Prevalence, predictors and economic consequences of no-shows.

BACKGROUND: Patients not attending to clinic appointments (no-show) significantly affects delivery, cost of care and resource planning. We aimed to evaluate the prevalence, predictors and economic consequences of patient no-shows. METHOD: This is a retrospective cohort study using administrative databases for fiscal years 1997-2008. We searched administrative databases for no-show frequency and cost at a large medical center. In addition, we estimated no-show rates and costs in another 10 regional hospitals. We studied no-show rates in primary care and various subspecialty settings over a 12-year period, the monthly and seasonal trends of no-shows, the effects of implementing a reminder system and the economic effects of missed appointments. RESULTS: The mean no-show rate was 18.8% (2.4%) in 10 main clinics with highest occurring in subspecialist clinics. No-show rate in the women clinic was higher and the no-show rate in geriatric clinic was lower compared to general primary care clinic (PCP). The no-show rate remained at a high level despite its reduction by a centralized phone reminder (from 16.3% down to 15.8%). The average cost of no-show per patient was $196 in 2008. CONCLUSIONS: Our data indicates that no-show imposed a major burden on this health care system. Further, implementation of a reminder system only modestly reduced the no-show rate.

Under the knife: a national survey of six sigma programs in US healthcare organizations.

PURPOSE: Medical and policy literature reports many six sigma applications at specific healthcare organizations. However, there is a lack of studies that investigate the broader status of six sigma in US healthcare systems. The purpose of this paper is to present the results from a national survey of six sigma programs in US healthcare organizations. DESIGN/METHODOLOGY/APPROACH: Through the design, distribution, and analysis of a nationwide survey, this paper assesses the implementation of six sigma in healthcare facilities. Two sets of surveys were designed based on whether an organization has adopted six sigma or not. FINDINGS: Findings from this paper indicate the common six sigma projects implemented in healthcare organizations, typical implementation durations, cost benefits, and major barriers in implementation, and so on. RESEARCH LIMITATIONS/IMPLICATIONS: This paper is limited by the low-response rate owing to time and budget constraints. Through the dissemination of this paper, it is hoped that more organizations will become interested in this subject and participate in future studies. ORIGINALITY/VALUE: This work is the first study to investigate the implementation status of six sigma in US healthcare systems. It will share experiences amongst six sigma institutions and promote its application in many institutions. The findings will provide instructive information to six sigma practitioners and researchers, and particularly to health care management.

On determining specifications and selections of alternative technologies for airport checked-baggage security screening.

Federal law mandates that every checked bag at all commercial airports be screened by explosive detection systems (EDS), explosive trace detection systems (ETD), or alternative technologies. These technologies serve as critical components of airport security systems that strive to reduce security risks at both national and global levels. To improve the operational efficiency and airport security, emerging image-based technologies have been developed, such as dual-energy X-ray (DX), backscatter X-ray (BX), and multiview tomography (MVT). These technologies differ widely in purchasing cost, maintenance cost, operating cost, processing rate, and accuracy. Based on a mathematical framework that takes into account all these factors, this article investigates two critical issues for operating screening devices: setting specifications for continuous security responses by different technologies; and selecting technology or combination of technologies for efficient 100% baggage screening. For continuous security responses, specifications or thresholds are used for classifying threat items from nonthreat items. By investigating the setting of specifications on system security responses, this article assesses the risk and cost effectiveness of various technologies for both single-device and two-device systems. The findings provide the best selection of image-based technologies for both single-device and two-device systems. Our study suggests that two-device systems outperform single-device systems in terms of both cost effectiveness and accuracy. The model can be readily extended to evaluate risk and cost effectiveness of multiple-device systems for airport checked-baggage security screening.