Home Visits for Patients at Risk for Appointment No-shows

Study Overview
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Brief Summary
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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

Official Title
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SNAP HOME: Smart No-show Analytics Paired With Home-based Outpatient Medical Engagement

Conditions
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Engagement, Patient, Utilization, Health Care, No-Show Patients

Intervention / Treatment
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* Other: Home visit


Participation Criteria
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Eligibility Criteria
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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

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Other
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| No Intervention: Control arm<br>Patients are reminded about their appointments | |
| Experimental: Intervention arm<br>Patients are offered a one-time home visit by providers in lieu of their upcoming in-person visit | Other: Home visit<br>* Home visit by medical provider<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Engagement | Subsequent show up rate for medical clinic appointments, that is, number of actual visits per total number of expected visits | 1 year post enrollment | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Healthcare utilization as assessed by number of hospitalizations | This will be assessed based on the Number of ER visits and hospitalizations | 1 year post enrollment |