Who Will Show? Predicting Missed Visits Among Patients in Routine HIV Primary Care in the United States
Missed HIV medical visits predict poor clinical outcomes. We sought to identify patients at high risk of missing visits. We analyzed 2002–2014 data from six large US HIV clinics. At each visit, we predicted the likelihood of missing the next scheduled visit using demographic, clinical, and patient-reported psychosocial variables. Overall, 10,374 participants contributed 105,628 HIV visits. For 17% of visits, the next scheduled appointment was missed. The strongest predictor of a future missed visit was past-year missed visits. A model with only this predictor had area under the receiver operator curve = 0.65; defining “high risk” as those with any past-year missed visits had 73% sensitivity and 51% specificity in correctly identifying a future missed visit. Inclusion of other clinical and psychosocial predictors only slightly improved performance. Past visit attendance can identify those at increased risk for future missed visits, allowing for proactive allocation of resources to those at greatest risk.
KeywordsHIV Retention in care Missed visits Appointment attendance Predictive models
BWP, SB, KC, HMC, EG, WCM, and MJM contributed to the acquisition of the data; BWP designed the analysis; BWP and MJM drafted the manuscript; BWP, AMB, SB, KC, SRC, HMC, EG, JK, WCM, and MJM assisted with the interpretation of the data and critically revised the manuscript for important intellectual content. All authors take responsibility for and approve the final version of the manuscript. We thank the National Institutes of Mental Health [Grant Number R01MH100970] and the National Institute of Allergy and Infectious Diseases [Grant Numbers R24AI067039 and P30 AI50410] for their support of this work.
This work was supported by the National Institutes of Mental Health [Grant Number R01MH100970 to BWP] and by the National Institute of Allergy and Infectious Disease [Grant Numbers R24AI067039, P30AI50410].
Compliance with Ethical Standards
Conflict of interest
BWP has received a speaking honorarium from MSD. KAC has been a scientific advisory board member for Roche and a community advisory board member for Gilead.
- 1.Bradley H, Hall HI, Wolitski RJ, et al. Vital signs: HIV diagnosis, care, and treatment among persons living with HIV–United States, 2011. MMWR Morb Mortal Wkly Rep. 2014;63(47):1113–7.Google Scholar
- 11.Bush K, Kivlahan DR, McDonell MB, Fihn SD, Bradley KA. The AUDIT alcohol consumption questions (AUDIT-C): an effective brief screening test for problem drinking. Ambulatory Care Quality Improvement Project (ACQUIP). Alcohol Use Disorders Identification Test. Arch Intern Med. 1998;158(16):1789–95.CrossRefGoogle Scholar
- 14.Chesney MA, Ickovics JR, Chambers DB, et al. Self-reported adherence to antiretroviral medications among participants in HIV clinical trials: the AACTG adherence instruments. Patient Care Committee & Adherence Working Group of the Outcomes Committee of the Adult AIDS Clinical Trials Group (AACTG). AIDS Care. 2000;12(3):255–66.CrossRefGoogle Scholar
- 17.Martin S. 98% of HBR Readers Love This Article: businesses are just beginning to understand the power of “social norms”. Harv Bus Rev. 2012;90(10):23–5.Google Scholar
- 22.Thompson MA, Mugavero MJ, Amico KR, et al. Guidelines for improving entry into and retention in care and antiretroviral adherence for persons with HIV: evidence-based recommendations from an international association of physicians in AIDS care panel. Ann Intern Med. 2012;156(11):817–33.CrossRefGoogle Scholar