<0.001) were significantly related to non-attendance. Our findings suggest a highly equitable specialist ambulatory care public system in Hong Kong. Health care resources are appropriately targeted at the socially indigent, and the poor are not discriminated against and pushed to seek alternative sources of care by the system. These results should be confirmed using a prospective design.     

Can outpatient non-attendance be predicted from the referral letter? An audit of default at neurology clinics.

Data obtained from new patient referral letters to regional and peripheral neurology clinics were studied prospectively over a 6-month period in an attempt to determine factors predicting non-attendance. Attendance at peripheral clinics was significantly better, confirming their value. At regional clinics, factors associated with non-attendance were male sex, patient age less than 50 years, urban home address, referral from Accident and Emergency Departments, symptom duration less than 12 months, and wait for appointment more than 2 months. Of these, referral source and waiting time were identified as factors which could be modified, confirming that this analysis of referral letters was a useful exercise.