Improving Access to Specialty Care: Analysis of Factors Affecting Follow-up Patterns in an Outpatient Academic Pulmonary Clinic

Prolonged wait times for appointments in pulmonary specialty clinics contribute to worse patient outcomes. We determined the follow-up patterns and factors associated with appointment no-show to identify opportunities to increase appointment availability while improving follow-up. We conducted a retrospective observational cohort study of patients scheduled from 2017-2019 in the outpatient pulmonary fellows’ clinic of an academic tertiary care hospital. A successful visit was an appointment documented as completed. Appointment-level associations with no-show were evaluated using multivariable logistic generalized estimating equations. Among 1,612 patients, 4,689 appointments were scheduled. After excluding 1,247 cancellations and 6 appointments with indeterminate disposition, 3,436 appointments among 1,479 patients were included in the no-show analysis; 1,461 (42.5%) were no-shows. Average intended and actual follow-up intervals were 11.2 weeks and 24.8 weeks, respectively. In the complete-case adjusted analysis (3,427 appointments among 1,470 patients), substance use disorders (adjusted odds ratios [aORs], 1.86-3.43; P≤.011), inpatient referral (aOR, 2.41; P<.001), and pneumonia (aOR, 2.63; P=.046) were associated with greater odds of no-show. Spanish language (aOR, 0.59; P<.001), charity care (aOR, 0.63; P=.002), and external outpatient referral (aOR, 0.49; P<.001) were associated with lower odds. Emergency department referral and driving distance were not independently associated with no-show. Our clinic had short intended follow-up intervals and a high no-show rate. These appointment-level associations may inform continuity-focused scheduling and targeted attendance support. Standardizing follow-up intervals and using prediction-based overbooking should be prospectively evaluated for effects on access, workflow, and patient experience.