'No-shows' or missed appointments result in under-utilized clinic capacity. We develop a logistic regression model using electronic medical records to estimate patients' no-show probabilities and illustrate the use of the estimates in creating clinic schedules that maximize clinic capacity utilization while maintaining small patient waiting times and clinic overtime costs. This study used information on scheduled outpatient appointments collected over a three-year period at a Veterans Affairs medical center. The call-in process for 400 clinic days was simulated and for each day two schedules were created: the traditional method that assigned one patient per appointment slot, and the proposed method that scheduled patients according to their no-show probability to balance patient waiting, overtime and revenue. Combining patient no-show models with advanced scheduling methods would allow more patients to be seen a day while improving clinic efficiency. Clinics should consider the benefits of implementing scheduling software that includes these methods relative to the cost of no-shows.

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Clinical overbooking is intended to reduce the negative impact of patient noshows on clinic operations and performance. In this paper, we study the clinical scheduling problem with overbooking for heterogeneous patients, i.e. patients who have different noshow probabilities. We consider the objective of maximizing expected profit, which includes revenue from patients and costs associated with patient waiting times and physician overtime. We show that the objective function with homogeneous patients, i.e. patients with the same no-show probability, is multimodular. We also show that this property does not hold when patients are heterogeneous. We identify properties of an optimal schedule with heterogeneous patients and propose a local search algorithm to find local optimal schedules. Then, we extend our results to sequential scheduling and propose two sequential scheduling procedures. Finally, we perform a set of numerical experiments and provide managerial insights for health care practitioners.

Objectives: Using predictive modeling techniques, we developed and compared appointment no-show prediction models to better understand appointment adherence in underserved populations. Methods and Materials: We collected electronic health record (EHR) data and appointment data including patient, provider and clinical visit characteristics over a 3-year period. All patient data came from an urban system of community health centers (CHCs) with 10 facilities. We sought to identify critical variables through logistic regression, artificial neural network, and naïve Bayes classifier models to predict missed appointments. We used 10-fold cross-validation to assess the models’ ability to identify patients missing their appointments. Results: Following data preprocessing and cleaning, the final dataset included 73811 unique appointments with 12,392 missed appointments. Predictors of missed appointments versus attended appointments included lead time (time between scheduling and the appointment), patient prior missed appointments, cell phone ownership, tobacco use and the number of days since last appointment. Models had a relatively high area under the curve for all 3 models (e.g., 0.86 for naïve Bayes classifier). Discussion: Patient appointment adherence varies across clinics within a healthcare system. Data analytics results demonstrate the value of existing clinical and operational data to address important operational and management issues. Conclusion: EHR data including patient and scheduling information predicted the missed appointments of underserved populations in urban CHCs. Our application of predictive modeling techniques helped prioritize the design and implementation of interventions that may improve efficiency in community health centers for more timely access to care. CHCs would benefit from investing in the technical resources needed to make these data readily available as a means to inform important operational and policy questions.

Chemotherapy operations planning and scheduling in oncology clinics is a complex problem due to several factors such as the cyclic nature of chemotherapy treatment plans, the high variability in resource requirements (treatment time, nurse time, pharmacy time) and the multiple clinic resources involved. Treatment plans are made by oncologists for each patient according to existing chemotherapy protocols or clinical trials. It is important to strictly adhere to the patient's optimal treatment plan to achieve the best health outcomes. However, it is typically difficult to attain strict adherence for every patient due to side effects of chemotherapy drugs and limited resources in the clinics. In this study, our aim is to develop operations planning and scheduling methods for chemotherapy patients with the objective of minimizing the deviation from optimal treatment plans due to limited availability of clinic resources (beds/chairs, nurses, pharmacists).Mathematical programming models are developed to solve chemotherapy operations planning and scheduling problem. A two-stage rolling horizon approach is used to solve these problems sequentially. Real-size problems are solved to demonstrate the effectiveness of the proposed algorithms in terms of solution quality and computational times.